Department of Ultrasound, Hunan Children's Hospital, University of South China, Changsha.
Department of Neonatology, Hunan Children's Hospital, University of South China, Changsha.
Medicine (Baltimore). 2021 Apr 16;100(15):e25421. doi: 10.1097/MD.0000000000025421.
This study aimed to assess the accuracy of ultrasonic grading in determining brain injury in very premature infants and analyze the affecting factors of these neonatal morbidity and mortality, and to investigate the relationship between serial cranial ultrasound (cUS) classification and Mental Developmental Index (MDI)/Psychomotor Developmental Index (PDI) in premature infants.
A total of 129 very preterm infants (Gestational Age ≤ 28 weeks) were subjected to serial cUS until 6 months or older and classified into 3 degrees in accordance with classification standards. The MDI and PDI (Bayley test) of the infants were measured until the infants reached the age of 24 months or older. The consistency between Term Equivalent Age (TEA)-cUS and TEA- magnetic resonance imaging (MRI) was calculated. Ordinal regression was performed to analyze the relationship among severe disease, early cUS classifications, psychomotor and mental development, and death. Operating characteristic curve were used to analyze the relationship between serial cUS grades and MDI/PDI scores.
The mortality and survival rates of 129 very preterm infants were 32.8% and 67.3%, respectively. Among the 86 surviving infants, 20.9% developed mild cerebral palsy (CP) and 5.8% to 6.9% developed severe CP. The consistency between TEA-cUS and TEA-MRI was 88%. Grades 2 and 3 at first ultrasound were associated with adverse mental (OR = 3.2, OR = 3.78) and motor (OR = 2.25, OR = 2.59) development. cUS classification demonstrated high sensitivity (79%-96%). Among all cUS classifications, the specificity of the first cUS was the lowest and that of TEA-cUS was the highest (57% for PDI and 48% for MDI).
Moderate and severe brain injury at first ultrasound is the most important factor affecting the survival rate and brain development of very premature infants. The cUS classification had high sensitivity and high specificity for the prediction of CP, especially in TEA-cUS.
本研究旨在评估超声分级在确定极早产儿脑损伤中的准确性，并分析这些新生儿发病率和死亡率的影响因素，同时探讨早产儿连续头颅超声（cUS）分级与精神发育指数（MDI）/运动发育指数（PDI）的关系。
对 129 例极早产儿（胎龄≤28 周）进行连续 cUS 检查，直至 6 个月或以上，并根据分级标准分为 3 度。测量婴儿的 MDI 和 PDI（贝利测试），直到婴儿达到 24 个月或更大。计算胎龄相当（TEA）-cUS 与 TEA-磁共振成像（MRI）的一致性。采用有序回归分析严重疾病、早期 cUS 分级、精神运动和精神发育以及死亡之间的关系。采用受试者工作特征曲线分析连续 cUS 分级与 MDI/PDI 评分的关系。
129 例极早产儿的死亡率和存活率分别为 32.8%和 67.3%。在 86 例存活婴儿中，20.9%发生轻度脑瘫（CP），5.8%-6.9%发生重度 CP。TEA-cUS 与 TEA-MRI 的一致性为 88%。首次超声检查 2 级和 3 级与不良精神（OR=3.2，OR=3.78）和运动（OR=2.25，OR=2.59）发育有关。cUS 分级具有较高的灵敏度（79%-96%）。在所有 cUS 分级中，首次 cUS 的特异性最低，TEA-cUS 的特异性最高（PDI 为 57%，MDI 为 48%）。
首次超声检查发现的中度和重度脑损伤是影响极早产儿存活率和脑发育的最重要因素。cUS 分级对 CP 的预测具有较高的灵敏度和特异性，尤其是在 TEA-cUS 中。
