Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands.
Eur J Paediatr Neurol. 2019 Jul;23(4):621-628. doi: 10.1016/j.ejpn.2019.04.004. Epub 2019 Apr 27.
Early diagnosis of unilateral cerebral palsy is important after asymmetric perinatal brain injury (APBI). Our objective is to estimate the risk of unilateral cerebral palsy (UCP) in infants with APBI during the first months of life using neuroimaging and clinical assessment.
Prognostic multivariable prediction modeling study including 52 infants (27 males), median gestational age 39.3 weeks with APBI from Sweden (n = 33) and the Netherlands (n = 19).
(1) neonatal MRI within one month after term equivalent age (TEA), (2) Hand Assessment for Infants (HAI) between 3.5 and 4.5 months of (corrected) age. UCP was diagnosed ≥24 months of age. Firth regression with cross-validation was used to construct and internally validate the model to estimate the risk for UCP based on the predictors corticospinal tract (CST) and basal ganglia/thalamus (BGT) involvement, contralesional HAI Each hand sum score (EaHS), gestational age and sex.
UCP was diagnosed in 18 infants (35%). Infants who developed UCP more often had involvement of the CST and BGT on neonatal MRI and had lower contralesional HAI EaHS compared to those who did not develop UCP. The final model showed excellent accuracy for UCP prediction between 3.5 and 4.5 months (area under the curve, AUC = 0.980; 95% CI 0.95-1.00).
Combining neonatal MRI, the HAI, gestational age and sex accurately identify the prognostic risk of UCP at 3.5-4.5 months in infants with APBI.
在不对称围产期脑损伤（APBI）后，早期诊断单侧脑瘫（UCP）非常重要。我们的目的是使用神经影像学和临床评估来估计 APBI 婴儿在生命最初几个月发生 UCP 的风险。
这是一项预后多变量预测模型研究，纳入了 52 名婴儿（男 27 名），中位胎龄为 39.3 周，APBI 来自瑞典（n=33）和荷兰（n=19）。
（1）在胎龄校正后 3.5 至 4.5 个月之间进行 Hand Assessment for Infants（HAI）；（2）在胎龄校正后 1 个月内进行新生儿 MRI。UCP 在 24 个月后被诊断。使用 Firth 回归和交叉验证来构建和内部验证模型，以根据皮质脊髓束（CST）和基底节/丘脑（BGT）受累、对侧 HAI 每个手总和得分（EaHS）、胎龄和性别预测 UCP 的风险。
18 名婴儿（35%）被诊断为 UCP。与未发生 UCP 的婴儿相比，发生 UCP 的婴儿在新生儿 MRI 上更常出现 CST 和 BGT 受累，对侧 HAI EaHS 较低。该最终模型在 3.5 至 4.5 个月之间对 UCP 预测具有出色的准确性（曲线下面积，AUC=0.980；95%CI 0.95-1.00）。
结合新生儿 MRI、HAI、胎龄和性别，可以在 APBI 婴儿中准确识别 3.5-4.5 个月时 UCP 的预后风险。
