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脑功能(aEEG)与脑结构(MRI)的关系及其对早产儿神经发育结局的预测价值。

Relationship between brain function (aEEG) and brain structure (MRI) and their predictive value for neurodevelopmental outcome of preterm infants.

机构信息

Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.

Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.

出版信息

Eur J Pediatr. 2018 Aug;177(8):1181-1189. doi: 10.1007/s00431-018-3166-2. Epub 2018 May 22.

Abstract

UNLABELLED

To improve the prediction of neurodevelopmental outcome in very preterm infants, this study used the combination of amplitude-integrated electroencephalography (aEEG) within the first 72 h of life and cranial magnetic resonance imaging (MRI) at term equivalent age. A single-center cohort of 38 infants born before 32 weeks of gestation was subjected to both investigations. Structural measurements were performed on MRI. Multiple regression analysis was used to identify independent factors including functional and structural brain measurements associated with outcome at a corrected age of 24 months. aEEG parameters significantly correlated with MRI measurements. Reduced deep gray matter volume was associated with low Burdjalov Score on day 3 (p < 0.0001) and day 1-3 (p = 0.0012). The biparietal width and the transcerebellar diameter were related to Burdjalov Score on day 1 (p = 0.0111; p = 0.0002). The final multiple regression analysis revealed independent predictors of neurodevelopmental outcome: intraventricular hemorrhage (p = 0.0060) and interhemispheric distance (p = 0.0052) for mental developmental index; Burdjalov Score day 1 (p = 0.0201) and interhemispheric distance (p = 0.0142) for psychomotor developmental index.

CONCLUSION

Functional aEEG parameters were associated with altered brain maturation on MRI. The combination of aEEG and MRI contributes to the prediction of outcome at 24 months. What is Known: • Prematurity remains a risk factor for impaired neurodevelopment. • aEEG is used to measure brain activity in preterm infants and cranial MRI is performed to identify structural gray and white matter abnormalities with impact on neurodevelopmental outcome. What is New: • aEEG parameters observed within the first 72 h of life were associated with altered deep gray matter volumes, biparietal width, and transcerebellar diameter at term equivalent age. • The combination of aEEG and MRI contributes to the prediction of neurodevelopmental outcome at 2 years of corrected age in very preterm infants.

摘要

目的

为了提高极早产儿神经发育结局的预测能力,本研究在生后 72 小时内使用振幅整合脑电图(aEEG)与胎龄校正足月时的头颅磁共振成像(MRI)相结合。将单中心队列中 38 名胎龄<32 周的婴儿纳入本研究,均进行了这两项检查。MRI 上进行结构测量。采用多元回归分析,确定与校正 24 月龄时结局相关的独立因素,包括功能和结构脑测量。aEEG 参数与 MRI 测量显著相关。灰质体积减少与第 3 天(p<0.0001)和第 1-3 天(p=0.0012)的 Burdjalov 评分低有关。大脑矢状宽度和小脑横径与第 1 天的 Burdjalov 评分相关(p=0.0111;p=0.0002)。最终多元回归分析显示神经发育结局的独立预测因素:脑室周围出血(p=0.0060)和大脑半球间距离(p=0.0052)与精神运动发育指数相关;第 1 天的 Burdjalov 评分(p=0.0201)和大脑半球间距离(p=0.0142)与精神发育指数相关。

结论

功能 aEEG 参数与 MRI 上的脑成熟改变相关。aEEG 和 MRI 的联合应用有助于预测 24 月龄时的结局。

已知

• 早产仍然是神经发育受损的危险因素。

• aEEG 用于测量早产儿的脑活动,头颅 MRI 用于识别对神经发育结局有影响的灰质和白质结构异常。

新发现

• 生后 72 小时内观察到的 aEEG 参数与胎龄校正足月时的深部灰质体积、大脑矢状宽度和小脑横径改变有关。

• aEEG 和 MRI 的联合应用有助于预测极早产儿校正 2 岁时的神经发育结局。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2681/6061051/ca709db1a041/431_2018_3166_Fig1_HTML.jpg

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