Subtle white matter injury is common in term‐born infants with a wide range of risks

International Journal of Developmental Neuroscience - Tập 28 - Trang 573-580 - 2010
Sachiko Iwata1,2, Alan Bainbridge3, Tomohiko Nakamura2, Masanori Tamura2, Sachio Takashima4, Toyojiro Matsuishi1, Osuke Iwata1,2
1Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
2Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
3Department of Medical Physics and Bio-Engineering, University College London, United Kingdom
4Yanagawa Institute for Developmental Disabilities, International University of Health and Welfare, Fukuoka, Japan.

Tóm tắt

AbstractObjectivesPerinatal hypoxia–ischaemia affects cognitive outcomes of infants even when clinical symptoms were latent and intensive care was not required. We performed a retrospective analysis in a cohort of term infants who required intensive care (i) to investigate the incidence of abnormal white matter appearances on the magnetic resonance imaging obtained before 2 months corrected age, and (ii) to examine its relationships with other cerebral lesions, clinical backgrounds, and short‐term outcome at 12 months.Study designWhite matter appearances on T2‐weighted imaging (T2WI) and fluid‐attenuated inversion recovery imaging (FLAIR) were assessed in relationship with other cerebral lesions, clinical backgrounds, established white matter lesions on follow‐up scans, and abbreviated developmental outcomes at 12 months in 150 term‐born infants who were cared for at a tertiary neonatal intensive care unit with mixed indications for admission (positive pressure ventilation and intravenous inotropes required in 38% and 49% of infants respectively).ResultsOn T2WI and FLAIR, 14.0% and 41.3% of infants showed abnormal white matter intensities respectively, which were both related with lesions in the internal capsule and deep grey matter. Abnormal T2WI appearances were correlated with low Apgar scores and low blood base‐excess whereas abnormal FLAIR appearances were associated with younger corrected age at scan. Follow‐up studies in a cohort of infants revealed that abnormal white matter intensities further correlated with chronic long‐T2 lesions after 8 months corrected age (n = 40) and severe neuro‐developmental disability at 12 months (n = 104).ConclusionsAbnormal white matter intensities were associated with pathological clinical variables. White matter injury may not be a specific form of cerebral damage in preterm infants. For the precise evaluation of newborn brain imaging, it may be beneficial to account for corrected age even in term infants.

Tài liệu tham khảo

10.1002/mrdd.20107 10.1148/radiology.166.1.3336675 Barkovich A.J., 2006, MR imaging MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy, AJNR Am. J. Neuroradiol., 27, 533 10.1542/peds.112.1.1 10.1177/08830738010160110201 10.1136/adc.2005.092445 10.1542/peds.2003-0935-L 10.1542/peds.107.3.455 10.1203/01.pdr.0000190582.49589.14 Inder T.E., 2003, White matter injury in the premature infant: a comparison between serial cranial sonographic and MR findings at term, AJNR Am. J. Neuroradiol., 24, 805 10.1542/peds.2004-0326 10.1046/j.1442-200x.2004.01873.x 10.1046/j.1442-200x.2004.01874.x 10.1016/j.ijdevneu.2007.09.009 10.1016/S0004-9514(14)60264-6 10.1016/S0022-3476(99)70133-2 10.1542/peds.106.2.235 10.1056/NEJMoa067393 10.1016/j.jpeds.2004.12.026 10.1203/01.PDR.0000084083.71422.16 Nair M.K., 2009, Effect of Child Development Centre model early stimulation among at risk babies—a randomized controlled trial, Indian Pediatr., 46, s20 10.1016/S0140-6736(09)60244-0 10.1136/bmj.316.7139.1236 10.1016/S0022-3476(89)80132-5 10.1542/peds.2004-0222 10.1542/peds.102.2.323 10.1542/peds.2006-2508 1990, Enhancing the outcomes of low‐birth‐weight, premature infants. A multisite, randomized trial. The Infant Health and Development Program, JAMA, 263, 3035, 10.1001/jama.1990.03440220059030 10.1007/s00431-007-0437-8 10.1542/peds.2005-0545
Thông tin
Thông tin xuất bản

International Journal of Developmental Neuroscience

Tập 28

573-580

Thông tin tác giả