Coniglio S J, Anderson S M, Ferguson J E
Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville, USA.
Am J Obstet Gynecol. 1997 Aug;177(2):319-24; discussion 324-6. doi: 10.1016/s0002-9378(97)70193-5.
The purpose of the current investigation was to determine cognitive developmental outcomes for a cohort of children with prenatally detected myelomeningocele and to determine whether the variables of (1) severity of ventriculomegaly and (2) anatomic level of lesion were predictive of cognitive development.
Prenatal ultrasonographic examinations were reviewed by a single perinatologist to determine the degree of ventriculomegaly and the anatomic level of the lesion. Ventriculomegaly was defined as a lateral ventricular atrial width > 10 mm. Anatomic level of lesion was defined as (1) thoracic, (2) high lumbar, (3) midlumbar, (4) low lumbar-high sacral, or (5) sacral. Cognitive developmental quotients for surviving children were determined by one of two developmental pediatricians with use of a modified version of the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale, a measure of visual-motor and language abilities.
The mean cognitive developmental quotient for subjects with absent to mild ventriculomegaly was 90.3 (range 54 to 120, SD 17.4), whereas the mean cognitive developmental quotient for those with moderate to severe ventriculomegaly was 74.0 (range 65 to 100, SD 17.1) (p < 0.01). There was a negative correlation between the degree of ventriculomegaly and the cognitive developmental quotient (r = -0.43, p < 0.025) and a positive correlation between the level of the lesion and the cognitive developmental quotient (r = 0.50, p < 0.01).
The degree of ventriculomegaly determined on high-resolution prenatal ultrasonography is predictive of early cognitive development in children with myelomeningocele, with worsening ventriculomegaly being associated with lower cognitive developmental quotients. The anatomic level of the lesion also has predictive value, with lower level lesions being associated with more favorable cognitive outcomes. However, because of the high degree of variance in developmental quotients within the two ventriculomegaly groups, we advise clinicians to use caution in the interpretation and use of our data.
本研究旨在确定一组产前诊断为脊髓脊膜膨出患儿的认知发育结局，并确定（1）脑室扩大的严重程度和（2）病变的解剖学水平这两个变量是否可预测认知发育。
由一位围产医学专家回顾产前超声检查结果，以确定脑室扩大程度和病变的解剖学水平。脑室扩大定义为侧脑室房部宽度>10mm。病变的解剖学水平定义为：（1）胸段，（2）高位腰段，（3）中位腰段，（4）低位腰段-高位骶段，或（5）骶段。两名发育儿科医生之一使用改良版的临床适应性测试/临床语言听觉里程碑量表（一种视觉运动和语言能力的测量方法）确定存活儿童的认知发育商。
脑室扩大程度为无至轻度的患儿，其平均认知发育商为90.3（范围54至120，标准差17.4），而脑室扩大程度为中度至重度的患儿，其平均认知发育商为74.0（范围65至100，标准差17.1）（p<0.01）。脑室扩大程度与认知发育商呈负相关（r=-0.43，p<0.025），病变水平与认知发育商呈正相关（r=0.50，p<0.01）。
高分辨率产前超声检查所确定的脑室扩大程度可预测脊髓脊膜膨出患儿的早期认知发育，脑室扩大加重与较低的认知发育商相关。病变的解剖学水平也具有预测价值，较低水平的病变与更有利的认知结局相关。然而，由于两个脑室扩大组内发育商的差异程度较高，我们建议临床医生在解释和使用我们的数据时要谨慎。
