系统产后皮质类固醇和极早产儿胼胝体和小脑的磁共振成像测量。
Systemic postnatal corticosteroids and magnetic resonance imaging measurements of corpus callosum and cerebellum of extremely preterm infants.
机构信息
Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia.
出版信息
J Paediatr Child Health. 2023 Feb;59(2):282-287. doi: 10.1111/jpc.16286. Epub 2022 Nov 20.
AIM
To compare the size of the corpus callosum (CC) and cerebellum on magnetic resonance imaging (MRI) brain scans conducted at term equivalent age (TEA) in extremely preterm infants who received systemic postnatal corticosteroids (PCS) to extremely preterm infants who did not receive systemic PCS and determine the dose-dependent effects on these outcomes.
METHODS
Single-centre retrospective cohort study including extremely preterm infants (born < 26 weeks' gestation) who had MRI brain scans at TEA. CC and cerebellar measurements were evaluated by two radiologists who were blinded to steroid use and their independent measurements were averaged. Comparative analyses were conducted between exposed (to systemic PCS) and non-exposed groups.
RESULTS
Eighty-three extremely preterm infants with mean (SD) 24.9 (0.91) weeks' gestational age, 721.8 (156) g birthweight were included; 38 with systemic PCS exposure and 45 without exposure. After adjustment for birthweight and other significant neonatal morbidities, there was no significant difference noted in corpus callosum length (CCL) between unexposed and exposed groups (adjusted mean (SE) 39.5 (0.57) mm vs. 38.5 (0.62) mm; P = 0.29). Similarly, the ratios of CCL/fronto-occipital diameter (FOD) and CCL/biparietal diameter (BPD) were not significantly different between the groups (CCL/FOD (0.40 (0.01) vs. 0.41 (0.01); P = 0.70) and CCL/BPD (0.51 (0.01) vs. 0.52 (0.01); P = 0.62)). Finally, no significant differences in cerebellar measurements, such as vermian height (adjusted mean (SE) 24.0 (0.46) mm vs. 23.5 (0.51 mm); P = 0.47) and transcerebellar diameter (adjusted mean (SE) 49.3 (0.74) mm vs. 4.78 (0.82) mm; P = 0.22) were found. No dose-dependent effects of systemic PCS on CC and cerebellar measurements were identified.
CONCLUSIONS
Systemic PCS use in extremely preterm infants was not associated with a change in the CC and cerebellar measurements on MRI brain scan at TEA.
目的
比较在胎龄相当（TEA）时接受全身产后皮质类固醇（PCS）和未接受全身 PCS 的极早产儿的磁共振成像（MRI）脑扫描中胼胝体（CC）和小脑的大小，并确定这些结果的剂量依赖性影响。
方法
这是一项单中心回顾性队列研究，纳入了在 TEA 时接受 MRI 脑扫描的极早产儿（出生胎龄<26 周）。由两名放射科医生对 CC 和小脑进行评估，他们对使用类固醇的情况并不知情，其独立测量值取平均值。对暴露（全身 PCS）和未暴露组进行了对比分析。
结果
共纳入 83 名极早产儿，平均（标准差）胎龄为 24.9（0.91）周，出生体重为 721.8（156）g；其中 38 名接受全身 PCS 暴露，45 名未暴露。在调整出生体重和其他显著新生儿合并症后，未暴露组和暴露组的胼胝体长度（CCL）无显著差异（调整后的平均（SE）分别为 39.5（0.57）mm 和 38.5（0.62）mm；P=0.29）。同样，两组间 CCL/额枕径（FOD）和 CCL/双顶径（BPD）的比值也无显著差异（CCL/FOD（0.40（0.01）比 0.41（0.01）；P=0.70）和 CCL/BPD（0.51（0.01）比 0.52（0.01）；P=0.62））。最后，在小脑测量方面，如蚓部高度（调整后的平均（SE）分别为 24.0（0.46）mm 和 23.5（0.51）mm；P=0.47）和小脑横径（调整后的平均（SE）分别为 49.3（0.74）mm 和 4.78（0.82）mm；P=0.22）也未发现有统计学差异。未发现全身 PCS 对 CC 和小脑测量值有剂量依赖性影响。
结论
在极早产儿中使用全身 PCS 与 TEA 时 MRI 脑扫描中 CC 和小脑的测量值变化无关。
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