围生期预警事件后缺氧缺血性脑病的治疗性低温：MRI 显示脑损伤减少，18-36 个月时神经发育结局改善。

Therapeutic hypothermia for hypoxic-ischemic encephalopathy after perinatal sentinel events: less brain injury on MRI and improved neurodevelopmental outcome at 18-36 months.

机构信息

Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.

Department of Pediatrics, Mansoura University, Mansoura, Egypt.

出版信息

J Perinatol. 2020 Apr;40(4):633-639. doi: 10.1038/s41372-020-0602-8. Epub 2020 Feb 12.

DOI:10.1038/s41372-020-0602-8

PMID:32051541

Abstract

OBJECTIVE

To study the association between perinatal sentinel events (PSE) and brain MRI/neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH).

DESIGN

This is a retrospective single-center study. Data collection included perinatal history, brain MRI, and neurodevelopmental outcome.

RESULTS

Out of the 182 neonates, 53 (29%) neonates had PSE and 129 (71%) neonates did not have PSE. Neonates with PSE had more normal MRIs (76%) compared with neonates without PSE (55%), p = 0.01. PSE was associated with favorable motor (p = 0.02), language outcome (p = 0.03), and trend to better cognitive scores (p = 0.13). In PSE, favorable motor outcome persisted (OR for impairment 0.15 (0.003-0.84), p = 0.03) after adjusting for the degree of encephalopathy and brain MRI injury. Injury on brain MRI despite TH after PSE was associated with unfavorable neurodevelopmental outcome (p < 0.001).

CONCLUSION

Neonates with HIE receiving TH after PSE had less severe injury on brain MRI after rewarming, and improved motor and language outcomes at 18-36 months.

摘要

目的

研究接受治疗性低温（TH）的缺氧缺血性脑病（HIE）新生儿围产期哨兵事件（PSE）与脑 MRI/神经发育结局的关系。

设计

这是一项回顾性单中心研究。数据收集包括围产期病史、脑 MRI 和神经发育结局。

结果

在 182 例新生儿中，53 例（29%）新生儿有 PSE，129 例（71%）新生儿无 PSE。与无脑 PSE 的新生儿相比，有 PSE 的新生儿 MRI 更正常（76%对 55%，p=0.01）。PSE 与良好的运动（p=0.02）、语言结局（p=0.03）和认知评分改善趋势相关（p=0.13）。在 PSE 中，尽管在 PSE 后进行了 TH，但运动结局良好仍然存在（OR 为 0.15（0.003-0.84），p=0.03），调整了脑病程度和脑 MRI 损伤。尽管在 PSE 后进行了 TH，但 PSE 后仍有脑 MRI 损伤与不良的神经发育结局相关（p<0.001）。