Guillot Mireille, Guo Ting, Ufkes Steven, Schneider Juliane, Synnes Anne, Chau Vann, Grunau Ruth E, Miller Steven P
Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Women-Mother-Child (Neonatology), University Hospital Center and University of Lausanne, Lausanne, Switzerland.
J Pediatr. 2020 Nov;226:87-95.e3. doi: 10.1016/j.jpeds.2020.05.039. Epub 2020 May 23.
To determine, in children born preterm, the association of mechanical ventilation duration with brainstem development, white matter maturation, and neurodevelopmental outcomes at preschool age.
This prospective cohort study included 144 neonates born at <30 weeks of gestation (75 male, mean gestational age 27.1 weeks, SD 1.6) with regional brainstem volumes automatically segmented on magnetic resonance imaging at term-equivalent age (TEA). The white matter maturation was assessed by diffusion tensor imaging and tract-based spatial statistics. Neurodevelopmental outcomes were assessed at 4.5 years of age using the Movement Assessment Battery for Children, 2nd Edition, and the Wechsler Primary and Preschool Scale of Intelligence, 4th Edition, full-scale IQ. The association between the duration of mechanical ventilation and brainstem development was validated in an independent cohort of children born very preterm.
Each additional day of mechanical ventilation predicted lower motor scores (0.5-point decrease in the Movement Assessment Battery for Children, 2nd Edition, score by day of mechanical ventilation, 95% CI -0.6 to -0.3, P < .0001). Prolonged exposure to mechanical ventilation was associated with smaller pons and medulla volumes at TEA in 2 independent cohorts, along with widespread abnormalities in white matter maturation. Pons and medulla volumes at TEA predicted motor outcomes at 4.5 years of age.
In neonates born very preterm, prolonged mechanical ventilation is associated with impaired brainstem development, abnormal white matter maturation, and lower motor scores at preschool age. Further research is needed to better understand the neural pathological mechanisms involved.
确定早产出生儿童机械通气持续时间与脑干发育、白质成熟及学龄前神经发育结局之间的关联。
这项前瞻性队列研究纳入了144例孕龄小于30周出生的新生儿（75例男性，平均孕龄27.1周，标准差1.6），在足月等效年龄（TEA）时通过磁共振成像自动分割区域脑干体积。通过扩散张量成像和基于纤维束的空间统计学评估白质成熟情况。使用儿童运动评估量表第二版和韦氏儿童智力量表第四版全量表智商在4.5岁时评估神经发育结局。在一个极早产出生儿童的独立队列中验证了机械通气持续时间与脑干发育之间的关联。
机械通气每增加一天，预测运动评分较低（儿童运动评估量表第二版评分因机械通气天数而降低0.5分，95%可信区间为-0.6至-0.3，P <.0001）。在两个独立队列中，长时间暴露于机械通气与足月等效年龄时脑桥和延髓体积较小有关，同时白质成熟存在广泛异常。足月等效年龄时的脑桥和延髓体积预测了4.5岁时的运动结局。
在极早产出生的新生儿中，长时间机械通气与脑干发育受损、白质成熟异常及学龄前运动评分较低有关。需要进一步研究以更好地了解其中涉及的神经病理机制。
