Drommelschmidt Karla, Mayrhofer Thomas, Müller Hanna, Foldyna Borek, Raudzus Janika, Göricke Sophia L, Schweiger Bernd, Sirin Selma
Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Sci Rep. 2025 May 25;15(1):18221. doi: 10.1038/s41598-025-02539-1.
Neurological impairment is high after preterm birth. This study evaluates the impact and interplay of cMRI-detected brain injuries (BI) and clinical risk factors on neurodevelopmental outcomes and extracts the most important key factors. A retrospective analysis was conducted on risk factors (perinatal/neonatal, cMRI-detected BI) for adverse motor (MO) and cognitive (CO) outcomes (Bayley Scales of Infant Development, 24 months corrected age) in a tertiary center cohort (2009-2018) of very preterm infants (< 32 weeks of gestation) using uni-/multivariable regression models. We included 342 infants (mean gestational age:28.0 ± 2.3 weeks; male:49%). Significant clinical predictors for MO/CO included GA, birthweight, APGAR score, catecholamine treatment, ventilation, retinopathy of prematurity, transfusion of red blood cells (RBCs), bronchopulmonary dysplasia, surgery, and patent ductus arteriosus interventions (all p < 0.01/p < 0.01), surfactant (MO: p = 0.037), and sepsis (p < 0.001/p = 0.016). (Severe) cMRI-detected BIs (> 1, all p < 0.05) and not only severe intraventricular hemorrhage (IVH) III°/III°+PVHI and ventricular dilatation (VD) (all p < 0.05), but also mild/moderate injuries like IVH II° (p < 0.001/p < 0.024), cerebellar hemorrhage (CO: p = 0.028), and moderate VD (MO: p = 0.005) significantly impacted outcomes. Independent key factors were > 1 severe cMRI-detected BI (MO/CO:-11.27/-10.3 score points (sp), p = 0.021/0.043), APGAR score (10 min, MO/CO:+5.3/+4.45 sp/point, p < 0.001/p < 0.001), surfactant administration (MO:+4.88 sp, p = 0.031), and transfusion of RBCs (MO/CO:-1.69/-1.96 sp/transfusion, p = 0.006/p < 0.001). In conclusion, combining imaging and clinical (key) risk factors is important for risk stratification of preterm infants. Even mild BI, like IVH II°, significantly contributes to adverse outcomes, underlining the importance of cMRI.
早产后脑神经功能损伤发生率很高。本研究评估了磁共振成像（cMRI）检测到的脑损伤（BI）和临床风险因素对神经发育结局的影响及其相互作用，并提取了最重要的关键因素。对一家三级医疗中心队列（2009 - 2018年）中极早产儿（孕周<32周）的运动（MO）和认知（CO）不良结局（贝利婴儿发育量表，矫正年龄24个月）的风险因素（围产期/新生儿期、cMRI检测到的BI）进行回顾性分析，采用单变量/多变量回归模型。我们纳入了342例婴儿（平均胎龄：28.0±2.3周；男性：49%）。MO/CO的显著临床预测因素包括孕龄、出生体重、阿氏评分、儿茶酚胺治疗、通气、早产儿视网膜病变、红细胞（RBC）输血、支气管肺发育不良、手术和动脉导管未闭干预（均p<0.01/p<0.01）、表面活性剂（MO：p = 0.037）和败血症（p<0.001/p = 0.016）。cMRI检测到的（严重）脑损伤（>1，均p<0.05），不仅严重脑室内出血（IVH）III°/III°+脑室周围出血性梗死（PVHI）和脑室扩张（VD）（均p<0.05），而且轻度/中度损伤如IVH II°（p<0.001/p<0.024）、小脑出血（CO：p = 0.028）和中度VD（MO：p = 0.005）对结局有显著影响。独立关键因素为cMRI检测到>1处严重脑损伤（MO/CO：-11.27/-10.3评分点（sp），p = 0.021/0.043）、阿氏评分（10分钟，MO/CO：+5.3/+4.45 sp/分，p<0.001/p<0.001）、表面活性剂给药（MO：+4.88 sp，p = 0.031）和RBC输血（MO/CO：-1.69/-1.96 sp/次输血，p = 0.006/p<0.001）。总之，结合影像学和临床（关键）风险因素对早产儿风险分层很重要。即使是轻度脑损伤，如IVH II°，也会显著导致不良结局，强调了cMRI的重要性。
