Al Amrani Fatema, Kwan Saskia, Gilbert Guillaume, Saint-Martin Christine, Shevell Michael, Wintermark Pia
Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
Pediatr Neurol. 2017 Aug;73:20-27. doi: 10.1016/j.pediatrneurol.2017.04.025. Epub 2017 May 19.
Brain injury can be identified as early as day two of life in asphyxiated newborns treated with hypothermia, when using diffusion magnetic resonance imaging (MRI). However, it remains unclear whether these diffusion changes can predict future neurodevelopment. This study aimed to determine whether abnormal early diffusion changes in newborns treated with hypothermia are associated with adverse neurodevelopmental outcome at age two years.
Asphyxiated newborns treated with hypothermia were enrolled prospectively. They underwent magnetic resonance imaging (MRI) at specific time points over the first month of life, including diffusion-weighted imaging and diffusion-tensor imaging. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in different regions of interest. Adverse neurodevelopmental outcome was defined as cerebral palsy, global developmental delay, and/or seizure disorder around age two years. ADC and FA values were compared between the newborns developing or not developing adverse outcome.
Twenty-nine asphyxiated newborns treated with hypothermia were included. Among the newborns developing adverse outcome, ADC values were significantly decreased on days two to three of life and increased around day ten of life in the thalamus, posterior limb of the internal capsule, and the lentiform nucleus. FA values decreased in the same regions around day 30 of life. These newborns also had increased ADC around day ten of life and around day 30 of life, and decreased FA around day 30 of life in the anterior and posterior white matter.
Diffusion changes that were evident as early as day two of life, when the asphyxiated newborns were still treated with hypothermia, were associated with later abnormal neurodevelopmental outcome.
对于接受低温治疗的窒息新生儿，在出生后第二天使用扩散磁共振成像（MRI）即可识别脑损伤。然而，这些扩散变化是否能够预测未来的神经发育仍不清楚。本研究旨在确定接受低温治疗的新生儿早期异常扩散变化是否与两岁时不良神经发育结局相关。
前瞻性纳入接受低温治疗的窒息新生儿。在出生后的第一个月内，他们在特定时间点接受磁共振成像（MRI）检查，包括扩散加权成像和扩散张量成像。在不同感兴趣区域测量表观扩散系数（ADC）和分数各向异性（FA）值。不良神经发育结局定义为两岁左右出现脑瘫、全面发育迟缓及/或癫痫发作障碍。比较出现或未出现不良结局的新生儿的ADC和FA值。
纳入29例接受低温治疗的窒息新生儿。在出现不良结局的新生儿中，丘脑、内囊后肢和豆状核的ADC值在出生后第二至三天显著降低，在出生后第十天左右升高。FA值在出生后第30天左右在相同区域降低。这些新生儿在出生后第十天左右和出生后第30天左右前、后白质的ADC也升高，在出生后第30天左右FA降低。
早在窒息新生儿仍在接受低温治疗的出生后第二天就明显出现的扩散变化与后期异常神经发育结局相关。
