From the Department of Radiology, Division of Neuroradiology (C.Z., J.K.S.); and Department of Psychiatry (E.A.C., Z.Y., J.H.G.), University of North Carolina School of Medicine, 2006 Old Clinic Building, CB# 7510, Chapel Hill, NC 27599-7510; and Division of Pediatric Imaging, Department of Diagnostic Imaging, Hasbro Children's Hospital, Rhode Island Medical Imaging, Warren Alpert Medical School of Brown University, Providence, RI (C.S.).
Radiology. 2021 Jan;298(1):173-179. doi: 10.1148/radiol.2020201857. Epub 2020 Oct 27.
Background Subdural hemorrhage (SDH) is thought to have a benign course in asymptomatic neonates. However, effects on neurodevelopmental outcomes have not been established. Purpose To evaluate neurodevelopmental outcomes, gray matter volumes, and MRI findings in asymptomatic neonates with SDH compared with control neonates. Materials and Methods This retrospective analysis was conducted between 2003 and 2016 and was based on data from the University of North Carolina Early Brain Development Study. Neurodevelopmental outcomes were evaluated at 2 years of age by using the Mullen Scales of Early Learning (MSEL). All infants were imaged with 3.0-T MRI machines and were evaluated for SDH at baseline (neonates) and at ages 1 and 2 years. Volumetric MRI for brain segmentation was performed at ages 1 and 2 years. A secondary analysis was performed in neonates matched 1:1 with control neonates. Differences in categorical variables were measured by using the Fisher exact test, and the test was used for continuous variables. Results A total of 311 neonates (mean gestational age ± standard deviation, 39.3 weeks ± 1.5), including 57 with SDH (mean gestational age, 39.5 weeks ± 1.2), were evaluated. The subgroup included 55 neonates with SDH (mean gestational age, 39.6 weeks ± 1.2) and 55 matched control neonates (mean gestational age, 39.7 weeks ± 1.2). Fifty-five of 57 neonates with SDH (97%; 95% CI: 92, 100) were delivered vaginally compared with 157 of 254 control neonates (62%, 95% CI: 56, 68; < .001). Otherwise, there were no differences in perinatal, maternal, or obstetric parameters. There were no differences in composite MSEL scores (115 ± 15 and 109 ± 16 at 2 years, respectively; = .05) or gray matter volumes between the neonatal SDH group and control neonates (730 cm ± 85 and 742 cm ± 76 at 2 years, respectively; = .70). There was no evidence of rebleeding at follow-up MRI. Conclusion Neurodevelopmental scores and gray matter volumes at age 2 years did not differ between asymptomatic neonates with subdural hemorrhage and control neonates. © RSNA, 2020
背景 幕上硬膜下血肿（SDH）被认为在无症状的新生儿中具有良性病程。然而，其对神经发育结局的影响尚未确定。目的 评估无症状新生儿与对照组新生儿相比，幕上硬膜下血肿的神经发育结局、灰质体积和 MRI 表现。材料与方法 本回顾性分析于 2003 年至 2016 年进行，基于北卡罗来纳大学早期脑发育研究的数据。通过使用 Mullen 早期学习量表（MSEL），在 2 岁时评估神经发育结局。所有婴儿均使用 3.0-T MRI 机器进行成像，并在基线（新生儿）和 1 岁和 2 岁时进行 SDH 评估。在 1 岁和 2 岁时进行大脑分割的容积 MRI。对新生儿进行了 1:1 与对照组新生儿匹配的二次分析。使用 Fisher 确切检验测量分类变量的差异，使用 t 检验测量连续变量的差异。结果 共评估了 311 名新生儿（平均胎龄 ± 标准差，39.3 周 ± 1.5），其中 57 名新生儿患有 SDH（平均胎龄，39.5 周 ± 1.2）。亚组包括 55 名患有 SDH 的新生儿（平均胎龄，39.6 周 ± 1.2）和 55 名匹配的对照组新生儿（平均胎龄，39.7 周 ± 1.2）。57 名患有 SDH 的新生儿中有 55 名（97%；95%CI：92，100）经阴道分娩，而 254 名对照组新生儿中有 157 名（62%，95%CI：56，68；<.001）。否则，围产期、产妇或产科参数无差异。两组新生儿的复合 MSEL 评分（分别为 2 岁时的 115 ± 15 和 109 ± 16； =.05）或灰质体积（分别为 2 岁时的 730 cm ± 85 和 742 cm ± 76； =.70）均无差异。在随访 MRI 中没有证据表明再出血。结论 无症状硬膜下血肿新生儿与对照组新生儿相比，2 岁时的神经发育评分和灰质体积无差异。
