Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
J Perinatol. 2018 Jun;38(6):728-733. doi: 10.1038/s41372-018-0080-4. Epub 2018 Feb 27.
Asphyxiated infants treated with therapeutic cooling can have persistent oral feeding difficulty because of involvement of neural pathways in the brainstem, cortex, and basal ganglia. The goal is to predict the composite adverse outcome of death or persistent oral feeding difficulty using precooling/cooling attributes, and the severity and distribution of hypoxic-ischemic lesions, especially brainstem lesions on post-cooling brain magnetic resonance imaging (MRI).
Retrospective review of 86 asphyxiated infants cooled from January 2006 to August 2014. Persistent feeding difficulty was defined as needing feeding support (gastrostomy tube (g-tube) or home gavage feeds) after discharge. Clinical and laboratory risk factors, and the brain MRI abnormalities including the presence of brainstem lesions were compared between infants with and without adverse outcome using univariate analysis. Significant variables were then analyzed in a stepwise logistic regression (LR) model.
Infants with adverse outcome (n = 31, 4 died pre-discharge) had longer hospital stay (26 days, interquartile range (IQR) 19-43 vs. 13 days, IQR 9-20; p < 0.01) and reached goal enteral feeds (oral/gavage) later (11 days vs. 8 days, p < 0.01) compared to 55 infants discharged on full oral feeds. The former infants were more likely to have cord pH ≤ 7.15, severely abnormal neurological examination, bleeding diathesis, continued need for ventilation, and positive MRI findings including brainstem lesions. In LR analysis, brainstem lesions on MRI (p = 0.00, odds ratio 19, 95% confidence interval 4-85) was independently associated with the adverse outcome.
Brainstem involvement on post-cooling brain MRI was predictive of adverse outcome. Early identification of these infants may facilitate discussion of home feeding plans between clinicians and parents earlier, thereby potentially reducing the length of hospital stay.
接受治疗性冷却的窒息婴儿可能会因脑干、皮质和基底节神经通路受累而持续存在口腔喂养困难。目标是使用预冷却/冷却属性以及缺氧缺血性病变的严重程度和分布，特别是在冷却后脑磁共振成像 (MRI) 上的脑干病变，预测死亡或持续口腔喂养困难的复合不良结局。
回顾性分析 2006 年 1 月至 2014 年 8 月期间接受冷却治疗的 86 名窒息婴儿。持续性喂养困难定义为出院后需要喂养支持（胃造口管（胃管）或家庭灌食）。使用单变量分析比较有无不良结局的婴儿之间的临床和实验室危险因素以及包括脑干病变在内的 MRI 异常。然后，使用逐步逻辑回归 (LR) 模型对有意义的变量进行分析。
有不良结局的婴儿（n=31，3 例在出院前死亡）的住院时间更长（26 天，四分位距（IQR）19-43 与 13 天，IQR 9-20；p<0.01），达到目标肠内喂养（口服/灌食）的时间也更晚（11 天与 8 天；p<0.01）。与 55 名出院时能完全口服喂养的婴儿相比。前者更有可能有脐带 pH 值≤7.15、严重异常的神经检查、出血倾向、持续需要通气以及 MRI 阳性发现，包括脑干病变。在 LR 分析中，MRI 上的脑干病变（p=0.00，优势比 19，95%置信区间 4-85）与不良结局独立相关。
冷却后脑 MRI 上的脑干受累与不良结局相关。早期识别这些婴儿可能有助于临床医生和家长更早地讨论家庭喂养计划，从而可能缩短住院时间。
