Kashou Nasser H, Dar Irfaan A, El-Mahdy Mohamed A, Pluto Charles, Smith Mark, Gulati Ish K, Lo Warren, Jadcherla Sudarshan R
Wright State University, Image Analysis Lab, Dayton, OH, USA.
Innovative Research Program in Neonatal and Infant Feeding Disorders, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Front Pediatr. 2017 Apr 10;5:73. doi: 10.3389/fped.2017.00073. eCollection 2017.
The usefulness of qualitative or quantitative volumetric magnetic resonance imaging (MRI) in early detection of brain structural changes and prediction of adverse outcomes in neonatal illnesses warrants further investigation. Our aim was to correlate certain brain injuries and the brain volume of feeding-related cortical and subcortical regions with feeding method at discharge among preterm dysphagic infants.
Using a retrospective observational study design, we examined MRI data among 43 (22 male; born at 31.5 ± 0.8 week gestation) infants who went home on oral feeding or gastrostomy feeding (G-tube). MRI scans were segmented, and volumes of brainstem, cerebellum, cerebrum, basal ganglia, thalamus, and vermis were quantified, and correlations were made with discharge feeding outcomes. Chi-squared tests were used to evaluate MRI findings vs. feeding outcomes. ANCOVA was performed on the regression model to measure the association of maturity and brain volume between groups.
Out of 43 infants, 44% were oral-fed and 56% were G-tube fed at hospital discharge (but not at time of the study). There was no relationship between qualitative brain lesions and feeding outcomes. Volumetric analysis revealed that cerebellum was greater ( < 0.05) in G-tube fed infants, whereas cerebrum volume was greater ( < 0.05) in oral-fed infants. Other brain regions did not show volumetric differences between groups.
This study concludes that neither qualitative nor quantitative volumetric MRI findings correlate with feeding outcomes. Understanding the complexity of swallowing and feeding difficulties in infants warrants a comprehensive and in-depth functional neurological assessment.
定性或定量容积磁共振成像（MRI）在新生儿疾病早期脑结构变化检测及不良预后预测中的应用价值值得进一步研究。我们的目的是将某些脑损伤以及与喂养相关的皮质和皮质下区域的脑容量与早产吞咽困难婴儿出院时的喂养方式相关联。
采用回顾性观察研究设计，我们检查了43名（22名男性；孕31.5±0.8周出生）经口喂养或胃造口喂养（G管喂养）出院婴儿的MRI数据。对MRI扫描进行分割，量化脑干、小脑、大脑、基底神经节、丘脑和蚓部的体积，并与出院时的喂养结果进行相关性分析。采用卡方检验评估MRI结果与喂养结果。对回归模型进行协方差分析，以测量两组之间成熟度与脑容量的关联。
43名婴儿中，44%在出院时（但不是在研究时）经口喂养，56%接受G管喂养。脑质性病变与喂养结果之间没有关系。容积分析显示，G管喂养婴儿的小脑体积更大（<0.05），而经口喂养婴儿的大脑体积更大（<0.05）。其他脑区在两组之间没有显示出体积差异。
本研究得出结论，定性或定量容积MRI结果均与喂养结果无关。了解婴儿吞咽和喂养困难的复杂性需要进行全面深入的功能性神经学评估。
