小脑损伤对伴有脑瘫的早产儿神经发育结局的影响。

Impact of Cerebellar Injury on Neurodevelopmental Outcomes in Preterm Infants With Cerebral Palsy.

机构信息

From the Division of Neonatology, Department of Pediatrics, Konkuk University Medical Center, Seoul, South Korea (YJK); Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea (YJK, E-KK, SHS, H-SK); Division of Neonatology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea (EK-K, SHS, H-SK); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J-EC); Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea (HS); and Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea (MSB, H-IS).

出版信息

Am J Phys Med Rehabil. 2023 Apr 1;102(4):340-346. doi: 10.1097/PHM.0000000000002099. Epub 2022 Aug 28.

DOI:10.1097/PHM.0000000000002099

PMID:36075880

Abstract

OBJECTIVE

We aimed to analyze brain imaging findings and neurodevelopmental outcomes of preterm infants diagnosed with cerebral palsy.

DESIGN

Brain magnetic resonance imaging of preterm infants born between 23 and 32 wks' gestation and diagnosed with cerebral palsy at 2 yrs of corrected age were evaluated. Brain lesions were categorized as periventricular leukomalacia, intraventricular hemorrhage, and cerebellar hemorrhage and graded by the severity. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition, at 18-24 mos corrected age, and the Korean Ages and Stages Questionnaire at 18 and 24 mos of corrected age.

RESULTS

Cerebral palsy was found in 38 children (6.1%) among 618 survivors. Cerebellar injury of high-grade cerebellar hemorrhage and/or atrophy accounted for 25%. Among patients with supratentorial lesions, those having cerebellar injury showed significantly lower scores on each Korean Ages and Stages Questionnaire domain except gross motor than patients without cerebellar injury. They also revealed a high proportion of patients below the cutoff value of Korean Ages and Stages Questionnaire in language, fine motor, and problem-solving domains ( P < 0.05) and lower Bayley Scales of Infant and Toddler Development, Third Edition, language composite scores ( P = 0.038).

CONCLUSIONS

Poor neurodevelopmental outcomes other than motor function were associated with cerebellar injury. Evaluation of the cerebellum may help predict functional outcomes of patients with cerebral palsy.

摘要

目的

分析诊断为脑瘫的早产儿的脑影像学表现和神经发育结局。

设计

评估胎龄 23 至 32 周之间出生且在 2 岁校正年龄时被诊断为脑瘫的早产儿的脑磁共振成像。根据病变的严重程度，将脑损伤分为脑室周围白质软化、脑室内出血和小脑出血。在 18-24 个月校正月龄时使用贝利婴幼儿发育量表第三版（Bayley Scales of Infant and Toddler Development, Third Edition）和 18 个月和 24 个月校正月龄的韩国年龄与阶段问卷（Korean Ages and Stages Questionnaire）评估神经发育结局。

结果

在 618 例幸存者中，有 38 例（6.1%）被诊断为脑瘫。高级别小脑出血和/或小脑萎缩的小脑损伤占 25%。在幕上病变患者中，与无小脑损伤的患者相比，有小脑损伤的患者在每个韩国年龄与阶段问卷领域的得分均明显较低，除了粗大运动领域外。他们还显示出语言、精细运动和解决问题领域的韩国年龄与阶段问卷低于临界值的患者比例较高（P<0.05），且贝利婴幼儿发育量表第三版语言综合评分较低（P=0.038）。