Cirillo Mario, Puzone Simona, De Rosa Alessandro Pasquale, Ugga Lorenzo, Caredda Elisabetta, Diplomatico Mario, De Vivo Massimiliano, Pirozzi Maria Agnese, D'Amico Alessandra, Del Giudice Emanuele Miraglia, Esposito Fabrizio, Montaldo Paolo
Department of Advanced Medical and Surgical Sciences, Advanced MRI Research Center, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Sci Rep. 2025 Aug 28;15(1):31676. doi: 10.1038/s41598-025-17246-0.
There is a lack of neuroimaging data and effective biomarkers in infants with mild hypoxic ischaemic encephalopathy (HIE). Cerebral reperfusion injury has shown potential as marker of neurodevelopmental outcome in moderate and severe HIE. We examined cerebral perfusion by using arterial spin labelling (ASL) in infants with mild HIE and its associations with adverse outcomes. We also studied the presence of any potential regional sensitivity of cerebral blood flow (CBF) on the effects of HIE severity. This prospective cohort study included term and near-term neonates admitted for HIE across 3 neonatal intensive care units in Italy between October 2019-2022. Magnetic resonance imaging (MRI)-ASL was performed between 4 and 10 days after birth. Neurodevelopmental outcome was assessed at 24-28 months. Of the 94 infants included in the analysis, 74 neonates had mild [79%], 15 moderate [16%], 5 severe encephalopathy [5%]. Of the 71 neonates with mild HIE and neurodevelopmental outcome available, 15 (21%) showed mild disability. Basal ganglia CBF was the only region significantly associated with cognitive, motor and language Bayley scores (false-discovery-rate < 0.05). HIE severity had a regional dependent effect with involvement of Heschl, Rolandic operculum, limbic lobe, subcortical gray nuclei followed by frontal lobes. Basal ganglia CBF in infants with mild HIE was associated with adverse outcomes even without any MRI visible deep brain nuclei injury.
轻度缺氧缺血性脑病（HIE）婴儿缺乏神经影像学数据和有效的生物标志物。脑再灌注损伤已显示出作为中度和重度HIE神经发育结局标志物的潜力。我们使用动脉自旋标记（ASL）检查了轻度HIE婴儿的脑灌注及其与不良结局的关联。我们还研究了脑血流量（CBF）对HIE严重程度影响的任何潜在区域敏感性。这项前瞻性队列研究纳入了2019年10月至2022年期间意大利3个新生儿重症监护病房收治的足月和近足月HIE新生儿。出生后4至10天进行磁共振成像（MRI）-ASL检查。在24至28个月时评估神经发育结局。纳入分析的94例婴儿中，74例新生儿为轻度[79%]，15例为中度[16%]，5例为重度脑病[5%]。在71例有轻度HIE且有神经发育结局数据的新生儿中，15例（21%）有轻度残疾。基底节CBF是与贝利认知、运动和语言评分显著相关的唯一区域（错误发现率<0.05）。HIE严重程度具有区域依赖性效应，累及颞横回、中央 operculum、边缘叶、皮质下灰质核，其次是额叶。轻度HIE婴儿的基底节CBF即使在MRI未发现任何深部脑核损伤的情况下也与不良结局相关。
