Parmentier Corline E J, Lequin Maarten H, Alderliesten Thomas, Swanenburg de Veye Henriëtte F N, van der Aa Niek E, Dudink Jeroen, Benders Manon J N L, Harteman Johanna C, Koopman-Esseboom Corine, Groenendaal Floris, de Vries Linda S
Department of Neonatology, Wilhelmina Children's Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
Department of Radiology, Wilhelmina Children's Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
J Pediatr. 2023 Jul;258:113402. doi: 10.1016/j.jpeds.2023.113402. Epub 2023 Apr 3.
To assess the evolution of neonatal brain injury noted on magnetic resonance imaging (MRI), develop a score to assess brain injury on 3-month MRI, and determine the association of 3-month MRI with neurodevelopmental outcome in neonatal encephalopathy (NE) following perinatal asphyxia.
This was a retrospective, single-center study including 63 infants with perinatal asphyxia and NE (n = 28 cooled) with cranial MRI <2 weeks and 2-4 months after birth. Both scans were assessed using biometrics, a validated injury score for neonatal MRI, and a new score for 3-month MRI, with a white matter (WM), deep gray matter (DGM), and cerebellum subscore. The evolution of brain lesions was assessed, and both scans were related to 18- to 24-month composite outcome. Adverse outcome included cerebral palsy, neurodevelopmental delay, hearing/visual impairment, and epilepsy.
Neonatal DGM injury generally evolved into DGM atrophy and focal signal abnormalities, and WM/watershed injury evolved into WM and/or cortical atrophy. Although the neonatal total and DGM scores were associated with composite adverse outcomes, the 3-month DGM score (OR 1.5, 95% CI 1.2-2.0) and WM score (OR 1.1, 95% CI 1.0-1.3) also were associated with composite adverse outcomes (occurring in n = 23). The 3-month multivariable model (including the DGM and WM subscores) had higher positive (0.88 vs 0.83) but lower negative predictive value (0.83 vs 0.84) than neonatal MRI. Inter-rater agreement for the total, WM, and DGM 3-month score was 0.93, 0.86, and 0.59.
In particular, DGM abnormalities on 3-month MRI, preceded by DGM abnormalities on the neonatal MRI, were associated with 18- to 24-month outcome, indicating the utility of 3-month MRI for treatment evaluation in neuroprotective trials. However, the clinical usefulness of 3-month MRI seems limited compared with neonatal MRI.
评估磁共振成像（MRI）显示的新生儿脑损伤的演变情况，制定一个用于评估3个月龄时MRI脑损伤的评分系统，并确定围产期窒息后新生儿脑病（NE）中3个月龄MRI与神经发育结局的关联。
这是一项回顾性单中心研究，纳入了63例围产期窒息和NE患儿（其中28例接受了亚低温治疗），分别在出生后2周内及2至4个月时进行头颅MRI检查。两次扫描均采用生物测量法、一种经过验证的新生儿MRI损伤评分系统以及一种新的3个月龄MRI评分系统进行评估，后者包括白质（WM）、深部灰质（DGM）和小脑亚评分。评估脑损伤的演变情况，并将两次扫描结果与18至24个月时的综合结局相关联。不良结局包括脑瘫、神经发育迟缓、听力/视力障碍和癫痫。
新生儿期的DGM损伤通常演变为DGM萎缩和局灶性信号异常，而WM/分水岭区损伤则演变为WM和/或皮质萎缩。尽管新生儿期的总分和DGM评分与综合不良结局相关，但3个月龄时的DGM评分（比值比1.5，95%可信区间1.2 - 2.0）和WM评分（比值比1.1，95%可信区间1.0 - 1.3）也与综合不良结局相关（共23例出现不良结局）。3个月龄时的多变量模型（包括DGM和WM亚评分）比新生儿期MRI具有更高的阳性预测值（0.88对0.83），但阴性预测值较低（0.83对0.84）。3个月龄时总分、WM和DGM评分的评分者间一致性分别为0.93、0.86和0.59。
特别是，新生儿期MRI显示DGM异常在先，3个月龄时MRI的DGM异常与18至24个月时的结局相关，这表明3个月龄时MRI在神经保护试验治疗评估中的实用性。然而，与新生儿期MRI相比，3个月龄时MRI的临床实用性似乎有限。
