Laneri G G, Claassen D L, Scher M S
Department of Neonatology, Magee-Womens Hospital, Pittsburgh, PA 15213-3180.
Pediatr Neurol. 1994 Jul;11(1):18-22. doi: 10.1016/0887-8994(94)90084-1.
Nonimmune hydrops fetalis (NIHF) comprised 79% (45/57) of all infants with hydrops fetalis at our institution over a 6-year period. Thirty-seven infants with NIHF were liveborn. One or more electroencephalograms were performed on 40% of liveborn infants (15/37); the majority (87%) were moderately to markedly abnormal, including burst suppression, lack of background, multifocal sharp waves, excessive discontinuity, and disorganization reflecting significant neonatal encephalopathies. Postmortem neuropathologic examinations were performed in 86% of infants with NIHF who died or were stillborn, 81% of whom demonstrated intrauterine brain insults including microcalcifications, cerebral and/or cerebellar hypoplasia, microcephaly, encephalomalacia, cavitary lesions, astrocytosis, polymicrogyria, and severe neuronal loss. Cranial ultrasonography failed to document the diverse pathologic lesions that were later noted on postmortem examination. Ten infants survived the neonatal period, but 6 were neurologically abnormal at the time of discharge. Infants with NIHF are at risk for antepartum brain injury, and electroencephalographic abnormalities reflect in part a fetal brain disorder. A prospective clinical study is needed to fully assess the prevalence, incidence, spectrum of central nervous system involvement, contribution of intrapartum and neonatal stress, and long-term outcome in surviving infants with NIHF.
在我们机构为期6年的时间里，非免疫性胎儿水肿（NIHF）占所有胎儿水肿婴儿的79%（45/57）。37例患有NIHF的婴儿为活产。40%的活产婴儿（15/37）进行了一次或多次脑电图检查；大多数（87%）为中度至明显异常，包括爆发抑制、背景缺失、多灶性尖波、过度不连续和紊乱，反映出严重的新生儿脑病。86%的NIHF死亡或死产婴儿进行了死后神经病理学检查，其中81%显示有宫内脑损伤，包括微钙化、大脑和/或小脑发育不全、小头畸形、脑软化、空洞性病变、星形细胞增多、多小脑回和严重的神经元丢失。头颅超声检查未能记录到后来在死后检查中发现的各种病理病变。10例婴儿存活至新生儿期，但6例在出院时存在神经功能异常。患有NIHF的婴儿有产前脑损伤的风险，脑电图异常部分反映了胎儿脑部疾病。需要进行一项前瞻性临床研究，以全面评估NIHF存活婴儿的患病率、发病率、中枢神经系统受累范围、产时和新生儿应激的影响以及长期预后。
