Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, 450018, China.
J Neurodev Disord. 2023 Aug 7;15(1):24. doi: 10.1186/s11689-023-09489-7.
Leukomalacia is a serious form of neonatal brain injury that often leads to neurodevelopmental impairment, and studies on neonatal leukomalacia and its long-term outcomes are lacking. The aim of this study was to analyze the clinical manifestations, imaging features, and long-term neurodevelopmental outcomes in preterm infants and term infants with leukomalacia.
Newborns diagnosed with leukomalacia by head magnetic resonance imaging (MRI) and who were admitted to intensive care units from January 2015 to June 2020 were enrolled. All infants were followed up to June 2022 (2-7 years old), and their neurodevelopmental outcomes were evaluated. The clinical data and long- term outcomes of preterm infants and term infants was analyzed by Chi-square tests.
A total of 218 surviving infants with leukomalacia including 114 preterm infants and 104 term infants completed the follow-up. The major typesof leukomalacia on MRI were periventricular leukomalacia in the preterm group and subcortical cystic leukomalacia in the term group, respectively (χ = 55.166; p < 0.001). When followed up to 2-7 years old, the incidence of neurodevelopmental impairment in the preterm group and term group was not significantly different (χ = 0.917; p = 0.338). However, the incidence of cerebral palsy (CP) in the preterm group was significantly higher (χ = 4.896; p = 0.027), while the incidence of intellectual disability (ID) (χ = 9.445; p = 0.002), epilepsy (EP) (χ = 23.049; p < 0.001), and CP combined with ID andEP (χ = 4.122; p = 0.042) was significantly lower than that in the term group.
Periventricular leukomalacia mainly occurred in preterm infants while subcortical cystic leukomalacia was commonly seen in term infants. Although the long-term neurodevelopmental outcomes of leukomalacia were both poor, preterm infants were more prone to CP, while term infants were more prone to ID, EP, and the combination of CP with ID and EP.
脑软化症是一种严重的新生儿脑损伤，常导致神经发育障碍，目前缺乏对新生儿脑软化症及其长期结局的研究。本研究旨在分析早产儿和足月儿脑软化症的临床表现、影像学特征和长期神经发育结局。
本研究纳入了 2015 年 1 月至 2020 年 6 月期间因头部磁共振成像（MRI）诊断为脑软化症并入住重症监护病房的新生儿。所有婴儿均随访至 2022 年 6 月（2-7 岁），评估其神经发育结局。采用卡方检验分析早产儿和足月儿的临床资料和长期结局。
共纳入 218 例存活的脑软化症患儿，其中早产儿 114 例，足月儿 104 例，完成随访。早产儿组 MRI 主要为脑室周围脑软化症，足月儿组主要为皮质下囊性脑软化症（χ²=55.166，p<0.001）。随访至 2-7 岁时，早产儿组和足月儿组神经发育障碍发生率差异无统计学意义（χ²=0.917，p=0.338）。但早产儿组脑瘫（CP）发生率明显较高（χ²=4.896，p=0.027），而智力障碍（ID）（χ²=9.445，p=0.002）、癫痫（EP）（χ²=23.049，p<0.001）、CP 合并 ID 和 EP（χ²=4.122，p=0.042）发生率明显较低。
脑室周围脑软化症主要发生在早产儿，而皮质下囊性脑软化症常见于足月儿。虽然脑软化症的长期神经发育结局均较差，但早产儿更易发生 CP，而足月儿更易发生 ID、EP 和 CP 合并 ID 和 EP。
