Monash Newborn, Monash Children's Hospital, Melbourne, Australia.
Diagnostic Imaging, Monash Health, Melbourne, Australia.
Pediatr Res. 2017 Aug;82(2):184-193. doi: 10.1038/pr.2017.37. Epub 2017 May 17.
Fetal growth restriction (FGR) is a common complication of pregnancy and, in severe cases, is associated with elevated rates of perinatal mortality, neonatal morbidity, and poor neurodevelopmental outcomes. The leading cause of FGR is placental insufficiency, with the placenta failing to adequately meet the increasing oxygen and nutritional needs of the growing fetus with advancing gestation. The resultant chronic fetal hypoxia induces a decrease in fetal growth, and a redistribution of blood flow preferentially to the brain. However, this adaptation does not ensure normal brain development. Early detection of brain injury in FGR, allowing for the prediction of short- and long-term neurodevelopmental consequences, remains a significant challenge. Furthermore, in FGR infants the detection and diagnosis of neuropathology is complicated by preterm birth, the etiological heterogeneity of FGR, timing of onset of growth restriction, its severity, and coexisting complications. In this review, we examine existing and emerging diagnostic tools from human and preclinical studies for the detection and assessment of brain injury in FGR fetuses and neonates. Increased detection rates, and early detection of brain injury associated with FGR, will offer opportunities for developing and assessing interventions to improve long-term outcomes.
胎儿生长受限（FGR）是妊娠的常见并发症，在严重情况下，与围产儿死亡率升高、新生儿发病率升高和神经发育不良结局有关。FGR 的主要原因是胎盘功能不全，随着妊娠的进展，胎盘无法充分满足不断增长的胎儿对氧气和营养的需求。由此导致的慢性胎儿缺氧会导致胎儿生长减少，并优先将血流重新分配到大脑。然而，这种适应并不能确保大脑的正常发育。早期发现 FGR 中的脑损伤，预测短期和长期神经发育后果，仍然是一个重大挑战。此外，在 FGR 婴儿中，由于早产、FGR 的病因异质性、生长受限的起始时间、其严重程度以及并存的并发症，使得对神经病理学的检测和诊断变得复杂。在这篇综述中，我们研究了来自人类和临床前研究的现有和新兴诊断工具，以检测和评估 FGR 胎儿和新生儿的脑损伤。增加的检测率和早期发现与 FGR 相关的脑损伤，将为开发和评估改善长期结局的干预措施提供机会。
