García Arias Hernán Felipe, Porras-Hurtado Gloria Liliana, Estrada-Álvarez Jorge Mario, Cardona-Ramirez Natalia, Restrepo-Restrepo Feliza, Serrano Carolina, Cárdenas-Peña David, Orozco-Gutiérrez Álvaro Ángel
SISTEMIC Research Group, University of Antioquia, Medellín 050010, Colombia.
Caja de Compensación Familiar de Risaralda, Salud Comfamiliar, Pereira 660003, Colombia.
J Clin Med. 2024 Nov 25;13(23):7121. doi: 10.3390/jcm13237121.
Perinatal asphyxia is a major cause of neonatal morbidity and mortality, often resulting in hypoxic-ischemic encephalopathy (HIE) with long-term neurodevelopmental impairments. While therapeutic hypothermia has emerged as a promising intervention to reduce brain damage, its specific impact on key brain structures and long-term neurodevelopmental outcomes remains underexplored. This study aims to evaluate the effects of therapeutic hypothermia on brain volumetry, cortical thickness, and neurodevelopment in term neonates with perinatal asphyxia. This prospective cohort study enrolled 34 term neonates with perinatal asphyxia, with 12 receiving therapeutic hypothermia and 22 serving as controls without hypothermia. Brain MRI data were analyzed using Infant FreeSurfer to quantify the basal ganglia volumes, gray matter, white matter, cerebellum, cortical gyri, and cortical thickness. Neurodevelopmental outcomes were assessed at 18 and 24 months, using the Bayley Scale III, evaluating the motor, cognitive, and language domains. Genetic analyses, including next-generation sequencing (NGS) and microarray testing, were performed to investigate potential neurodevelopmental markers and confounding factors. Neonates treated with hypothermia demonstrated significantly larger gray and white matter volumes, with a 3.7-fold increase in gray matter ( = 0.025) and a 2.2-fold increase in white matter ( = 0.025). Hippocampal volume increased 3.4-fold ( = 0.032) in the hypothermia group. However, no significant volumetric differences were observed in the cerebellum, thalamus, or other subcortical regions. Moderate correlations were found between white matter volume and cognitive outcomes, but these associations were not statistically significant. Therapeutic hypothermia appears to have region-specific neuroprotective effects, particularly in gray and white matter and the hippocampus, which may contribute to improved neurodevelopmental outcomes. However, the impact was not uniform across all brain structures. Further research is needed, to investigate the long-term benefits and to optimize therapeutic strategies by integrating advanced neuroimaging techniques and genetic insights.
围产期窒息是新生儿发病和死亡的主要原因，常导致缺氧缺血性脑病（HIE）及长期神经发育障碍。虽然治疗性低温已成为一种有前景的减少脑损伤的干预措施，但其对关键脑结构和长期神经发育结局的具体影响仍未得到充分研究。本研究旨在评估治疗性低温对足月围产期窒息新生儿脑容量、皮质厚度和神经发育的影响。这项前瞻性队列研究纳入了34例足月围产期窒息新生儿，其中12例接受治疗性低温，22例作为未接受低温治疗的对照组。使用婴儿版FreeSurfer分析脑MRI数据，以量化基底节体积、灰质、白质、小脑、脑回和皮质厚度。在18个月和24个月时，使用贝利婴幼儿发展量表第三版评估神经发育结局，评估运动、认知和语言领域。进行了包括下一代测序（NGS）和微阵列检测在内的基因分析，以研究潜在的神经发育标志物和混杂因素。接受低温治疗的新生儿灰质和白质体积显著增大，灰质增加3.7倍（ = 0.025），白质增加2.2倍（ = 0.025）。低温治疗组海马体积增加3.4倍（ = 0.032）。然而，在小脑、丘脑或其他皮质下区域未观察到显著的体积差异。白质体积与认知结局之间存在中等程度的相关性，但这些关联无统计学意义。治疗性低温似乎具有区域特异性神经保护作用，特别是在灰质、白质和海马体中，这可能有助于改善神经发育结局。然而，这种影响在所有脑结构中并不一致。需要进一步研究，以探讨长期益处，并通过整合先进的神经成像技术和基因见解来优化治疗策略。
