Otero Hansel J, Miranda-Schaeubinger Monica, Schenkel Sara Rae, Ramirez-Suarez Karen I, Cerron-Vela Carmen R, Wannasarnmetha Mix, Kgole Samuel W, Masasa Gosego, Ngwaca Martha, Phale Boitshepo, Ralegoreng Thuto, Makhema Joseph M, Mokane Thuso, Lowenthal Elizabeth D, Powis Kathleen M
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, USA.
Children (Basel). 2024 Aug 25;11(9):1039. doi: 10.3390/children11091039.
Children who are exposed to HIV in utero but are uninfected (HIV-exposed uninfected or HEU) are at higher risk of neurodevelopmental delays compared to children born to persons without HIV. Magnetic resonance imaging (MRI) studies have revealed differences in grey matter volumes, cerebral perfusion, and white matter changes in these children. However, MRI is costly and not widely available in areas with high HIV prevalence, like Botswana, where more than 15% of children are HEU. To address this, we explored the use of brain ultrasound, conducted by trained study nurses, as a safe, less costly, and accurate alternative method for assessing differences relating to HIV exposure status in the brain structures of neonates.
Brain ultrasounds of newborns in the Following Longitudinal Outcomes to Understand, Report, Intervene and Sustain Health for Infants, Children, Adolescents who are HIV Exposed Uninfected (FLOURISH) observational study-comprising 35 HEU newborns and 24 HIV-unexposed (HU) newborns-were performed by study nurses and evaluated by a pediatric radiologist for quality and structural abnormalities, such as calcifications, cysts, and hemorrhages. Two radiologists measured extra-axial cerebrospinal fluid spaces, ventricles, and the corpus callosum.
Ultrasound studies of 59 newborns (59% boys; median gestational age 38.4 weeks) were completed. All studies were of diagnostic quality, with 90.2% rated as being of good or excellent quality. Structural abnormalities were rare (10.2% incidence) and did not differ by HIV exposure group. Corpus callosum length was shorter in HEU infants compared to HU infants (45.7 mm vs. 47.3 mm; = 0.03). Other ventricular and corpus callosum measurements showed no significant variations.
Brain ultrasounds conducted by study nurses are feasible and reveal differences in corpus callosum length between HEU and HU infants. The benefits of easier training, lower cost, and rapid deployment make ultrasound a promising screening tool in resource-limited settings.
与未感染艾滋病毒者所生的儿童相比，子宫内接触艾滋病毒但未感染（艾滋病毒暴露未感染或HEU）的儿童神经发育迟缓风险更高。磁共振成像（MRI）研究显示，这些儿童的灰质体积、脑灌注和白质变化存在差异。然而，MRI成本高昂，在艾滋病毒高流行地区（如博茨瓦纳，超过15%的儿童为HEU）并不广泛可用。为解决这一问题，我们探索了由经过培训的研究护士进行脑超声检查，作为一种安全、成本较低且准确的替代方法，用于评估与艾滋病毒暴露状况相关的新生儿脑结构差异。
在“为艾滋病毒暴露未感染的婴儿、儿童、青少年理解、报告、干预和维持健康的纵向结果随访”（FLOURISH）观察性研究中，由研究护士对35名HEU新生儿和24名未暴露于艾滋病毒（HU）的新生儿进行脑超声检查，并由一名儿科放射科医生评估其质量和结构异常情况，如钙化、囊肿和出血。两名放射科医生测量了轴外脑脊液间隙、脑室和胼胝体。
完成了对59名新生儿（59%为男孩；中位胎龄38.4周）的超声检查。所有检查均具有诊断质量，90.2%被评为良好或优秀质量。结构异常很少见（发生率为10.2%），且在艾滋病毒暴露组之间无差异。与HU婴儿相比，HEU婴儿的胼胝体长度较短（45.7毫米对47.3毫米；P = 0.03）。其他脑室和胼胝体测量结果无显著差异。
由研究护士进行的脑超声检查是可行的，并且揭示了HEU和HU婴儿在胼胝体长度上的差异。培训更容易、成本更低和部署迅速的优势使超声成为资源有限环境中有前景的筛查工具。
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