Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
Department of Radiology and Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA.
Pediatr Res. 2022 Dec;92(6):1731-1736. doi: 10.1038/s41390-022-02026-7. Epub 2022 Mar 30.
Mild hypoxic-ischemic encephalopathy (HIE) is increasingly recognized as a risk factor for neonatal brain injury. We examined the timing and pattern of brain injury in mild HIE.
This retrospective cohort study includes infants with mild HIE treated at 9 hospitals. Neonatal brain MRIs were scored by 2 reviewers using a validated classification system, with discrepancies resolved by consensus. Severity and timing of MRI brain injury (i.e., acute, subacute, chronic) was scored on the subset of MRIs that were performed at or before 8 days of age.
Of 142 infants with mild HIE, 87 (61%) had injury on MRI at median age 5 (IQR 4-6) days. Watershed (23%), deep gray (20%) and punctate white matter (18%) injury were most common. Among the 125 (88%) infants who received a brain MRI at ≤8 days, mild (44%) injury was more common than moderate (11%) or severe (4%) injury. Subacute (37%) lesions were more commonly observed than acute (32%) or chronic lesions (1%).
Subacute brain injury is common in newborn infants with mild HIE. Novel neuroprotective treatments for mild HIE will ideally target both subacute and acute injury mechanisms.
Almost two-thirds of infants with mild HIE have evidence of brain injury on MRI obtained in the early neonatal period. Subacute brain injury was seen in 37% of infants with mild HIE. Neuroprotective treatments for mild HIE will ideally target both acute and subacute injury mechanisms.
轻度缺氧缺血性脑病（HIE）越来越被认为是新生儿脑损伤的危险因素。我们研究了轻度 HIE 中的脑损伤时间和模式。
这项回顾性队列研究包括在 9 家医院接受治疗的轻度 HIE 婴儿。两名审阅者使用经验证的分类系统对新生儿脑 MRI 进行评分，通过共识解决分歧。对在出生后 8 天内进行的 MRI 子集进行 MRI 脑损伤（即急性、亚急性、慢性）的严重程度和时间评分。
在 142 名轻度 HIE 婴儿中，87 名（61%）在中位数为 5 天（IQR 4-6）的年龄时 MRI 上有损伤。分水岭（23%）、深部灰质（20%）和点状白质（18%）损伤最常见。在 125 名（88%）≤8 天接受脑 MRI 的婴儿中，轻度（44%）损伤比中度（11%）或重度（4%）损伤更常见。亚急性（37%）病变比急性（32%）或慢性病变（1%）更常见。
亚急性脑损伤在患有轻度 HIE 的新生儿中很常见。针对轻度 HIE 的新型神经保护治疗方法理想情况下应针对亚急性和急性损伤机制。
近三分之二的轻度 HIE 婴儿在新生儿早期获得的 MRI 上有脑损伤的证据。轻度 HIE 婴儿中有 37%存在亚急性脑损伤。针对轻度 HIE 的神经保护治疗方法理想情况下应针对急性和亚急性损伤机制。
