de Vries L S, Rademaker K J, Groenendaal F, Eken P, van Haastert I C, Vandertop W P, Gooskens R, Meiners L C
Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Neuropediatrics. 1998 Aug;29(4):180-8. doi: 10.1055/s-2007-973558.
During a 7-year-period, 1625 infants of 34 weeks gestation or less were enrolled in a prospective ultrasound (US) study. One hundred and eleven (6.8%) infants developed a large intraventricular haemorrhage (IVH) with or without unilateral parenchymal involvement (PI). Fifty-six of these 111 infants survived (50.4%) and in 23 (41%) of them a magnetic resonance imaging (MRI) study was performed beyond 12 months corrected age. There appeared to be a good agreement between neonatal ultrasound findings and MRI changes noted in infancy. Of the 10 cases with a large IVH without PI (group A), seven had a VP shunt with complete decompression of previously enlarged ventricles. Six of these seven infants had periventricular hyperintensity (PVHI) but none developed cerebral palsy (CP). Two of the ten cases without a VP shunt had irregular ventricular enlargement (VE) with PVHI in one. Both developed CP. Seven cases showed thinning of the corpus callosum. Of the 13 cases with a large IVH associated with PI (group B), the site of the PI could still be recognised on MRI and the degree of communication of the porencephalic cyst (PC) with the lateral ventricles correlated well with neonatal US findings. On MRI, VE was present in only 6 cases. Wallerian degeneration was present in 9/13 infants and all but one developed a hemiplegia. In 12/13 cases there was thinning of the corpus callosum, either focal or diffuse. PVHI was present in all infants. In 6/13 PVHI was only present around the PC. Neurodevelopmental outcome differed for both groups. CP was only present in 2/10 infants in group A, compared to 11/ 13 in group B. Global delay, in the absence of CP, was more common in infants with a large IVH than in those with associated PI.
Combining neonatal US with MRI in infancy enhances our understanding of the long-term effects of severe haemorrhagic brain lesions, occurring in preterm infants.
在7年期间，1625名孕周34周及以下的婴儿被纳入一项前瞻性超声（US）研究。111名（6.8%）婴儿发生了伴有或不伴有单侧脑实质受累（PI）的大量脑室内出血（IVH）。这111名婴儿中有56名存活（50.4%），其中23名（41%）在矫正年龄超过12个月时接受了磁共振成像（MRI）检查。新生儿超声检查结果与婴儿期MRI变化之间似乎有很好的一致性。在10例无PI的大量IVH病例（A组）中，7例进行了脑室腹腔分流术，先前扩大的脑室完全减压。这7例婴儿中有6例有脑室周围高信号（PVHI），但均未发生脑瘫（CP）。10例未进行脑室腹腔分流术的病例中有2例出现不规则脑室扩大（VE），其中1例有PVHI。两者均发生了CP。7例显示胼胝体变薄。在13例伴有PI的大量IVH病例（B组）中，PI的部位在MRI上仍可识别，脑穿通性囊肿（PC）与侧脑室的连通程度与新生儿超声检查结果相关性良好。在MRI上，仅6例出现VE。9/13的婴儿出现了华勒氏变性，除1例之外均发生了偏瘫。12/13的病例中存在胼胝体变薄，可为局灶性或弥漫性。所有婴儿均有PVHI。6/13的病例中PVHI仅出现在PC周围。两组的神经发育结局不同。A组10例婴儿中仅2例发生CP，而B组为11/13。在无CP的情况下，大量IVH婴儿比伴有PI的婴儿更常见整体发育迟缓。
将新生儿期超声与婴儿期MRI相结合，可增强我们对早产儿严重出血性脑损伤长期影响的理解。
