Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada; Department of Pediatrics (Neonatology), Université Laval and Centre Hospitalier Universitaire de Québec, Québec, Canada.
Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada.
Semin Perinatol. 2021 Nov;45(7):151469. doi: 10.1016/j.semperi.2021.151469. Epub 2021 Aug 20.
White matter injury (WMI) represents a frequent form of parenchymal brain injury in preterm neonates. Several dimensions of WMI are recognized, with distinct neuropathologic features involving a combination of destructive and maturational anomalies. Hypoxia-ischemia is the main mechanism leading to WMI and adverse white matter development, which result from injury to the oligodendrocyte precursor cells. Inflammation might act as a potentiator for WMI. A combination of hypoxia-ischemia and inflammation is frequent in several neonatal comorbidities such as postnatal infections, NEC and bronchopulmonary dysplasia, all known contributors to WMI. White matter injury is an important predictor of adverse neurodevelopmental outcomes. When WMI is detected on neonatal brain imaging, a detailed characterization of the injury (pattern of injury, severity and location) may enhance the ability to predict outcomes. This clinically-oriented review will provide an overview of the pathophysiology and imaging diagnosis of the multiple dimensions of WMI, will explore the association between postnatal complications and WMI, and will provide guidance on the signification of white matter anomalies for motor and cognitive development.
脑白质损伤（WMI）是早产儿脑实质损伤的常见形式。WMI 有几个不同的维度，具有不同的神经病理学特征，涉及破坏性和成熟性异常的结合。缺氧缺血是导致 WMI 和不良白质发育的主要机制，这是由少突胶质前体细胞损伤引起的。炎症可能是 WMI 的增强因素。缺氧缺血和炎症的结合在几种新生儿合并症中很常见，如产后感染、NEC 和支气管肺发育不良，这些都是 WMI 的已知诱因。WMI 是不良神经发育结局的重要预测因素。当新生儿脑影像学检查发现 WMI 时，对损伤的详细特征（损伤模式、严重程度和位置）进行描述可能会增强预测结局的能力。本临床导向的综述将概述 WMI 的多个维度的病理生理学和影像学诊断，探讨与 WMI 相关的产后并发症，并就白质异常对运动和认知发育的意义提供指导。
