Rutkowska Magdalena, Bekiesińska-Figatowska Monika, Kmita Grażyna, Terczyńska Iwona, Polak Katarzyna, Kalisiak Marcin, Prażmowska Dorota, Kiepura Eliza, Szkudlińska-Pawlak Sylwia, Seroczyńska Małgorzata, Helwich Ewa
Klinika Neonatologii i Intensywnej Terapii Noworodka Instytut Matki i Dziecka, Warszawa, Polska.
Zakład Diagnostyki Obrazowej Instytut Matki i Dziecka, Warszawa, Polska.
Dev Period Med. 2018;22(1):39-48. doi: 10.34763/devperiodmed.20182201.3948.
Infants ≤28 GA are at particular risk of psychomotor and neurological developmental disorder. They also remain at a higher risk of developing autism spectrum disorder (ASD), characterized by persistent deficits in communication/social interactions and restricted, repetitive behaviors, activities and interests. Monitoring their development by a team of specialists (a neurologist, psychologist, psychiatrist) allows us to make an early diagnosis and to implement appropriate therapy. Neuroimaging studies during the neonatal period may be helpful in clarifying diagnosis and prognosis. Objective: The aim of the study was to search for the interrelation between the results of neuroimaging and the neurological, psychological and psychiatric evaluation at the age of 2.
Material and methods: Neonates born at ≤28 weeks between 01.06.2013 and 31.12.2015 and hospitalized at NICU were enrolled. We present the results of the first 12 children who have attained 2 years of corrected age and have undergone both neuroimaging, and neurological, psychological and psychiatric assessments. Transfontanel ultrasound was performed according to general standards, MRI between 38 and 42 weeks of corrected age. Neurological examination based on the Denver scale, ASD screening with use of the STAT test and psychological DSR assessment were performed at 2 years of corrected age.
Results: Median GA was 26 weeks and median weight 795 g. The ultrasound examination was normal in 9 cases (75%) and MRI in 4 (33%). Abnormalities in the cerebellum were the main additional information found in MRI as compared to US. Neurological examination was normal in 8 infants (67#37;), in 4 of whom neuroimaging was normal. In 4 (33%) infants the neurological examination was abnormal. Psychomotor development at an average level or above was found in seven (58#37;) children. In 4 of them neuroimaging was normal, whereas 3 had ventricular dilatation and haemorrhagic infarct. There were no abnormalities within the cerebellum in this group. In the remaining 5 children (42#37;) psychomotor development was rated as delayed. All of them had cerebellar haemorrhage. An increased risk of ASD was observed in 4 children who developed cerebellar hemorrhage.
Conclusions: 1. The use of MRI at a term-equivalent age may contribute to the prognosis of neurodevelopmental outcomes in extremely premature infants, allowing risk stratification and thus enhancing early monitoring of a child's development and functional status 2. There is a clear tendency towards abnormal psychomotor development and positive screening for ASD to co-occur with abnormal MRI findings in the cerebellum.
孕周≤28周的婴儿发生精神运动和神经发育障碍的风险特别高。他们患自闭症谱系障碍（ASD）的风险也较高，其特征为沟通/社交互动持续存在缺陷以及存在受限的重复行为、活动和兴趣。由一组专家（神经科医生、心理学家、精神科医生）对其发育情况进行监测，有助于我们进行早期诊断并实施适当的治疗。新生儿期的神经影像学研究可能有助于明确诊断和预后。目的：本研究旨在探寻神经影像学结果与2岁时神经、心理和精神评估结果之间的相互关系。
材料和方法：纳入2013年6月1日至2015年12月31日期间出生且孕周≤28周并在新生儿重症监护病房住院的新生儿。我们展示了首批12名已达到2岁矫正年龄并接受了神经影像学检查以及神经、心理和精神评估的儿童的结果。经囟门超声检查按照一般标准进行，在矫正年龄38至42周时进行磁共振成像（MRI）检查。在矫正年龄2岁时，根据丹佛量表进行神经学检查，使用STAT测试进行ASD筛查以及进行心理DSR评估。
结果：中位孕周为26周，中位体重为795克。9例（75%）超声检查正常，4例（33%）MRI检查正常。与超声相比，MRI发现的主要额外信息是小脑异常。8名婴儿（67%）神经学检查正常，其中4名神经影像学检查也正常。4名（33%）婴儿神经学检查异常。7名（58%）儿童的精神运动发育处于平均水平或以上。其中4名神经影像学检查正常，而3名有脑室扩张和出血性梗死。该组小脑中无异常。其余5名儿童（42%）精神运动发育被评定为延迟。他们均有小脑出血。4名发生小脑出血的儿童患ASD的风险增加。
结论：1. 在足月等效年龄使用MRI可能有助于极早产儿神经发育结局的预后评估，实现风险分层，从而加强对儿童发育和功能状态的早期监测 2. 精神运动发育异常和ASD筛查呈阳性与小脑MRI检查异常同时出现的趋势明显。
