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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 8  |  Page : 920-926

Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury


1 Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515; Department of Ultrasound, Hunan Children's Hospital, University of South China, Changsha, Hunan 410007, China
2 Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
3 Department of Ultrasound, Hunan Children's Hospital, University of South China, Changsha, Hunan 410007, China
4 Department of Neonatology, Hunan Children's Hospital, University of South China, Changsha, Hunan 410007, China

Correspondence Address:
Dr. Shi-Jun Qiu
Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.229895

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Background: Compared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants. Methods: Totally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children's Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed. Results: The consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively). Conclusions: Very premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.

 

 Abstract in Chinese

颅脑超声对极早产儿脑损伤脑神经发育预测价值的研究

摘要

背景:与足月儿相比,早产儿发生长期残疾或早死亡的危险性要高许多。超声及影像学对脑神经发育的预测价值是研究的热点之一,本研究拟总结极早产儿脑损伤的特点,分析不同早、晚期脑损伤与脑神经发育之间的相关性。
方法:129例孕龄 ≤28 w的,住院期间每周查超声一次,后每月查超声一次至出院,于等足月时对所有患儿进行核磁共振扫查,随访智力发育指数(mental developmental index -MDI)及精神运动发育指数(psychomotor developmental index -PDI)评分结果至2岁或更大,分析脑损伤与MDI、PDI的相关性。
结果:等足月超声与等足月核磁共振结果一致率为88%。首次超声:3、4级GMH、住院时间及体重与MDI、PDI及预后显著相关性(P<0.05)。末次超声:出生孕周、中-重度脑积水及广泛的脑白质软化对MDI有显著影响(P<0.05)。广泛脑白质软化及中-重度脑积水对对PDI有显著影响(P<0.05)。
结论:3、4级GMH、短住院时间及极低体重是导致极早产儿生存率低、大脑神经发育不良的重要因素。重脑出血、中度及重度脑室扩张、大片脑白质软化是引起脑瘫的重要因素,超声下持续的、不均匀性的脑室旁白质回声增强可能提微小病灶的脑损伤,是影响脑神经发育不良危险信号。



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