极早产儿脑室容积：与 4.5 岁时脑成熟度和神经发育的关系。

Ventricular Volume in Infants Born Very Preterm: Relationship with Brain Maturation and Neurodevelopment at Age 4.5 Years.

机构信息

Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada.

Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.

出版信息

J Pediatr. 2022 Sep;248:51-58.e2. doi: 10.1016/j.jpeds.2022.05.003. Epub 2022 May 11.

DOI:10.1016/j.jpeds.2022.05.003

PMID:35561806

Abstract

OBJECTIVE

To evaluate the relationship of quantitative ventricular volume with brain maturation and neurodevelopmental outcomes at age 4.5 years in children born very preterm.

STUDY DESIGN

T1-weighted imaging, diffusion tensor imaging, and magnetic resonance spectroscopy were performed shortly after birth (n = 212) and at term-equivalent age (TEA) (n = 194). Intraventricular hemorrhage (IVH) grade and white matter injury (WMI) volume were measured on early T1-weighted magnetic resonance imaging (MRI) scans. Total cerebral volume and ventricular volume were quantified using the Multiple Automatically Generated Templates-Brain pipeline. At age 4.5 years, 178 children (84%) underwent cognitive and motor assessments. Multivariable linear regression was used to examine the relationships between ventricular volume and neurodevelopmental outcomes. Generalized estimating equations were used to account for repeated measures when analyzing neonatal MRI data. All models accounted for sex, postmenstrual age at scan, WMI volume, IVH grade, and total cerebral volume and were corrected for multiple comparisons.

RESULTS

On early MRI, 97 infants had IVH (grade 1, n = 22; grade 2, n = 66; grade 3, n = 9), and 68 had WMI (median, 44 mm; IQR, 21-296 mm). IQ at 4.5 years was associated with MRI ventricular volume at the early (β = -0.64; P < .001) and TEA (β = -0.44, P < .001) time points. Motor outcomes were associated with ventricular volume at TEA (β = -0.84, P = .01). Greater ventricular volume independently predicted lower fractional anisotropy in corpus callosum (genu: β = -0.0008, P = .002; splenium: β = -0.003, P < .001) and optic radiations (β = -0.001, P = .004); ventricular volume did not predict the N-acetylaspartate/choline ratio.

CONCLUSIONS

In children born very preterm, neonatal ventricular size was associated with 4.5-year neurodevelopmental outcomes. Our findings suggest that white matter maturation may be abnormal in the setting of enlarged ventricular size beyond that expected from concurrent brain injuries.

摘要

目的

评估定量脑室容积与胎龄小于 37 周早产儿在 4.5 岁时脑成熟度和神经发育结局的关系。

研究设计

在出生后不久（n=212）和胎龄相当（TEA）时（n=194）进行 T1 加权成像、弥散张量成像和磁共振波谱检查。在早期 T1 加权磁共振成像（MRI）扫描上测量脑室内出血（IVH）分级和脑白质损伤（WMI）体积。使用多自动生成模板-大脑管道量化总脑体积和脑室体积。在 4.5 岁时，178 名儿童（84%）接受了认知和运动评估。多变量线性回归用于检查脑室容积与神经发育结局之间的关系。当分析新生儿 MRI 数据时，使用广义估计方程来考虑重复测量。所有模型均考虑了性别、扫描时的校正后胎龄、WMI 体积、IVH 分级、总脑体积，并进行了多次比较校正。

结果

在早期 MRI 上，97 名婴儿有 IVH（1 级，n=22；2 级，n=66；3 级，n=9），68 名婴儿有 WMI（中位数 44mm；IQR 21-296mm）。4.5 岁时的智商与早期（β=-0.64；P<0.001）和 TEA（β=-0.44，P<0.001）时的 MRI 脑室容积相关。运动结局与 TEA 时的脑室容积相关（β=-0.84，P=0.01）。更大的脑室容积独立预测胼胝体（膝部：β=-0.0008，P=0.002；压部：β=-0.003，P<0.001）和视辐射（β=-0.001，P=0.004）的各向异性分数降低；脑室容积与 N-乙酰天门冬氨酸/胆碱比无关。