Malova Mariya, Parodi Alessandro, Severino Mariasavina, Tortora Domenico, Calevo Maria Grazia, Traggiai Cristina, Massirio Paolo, Minghetti Diego, Uccella Sara, Preiti Deborah, Nobili Lino, Rossi Andrea, Ramenghi Luca Antonio
Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Curr Pediatr Rev. 2024;20(1):94-105. doi: 10.2174/1573396319666230208092416.
During the last decades, severe brain lesions affecting very low birth weight (<1500 gr, VLBW) infants were gradually substituted by milder lesions with debatable prognoses.
The objective of this study is to define type, frequency and 3 years of neurodevelopmental outcome of prematurity-related brain lesions in a modern cohort of VLBW infants.
VLBW infants admitted to our NICU in 5 years period with brain MRI at term-equivalent age were included. MRI scans were reviewed to identify and grade white matter lesions (WML), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH). Linear measurements of brain size, biparietal width (BPW) and trans-cerebellar diameter (TCD) were carried out. Total maturation score (TMS) was calculated. Developmental Coefficients (DQ) on Griffiths Scale at 3 years of age were compared between patients with different types and grades of lesions and patients without lesions; possible correlations between linear brain measurements, brain maturation and outcome were explored.
Study included 407 patients. Of them, 187 (46%) had at least one brain lesion on MRI, while 37 (9%) had severe lesions. The most frequent lesion was IVH (28%), followed by WML (21%) and CBH (17%). Mild and severe IVH, moderate and severe WML and all grades of CBH were related to worst outcome at 3 years. In patients without lesions, small BPW and small TCD were associated with worse outcomes. No correlations were observed between TMS and outcome.
We have observed that even mild brain lesions have a negative influence on neurological outcome at 3 years of age.
在过去几十年中，影响极低出生体重（<1500克，VLBW）婴儿的严重脑损伤逐渐被预后存在争议的较轻损伤所取代。
本研究的目的是确定现代VLBW婴儿队列中早产相关脑损伤的类型、频率及3年神经发育结局。
纳入5年内入住我们新生儿重症监护病房（NICU）且在足月等效年龄时进行脑部MRI检查的VLBW婴儿。对MRI扫描结果进行评估，以识别并分级白质损伤（WML）、脑室内出血（IVH）和小脑出血（CBH）。进行脑尺寸的线性测量，包括双顶径（BPW）和小脑横径（TCD）。计算总成熟评分（TMS）。比较不同类型和分级损伤的患者与无损伤患者在3岁时的格里菲斯量表发育系数（DQ）；探讨脑线性测量、脑成熟度与结局之间可能的相关性。
研究纳入407例患者。其中，187例（46%）在MRI上至少有一处脑损伤，37例（9%）有严重损伤。最常见的损伤是IVH（28%），其次是WML（21%）和CBH（17%）。轻度和重度IVH、中度和重度WML以及所有分级的CBH与3年时的最差结局相关。在无损伤的患者中，较小的BPW和较小的TCD与较差的结局相关。未观察到TMS与结局之间的相关性。
我们观察到，即使是轻度脑损伤在3岁时也会对神经学结局产生负面影响。
