Felderhoff-Müser Ursula, Hüning Britta
Klinik für Kinderheilkunde I, Neonatologie, Päd. Intensivmedizin, Neuropädiatrie, Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45157 Essen, Deutschland.
Monatsschr Kinderheilkd. 2022;170(8):688-703. doi: 10.1007/s00112-022-01542-4. Epub 2022 Jul 1.
In the perinatal period the developing brain is extremely vulnerable for a variety of insults. Perinatal conditions, such as extreme prematurity, perinatal asphyxia, and their complications can lead to lifelong sensorimotor, cognitive and behavioral impairment. Prediction of long-term neurodevelopment of preterm and ill term infants at risk for brain injury at an early stage remains a big challenge. Identification of brain lesions and disturbed function is essential for an accurate diagnosis. Currently, the prediction of the outcome is based on a variety of diagnostic tools and clinical assessment of developmental milestones. Several methods for early diagnosis and neuromonitoring of brain injury are available, such as cerebral ultrasound, magnetic resonance imaging (MRI) at term-equivalent age as well as neuromonitoring tools, such as amplitude-integrated electroencephalography (aEEG) and/or conventional EEG and near-infrared spectroscopy (NIRS), general movements assessment (GMA) and clinical assessment by, e.g., the Hammersmith neonatal/infant neurological examination (HNNE/HINE), all of which require substantial personnel and also technical resources. As better biomarkers are urgently needed scientific investigations currently focus on identification of innovative biomarker patterns (omics) and (epi)genetic markers. Furthermore, the individual child's development is determined not only by clinical risk factors, such as associated diseases but also by the socioeconomic environment. Estimation of the most accurate and early prognosis is cost-intensive, but crucial to adequately guide patients and counsel families. The initiation of early interventions is important as the plasticity of the developing brain is highest around birth and in the first few months of life. This review focuses on the characterization of the abovementioned diagnostic tools and the possibilities for combination for outcome prognosis. In addition, an outlook is given on how new technologies can facilitate the prediction of development and follow-up care of these children following perinatal brain injury.
在围产期，发育中的大脑极易受到各种损伤。围产期状况，如极度早产、围产期窒息及其并发症，可导致终身的感觉运动、认知和行为障碍。对有脑损伤风险的早产和患病足月婴儿的长期神经发育进行早期预测仍然是一项巨大挑战。识别脑损伤和功能紊乱对于准确诊断至关重要。目前，结局预测基于多种诊断工具和发育里程碑的临床评估。有几种脑损伤早期诊断和神经监测方法，如脑超声、足月等效年龄时的磁共振成像（MRI）以及神经监测工具，如振幅整合脑电图（aEEG）和/或传统脑电图以及近红外光谱（NIRS）、全身运动评估（GMA）以及通过例如哈默史密斯新生儿/婴儿神经检查（HNNE/HINE）进行的临床评估，所有这些都需要大量人员和技术资源。由于迫切需要更好的生物标志物，目前的科学研究集中在识别创新的生物标志物模式（组学）和（表观）遗传标记。此外，个体儿童的发育不仅由临床风险因素（如相关疾病）决定，还受社会经济环境影响。最准确和早期预后的评估成本高昂，但对于充分指导患者和为家庭提供咨询至关重要。早期干预的启动很重要，因为发育中的大脑在出生前后及生命的头几个月可塑性最高。本综述重点介绍上述诊断工具的特点以及联合用于结局预后的可能性。此外，还展望了新技术如何促进对这些围产期脑损伤儿童发育的预测和后续护理。
