目的 了解高危晚期早产儿（LPI）脑病的危险因素、临床特点及磁共振（MRI）影像学变化。方法 对2009年1月至2014年12月住院且存在脑损伤高危因素的LPI，进行头颅MRI检查，分析LPI脑病危险因素、临床特点及头颅MRI特征。结果 完成MRI检查的LPI共1 007例，影像学符合早产儿脑病患儿313例（31.1%）。LPI脑病中白质损伤占76.7%。LPI脑病的发生与胎龄无相关性，但随着出生体重增加，脑病检出率逐渐增高（P < 0.05）。Logistic回归分析结果显示：复苏史是早产儿脑病发生的独立危险因素（P < 0.01）。结论 早产儿脑病在高危LPI中亦较常见，特别是脑白质损伤。复苏病史是LPI脑病的独立危险因素，需引起重视。
Abstract
Objective To investigate the risk factors, clinical features, and magnetic resonance imaging (MRI) changes of encephalopathy in high-risk late preterm infants. Methods Head MRI scan was performed for late preterm infants with high-risk factors for brain injury who were hospitalized between January 2009 and December 2014. The risk factors, clinical features, and head MRI features of encephalopathy in late preterm infants were analyzed. Results A total of 1 007 late preterm infants underwent MRI scan, among whom 313 (31.1%) had imaging features in accordance with the features of encephalopathy of prematurity. Of all infants, 76.7% had white matter damage. There was no association between the development of encephalopathy and gestational age in late preterm infants, but the detection rate of encephalopathy gradually increased with the increasing birth weight (P < 0.05). The logistic regression analysis showed that a history of resuscitation was an independent risk factor for encephalopathy of prematurity (P < 0.01). Conclusions Encephalopathy of prematurity is commonly seen in high-risk late preterm infants, especially white matter damage. A history of resuscitation is an independent risk factor for encephalopathy in late preterm infants.
关键词
早产儿脑病 /
磁共振成像 /
危险因素 /
晚期早产儿
Key words
Encephalopathy of prematurity /
Magnetic resonance imaging /
Risk factor /
Late preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Martin JA, Hamilton BE, Osterman MJ, et al. Births:Final Data for 2015[J]. Natl Vital Stat Rep, 2017, 66(1):1.
[2] Harijan P, Boyle EM. Health outcomes in infancy and childhood of moderate and late preterm infants[J]. Semin Fetal Neonatal Med, 2012, 17(3):159-162.
[3] Mercuri E, Ricci D, Romeo DM. Neurological and visual assessments in very and late low-risk preterm infants[J]. Early Hum Dev, 2012, 88(Suppl 1):S31-S33.
[4] Teune MJ, Bakhuizen S, Gyamfi Bannerman C, et al. A systematic review of severe morbidity in infants born late preterm[J]. Am J Obstet Gynecol, 2011, 205(4):374.
[5] McGowan JE, Alderdice FA, Holmes VA, et al. Early childhood development of late-preterm infants:a systematic review[J]. Pediatrics, 2011, 127(6):1111-1124.
[6] 殷张华, 钱继红, 王蓓等. 晚期早产儿近期并发症及智能发育前瞻性研究[J]. 中国新生儿科杂志, 2015, 30(2):112-116.
[7] Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, et al. Risk factors for neonatal morbidity and mortality among "healthy," late preterm newborns[J]. Semin Perinatol, 2006, 30(2):54-60.
[8] Talge NM, Holzman C, Wang J, et al. Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age[J]. Pediatrics, 2010, 126(6):1124-1131.
[9] Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth[J]. N Engl J Med, 2008, 359(3):262-273.
[10] 《新生儿神经病学论坛》专家组. 早产儿脑白质损伤诊断、防治与综合管理的专家组意见[J]. 中国新生儿科杂志, 2015, 30(3):175-177.
[11] Woodward LJ, Anderson PJ, Austin NC, et al. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants[J]. N Engl J Med, 2006, 355(7):685-694.
[12] Shapiro-Mendoza CK, Lackritz EM. Epidemiology of late and moderate preterm birth[J]. Semin Fetal Neonatal Med, 2012. 17(3):120-125.
[13] Martin JA, Hamilton BE, Sutton PD, et al. Births:final data for 2008[J]. Natl Vital Stat Rep, 2010. 59(1):1, 3-71.
[14] 张莹, 赫英东, 陈倩. 晚期早产的危险因素及围产期并发症分析[J]. 中华围产医学杂志, 2014, (6):379-383.
[15] Petrini JR, Dias T, McCormick MC, et al. Increased risk of adverse neurological development for late preterm infants[J]. J Pediatr, 2009, 154(2):169-176.
[16] 陈丹, 毛健, 李娟等. 晚期早产儿脑白质损伤临床特点及磁共振影像学发现[J]. 中国当代儿科杂志, 2010, 12(5):321-326.
[17] Woodward LJ, Clark CA, Bora S, et al. Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very preterm children[J]. PLoS One, 2012, 7(12):e51879.
[18] Inder TE, Wells SJ, Mogridge NB, et al. Defining the nature of the cerebral abnormalities in the premature infant:a qualitative magnetic resonance imaging study[J]. J Pediatr, 2003, 143(2):171-179.
[19] Roelants-van RAM, Groenendaal F, Beek FJ, et al. Parenchymal brain injury in the preterm infant:comparison of cranial ultrasound, MRI and neurodevelopmental outcome[J]. Neuropediatrics, 2001, 32(2):80-89.
[20] Sie LT, Hart AA, van Hof J, et al. Predictive value of neonatal MRI with respect to late MRI findings and clinical outcome. A study in infants with periventricular densities on neonatal ultrasound[J]. Neuropediatrics, 2005, 36(2):78-89.
[21] 鲁利群, 母得志. 晚期早产儿的神经发育[J]. 中华实用儿科临床杂志, 2014, 29(2):144-146.
[22] Romeo DM, Luciano R, Corsello M, et al. Neonatal neurological examination of late preterm babies[J]. Early Hum Dev, 2013, 89(8):537-545.
PDF(1584 KB)
