Walsh Brian H, Neil Jeffrey, Morey JoAnn, Yang Edward, Silvera Michelle V, Inder Terrie E, Ortinau Cynthia
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA.
Department of Neurology, Boston Children's Hospital, Boston, MA.
J Pediatr. 2017 Aug;187:26-33.e1. doi: 10.1016/j.jpeds.2017.03.065. Epub 2017 May 4.
To assess and contrast the incidence and severity of abnormalities on cerebral magnetic resonance imaging (MRI) between infants with mild, moderate, and severe neonatal encephalopathy who received therapeutic hypothermia.
This retrospective cohort studied infants with mild, moderate, and severe neonatal encephalopathy who received therapeutic hypothermia at a single tertiary neonatal intensive care unit between 2013 and 2015. Two neuroradiologists masked to the clinical condition evaluated brain MRIs for cerebral injury after therapeutic hypothermia using the Barkovich classification system. Additional abnormalities not included in this classification system were also noted. The rate, pattern, and severity of abnormalities/injury were compared across the grades of neonatal encephalopathy.
Eighty-nine infants received therapeutic hypothermia and met study criteria, 48 with mild neonatal encephalopathy, 35 with moderate neonatal encephalopathy, and 6 with severe neonatal encephalopathy. Forty-eight infants (54%) had an abnormality on MRI. There was no difference in the rate of overall MRI abnormalities by grade of neonatal encephalopathy (mild neonatal encephalopathy 54%, moderate neonatal encephalopathy 54%, and severe neonatal encephalopathy 50%; P= .89). Basal ganglia/thalamic injury was more common in those with severe neonatal encephalopathy (mild neonatal encephalopathy 4%, moderate neonatal encephalopathy 9%, severe neonatal encephalopathy 34%; P = .03). In contrast, watershed injury did not differ between neonatal encephalopathy grades (mild neonatal encephalopathy 36%, moderate neonatal encephalopathy 32%, severe neonatal encephalopathy 50%; P = .3).
Mild neonatal encephalopathy is commonly associated with MRI abnormalities after therapeutic hypothermia. The grade of neonatal encephalopathy during the first hours of life may not discriminate adequately between infants with and without cerebral injury noted on MRI after therapeutic hypothermia.
评估和对比接受亚低温治疗的轻度、中度和重度新生儿脑病婴儿脑磁共振成像（MRI）异常的发生率及严重程度。
这项回顾性队列研究纳入了2013年至2015年间在一家三级新生儿重症监护病房接受亚低温治疗的轻度、中度和重度新生儿脑病婴儿。两名对临床情况不知情的神经放射科医生使用Barkovich分类系统评估亚低温治疗后脑MRI的脑损伤情况。还记录了该分类系统未涵盖的其他异常情况。比较了不同等级新生儿脑病的异常/损伤发生率、模式及严重程度。
89名婴儿接受了亚低温治疗并符合研究标准，其中48名患有轻度新生儿脑病，35名患有中度新生儿脑病，6名患有重度新生儿脑病。48名婴儿（54%）MRI检查存在异常。不同等级新生儿脑病的MRI总体异常发生率无差异（轻度新生儿脑病54%，中度新生儿脑病54%，重度新生儿脑病50%；P = 0.89）。基底节/丘脑损伤在重度新生儿脑病患儿中更常见（轻度新生儿脑病4%，中度新生儿脑病9%，重度新生儿脑病34%；P = 0.03）。相比之下，分水岭区损伤在不同等级新生儿脑病之间无差异（轻度新生儿脑病36%，中度新生儿脑病32%，重度新生儿脑病50%；P = 0.3）。
轻度新生儿脑病在亚低温治疗后常伴有MRI异常。出生后最初几小时的新生儿脑病等级可能无法充分区分亚低温治疗后MRI检查有或无脑损伤的婴儿。
