早产儿手术性坏死性小肠结肠炎的脑损伤：临床与肠道病理相关性。
Brain injury in preterm infants with surgical necrotizing enterocolitis: clinical and bowel pathological correlates.
机构信息
Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, MS, USA.
Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA.
出版信息
Pediatr Res. 2022 Apr;91(5):1182-1195. doi: 10.1038/s41390-021-01614-3. Epub 2021 Jun 8.
BACKGROUND
The objective of this study was to determine the risk factors and outcomes of white matter brain injury (WMBI) on magnetic resonance imaging (MRI) at term-equivalent age in infants with surgical necrotizing enterocolitis (NEC).
METHODS
This retrospective study compared clinical/pathological information between infants with and those without WMBI.
RESULTS
Out of 69 infants with surgical NEC, 17 (24.6%) had mild WMBI, 13 (18.8%) had moderate WMBI, and six (8.7%) had severe WMBI on the brain MRI. Several clinical factors (gestational age, more red blood cell (RBC) transfusions before NEC onset, pneumoperitoneum, earlier NEC onset age, postoperative ileus, acute kidney injury (AKI) by serum creatinine, postnatal steroids, hospital stay) and histopathological findings (necrosis, hemorrhage) had univariate associations with WMBI. Associations with RBC transfusion (odds ratio (OR) 23.6 [95% confidence interval (CI): 4.73-117.97]; p = 0.0001), age at NEC onset (OR 0.30 [95%CI: 0.11-0.84]; p = 0.021), necrosis (OR 0.10 [95%CI: 0.01-0.90]; p = 0.040), and bowel hemorrhage (OR 7.79 [95%CI: 2.19-27.72]; p = 0.002) persisted in multivariable association with grade 3-4 WMBI. The infants with WMBI had lower mean motor, cognitive, language scores, and higher ophthalmic morbidity at 2 years of age.
CONCLUSIONS
The WMBI was most likely associated with earlier NEC onset, higher RBC transfusions, and less necrosis and greater hemorrhage lesions on intestinal pathology in preterm infants with surgical NEC.
IMPACT
In preterm infants with surgical NEC, brain MRI showed injury in the white matter in 52%, gray matter in 10%, and cerebellar region in 30%. Preterm infants with severe WMBI (grade 3-4) had less necrosis and greater hemorrhagic lesions on histopathology of the bowel. Preterm infants with WMBI were more likely to have a more severe postoperative course, AKI, and longer length of hospitalization. Neuroprotective strategies to prevent brain injury in preterm infants with surgical NEC are needed with the goal of improving the neurodevelopmental outcomes.
背景
本研究旨在确定在接受手术治疗的坏死性小肠结肠炎（NEC）婴儿中，足月时磁共振成像（MRI）显示的脑白质损伤（WMBI）的危险因素和结局。
方法
本回顾性研究比较了伴有和不伴有 WMBI 的婴儿的临床/病理信息。
结果
在 69 例接受手术治疗的 NEC 婴儿中，17 例（24.6%）MRI 显示轻度 WMBI，13 例（18.8%）显示中度 WMBI，6 例（8.7%）显示严重 WMBI。一些临床因素（胎龄、NEC 发病前接受更多的红细胞（RBC）输血、气腹、更早的 NEC 发病年龄、术后肠梗阻、急性肾损伤（AKI）由血清肌酐、出生后类固醇、住院时间）和组织病理学发现（坏死、出血）与 WMBI 存在单变量关联。与 RBC 输血（比值比（OR）23.6[95%置信区间（CI）：4.73-117.97]；p=0.0001）、NEC 发病年龄（OR 0.30[95%CI：0.11-0.84]；p=0.021）、坏死（OR 0.10[95%CI：0.01-0.90]；p=0.040）和肠出血（OR 7.79[95%CI：2.19-27.72]；p=0.002）的多变量关联在统计学上持续存在。患有 WMBI 的婴儿在 2 岁时的运动、认知、语言评分较低，眼部发病率较高。
结论
在接受手术治疗的 NEC 早产儿中，WMBI 最可能与 NEC 发病较早、RBC 输血较多以及肠道病理上的坏死和出血病变较少有关。
意义
在接受手术治疗的 NEC 早产儿中，脑 MRI 显示 52%的早产儿有脑白质损伤，10%的早产儿有灰质损伤，30%的早产儿有小脑区域损伤。严重 WMBI（3-4 级）的早产儿肠道病理检查显示坏死程度较轻，出血性病变程度较大。患有 WMBI 的早产儿更有可能经历更严重的术后过程、AKI 和更长的住院时间。需要制定神经保护策略来预防手术治疗的 NEC 早产儿的脑损伤，以改善神经发育结局。
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