Hüppi P S, Schuknecht B, Boesch C, Bossi E, Felblinger J, Fusch C, Herschkowitz N
Department of Pediatrics, University of Berne, Switzerland.
Pediatr Res. 1996 May;39(5):895-901. doi: 10.1203/00006450-199605000-00026.
Postnatal brain development of healthy prematurely born infants was assessed to study possible influence of premature birth and early extrauterine environment on structural, biochemical, and functional brain development. Myelination and differentiation of gray and white matter were studied by in vivo magnetic resonance (MR) imaging (MRI), changes in cerebral metabolism by 1HMR spectroscopy (MRS), and changes in early human neurobehavior by the assessment of preterm infant's behavior (APIB). The stage of intrauterine and extrauterine brain development in prematurely born infants at term was compared with the stage of mainly intrauterine brain development in a group of full-term infants. Eighteen preterm infants unremarkable with respect to neurologic and medical status were studied at approximately 2 wk of postnatal age [gestational age (GA) 1: 32.5 +/- 1.2 wk] and again at term (GA 2: 40.0 +/- 1.1 wk). For comparison a group of 13 full-term born infants (GA T: 40.6 +/- 2.1 wk) were studied by MR and six by APIB. When GA 2 to GA 1 was compared, significant maturational changes were found with MRI in gray and white matter and myelination, with 1H MRS in the concentration of N-acetylaspartate and with all scores of APIB. In preterm infants at term (GA 2) compared with full-term infants (GA T) significantly less gray and white matter differentiation and myelination was observed as well as significantly poorer performance in four neurobehavioral parameters (autonomic reactivity, motoric reactivity, state organization, attentional availability). We conclude that MRI and 1H MRS can be used to study postnatal brain development in preterm infants. Structural and biochemical maturation is accompanied by functional maturation as shown with the neurobehavior assessment. Preterm infants at term compared with full-term infants show a structural as well as a functional delay in brain development assessed at 40 wk of postconceptional age.
对健康早产儿的产后大脑发育进行评估，以研究早产和宫外早期环境对大脑结构、生化及功能发育的可能影响。通过活体磁共振成像（MRI）研究灰质和白质的髓鞘形成及分化，通过氢质子磁共振波谱（MRS）研究脑代谢变化，通过评估早产儿行为（APIB）研究早期人类神经行为变化。将足月时早产儿的宫内和宫外大脑发育阶段与一组足月儿主要的宫内大脑发育阶段进行比较。对18名神经和医学状况无异常的早产儿在出生后约2周（胎龄1：32.5±1.2周）进行研究，并在足月时（胎龄2：40.0±1.1周）再次进行研究。为作比较，对一组13名足月儿（胎龄T：40.6±2.1周）进行了磁共振成像研究，对6名足月儿进行了APIB评估。比较胎龄2至胎龄1时发现，MRI显示灰质、白质及髓鞘形成有显著的成熟变化，MRS显示N-乙酰天门冬氨酸浓度有变化，APIB各项评分也有变化。与足月儿（胎龄T）相比，足月时的早产儿灰质和白质分化及髓鞘形成明显较少，并且在四个神经行为参数（自主反应性、运动反应性、状态组织、注意力可及性）方面表现明显较差。我们得出结论，MRI和MRS可用于研究早产儿的产后大脑发育。如神经行为评估所示，结构和生化成熟伴随着功能成熟。与足月儿相比，足月时的早产儿在孕龄40周时评估的大脑发育存在结构和功能延迟。
