足月儿与早产儿细菌性脑膜炎的临床分析

目的 探讨足月儿和早产儿细菌性脑膜炎的临床特征及转归特点。方法 回顾性分析102例新生儿细菌性脑膜炎患儿的临床资料,根据胎龄分为早产儿组（n=46）及足月儿组（n=56）,比较两组患儿临床表现、实验室结果、影像学结果及临床转归。结果 早产儿组临床表现主要为反应差和呼吸暂停/急促（P < 0.05）,足月儿组则以发热及抽搐多见（P < 0.05）。足月儿组脑脊液糖高于早产儿组（P < 0.05）,早产儿组C-反应蛋白、血培养阳性率及不良预后发生率高于足月儿组（P < 0.05）。两组外周血白细胞计数、脑脊液白细胞、脑脊液蛋白及脑脊液培养阳性率差异无统计学意义（P > 0.05）。结论 早产儿及足月儿细菌性脑膜炎临床表现有所不同,早产儿组不良预后发生率更高。     

早产儿缺氧缺血性脑病诊断标准探讨

新生儿脑缺氧缺血损伤(或称缺氧缺血性脑病)在病理上分为5种类型，分别为：选择性神经元坏死、基底神经节丘脑损伤、旁矢状区损伤、脑动脉梗死以及脑室周围白质软化。除了脑室周围白质软化是早产儿所特有的病变、旁矢状区损伤是足月儿特有的病变外，其余病变类型足月儿和早产儿均可发生，但以足月儿多见。     

早产儿脑室周围白质软化症和脑性瘫痪

为探讨早产儿脑室周围白质软化症患儿脑性瘫痪的发病情况 ,以 30例足月儿的缺氧缺血性脑病作为对照 ,并将观察组的 2 3例早产儿脑室周围白质软化症依据头颅ＣＴ是否有两侧对称性病变分为两组进行研究。结果早产儿脑室周围白质软化症患儿的脑性瘫痪发病率明显高于对照组 (Ｐ <0 .0 1) ;呈现两侧对称性病变组 ,脑性瘫痪发病率明显高于单侧病变者 (Ｐ <0 .0 1)。故早产儿脑室周围白质软化症患儿的脑性瘫痪发病率高 ,头颅ＣＴ显示的病变范围及是否为两侧对称性病变可较好地预测患儿的预后。早产儿脑室周围白质软化症和脑性瘫痪$山西省儿童医院!0…     

3-硝基丙酸致未成熟鼠脑室周围脑白质软化的神经行为学及磁共振成像变化

目的 通过脑内定位注射3-硝基丙酸(3-NPA)建立新生鼠脑室周围白质软化(PVL)模型,探讨远期神经行为学和磁共振成像(MRI)变化.方法 新生5 d(P5)SD大鼠随机分成实验组(NPA组)与假手术组(PBS组),脑立体定位仪定位于左侧脑室上方胼胝体,分别注入等量3-NPA和PBS,造模后1、2、3、9 d灌注固定取脑,石蜡切片作HE染色;术后不同时间点观察体重、睁眼时间等生长发育情况;P29-30进行神经行为学检测,观察两组大鼠肢体肌力、随意运动、情感行为能力和学习记忆能力;P30行MRI检查.结果 NPA组大鼠术后睁眼时间延迟,体重增加高于PBS组,差异有统计学意义(P<0.05);HE染色显示NPA组大鼠P6、p7、P8 NPA组注射3-NPA侧皮质下及脑室周围白质出现不同程度疏松及液化灶,P14时出现同侧脑室明显扩大,PBS组无明显变化;神经行为学检测实验组鼠肢体肌力、随意运动、情感行为能力和学习能力较假手术组减退,评分差异有统计学意义(P<0.05);P30 MRI检查显示NPA组脑内注射侧脑室周围局部有脑组织软化信号改变.结论 P5大鼠脑内注射3-NPA制作的脑室周围白质软化模型.能真实地模拟在体病理改变,经神经行为学检测与临床症状相符,MRI检查可显示脑白质损伤的解剖形态学变化,作为诊断PVL的方法具有可行性.     

Snsceptibility-weighted imaging findings in periventricular white matter injury in preterm infants

目的 脑室旁白质损伤是早产儿围生期窒息后常见的脑损伤类型之一,其MRI表现具有特征性,但常规序列难以区分病灶内是否合并出血,而出血与否可能影响治疗和预后.该研究应用磁敏感加权成像( SWAN)来检测存在白质损伤的早产儿脑内的出血性病变.方法 对临床怀疑围生期窒息后脑损伤的75例早产儿行头颅GE HDx Twin Speed 3.0T MRI检查,扫描序列包括T1FLAIR、T2FLAIR、DWI和SWAN.结果 44例(58.7％)早产儿存在脑室旁白质损伤,其中4例(9.1％)存在出血性白质损伤.在这4例中有3例合并生发基质出血-脑室内出血；4例合并小脑出血；1例合并蛛网膜下隙出血.结论 脑室旁白质损伤中绝大多数为非出血性损伤,当伴有生发基质出血或脑室内出血时,脑室周围白质损伤病灶中常存在出血.     

磁敏感加权成像在早产儿伴脑室旁白质损伤中的应用研究

目的脑室旁白质损伤是早产儿围生期窒息后常见的脑损伤类型之一,其MRI表现具有特征性,但常规序列难以区分病灶内是否合并出血,而出血与否可能影响治疗和预后。该研究应用磁敏感加权成像(SWAN)来检测存在白质损伤的早产儿脑内的出血性病变。方法对临床怀疑围生期窒息后脑损伤的75例早产儿行头颅GE HDx Twin Speed 3.0T MRI检查,扫描序列包括T1FLAIR、T2FLAIR、DWI和SWAN。结果44例(58.7%)早产儿存在脑室旁白质损伤,其中4例(9.1%)存在出血性白质损伤。在这4例中有3例合并生发基质出血-脑室内出血;4例合并小脑出血;1例合并蛛网膜下隙出血。结论脑室旁白质损伤中绝大多数为非出血性损伤,当伴有生发基质出血或脑室内出血时,脑室周围白质损伤病灶中常存在出血。     

早产儿脑室旁白质损伤的诊断与评价

脑室旁白质损伤是早产儿特征性脑损伤形式之一,影像学检查是确诊的重要手段.应注重3个阶段的诊断:1.脑室旁白质软化易发生在侧脑室前角、后角三角区附近及侧脑审背外侧.2.脑室旁白质损伤早期弥散加权磁共振成像技术对水肿性病变敏感性极高,超声也有较好的诊断效果.3.脑室旁白质损伤后期对髓鞘化程度、脑白质容积大小及神经纤维走行作出判断.     

早产儿缺血缺氧性脑损伤的CT与磁共振诊断

早产儿缺血缺氧性脑损伤是引起儿童致残的重要因素,它包括脑室周围白质软化( periventricu larleukomalacia ,PVL)、生发基质出血、脑室内出血及脑室周围出血性梗塞。早产儿缺血缺氧性脑损伤导致的颅内改变有别于足月儿,产生的后果也不相同,这些都与早产儿脑的解剖生理特点有关。影像学检查的目的是观察有无脑损害表现,了解脑损害的程度,同时正确判断预后,使临床医生及时对患儿作出恰当的处理,从而最大程度地降低患儿的致残率。1　早产儿缺血缺氧性脑损伤病理基础妊娠早、中期,脑室周围白质的血供主要来自脑表面向脑室方向走行的穿支血管,…     

足月儿早产儿痉挛型脑性瘫痪CT的对比研究

目的：研究足月儿与早产儿痉挛型脑性瘫痪的CT表现。方法：回顾性分析88例痉挛型脑性瘫痪患儿CT表现,分早产儿和足月儿两组分析,其中46例足月儿,42例早产儿。结果：88例痉挛型脑性瘫痪患儿CT表现的阳性率78.4%(69/88)。主要是脑室周围白质软化(PVL)后遗改变,为47/88例,其中足月儿17例,早产儿30例,两组差异有显著性意义(P<0.05);PVL白质减少可发生于侧脑室体中前部、侧脑室体后部、侧脑室三角区、半卵圆中心,两组间白质减少和侧脑室扩大部位差异无显著性意义;而侧脑室形态不规则扩大在早产儿30例中有7例,足月儿侧脑室扩大未见不规则改变,两组差异有显著性意义(P<0.05)。结论：痉挛型脑性瘫痪CT主要表现为PVL后遗改变,早产儿出现PVL和重度PVL的概率明显大于足月儿。     

3-硝基丙酸脑内注射诱导新生鼠脑室周围脑白质软化模型的建立

目的探讨脑内注射3-硝基丙酸（3-NPA）建立新生鼠脑室周围白质软化（PVL）模型的可行性，探索可靠的造模方法。方法新生5d（P5）SD大鼠64只，随机分成NPA与磷酸盐缓冲液（PBS）组，每组32只，脑立体定位仪定位于左侧脑室上方胼胝体，分别注入3-NPA（300mmol／L）和等量PBS，于造模后24h（P6）、48h（P7）、72h（P8）、9d（P14）灌注固定取脑，作HE染色及少突胶质细胞04、髓鞘碱性蛋白（MBP）免疫组织化学染色。结果HE染色显示P6、P7、P8NPA组皮质下及脑室周围白质出现疏松及液化灶，P14出现脑室扩大，脑室指数较PBS组高，有显著性差异（P〈0．01），脑皮质无明显变化；04染色示NPA组阳性细胞较PBS组明显减少，差异有显著性（P〈0．01）；MBP免疫染色示NPA组平均光密度值较PBS组低，有显著性差异（P〈0．05）。结论3-NPA脑内注射诱导新生鼠PVL模型以脑室周围白质损伤为突出表现，皮质无明显改变，可作为疾病研究的可靠模型。     

Magnetic resonance imaging of the brain in a cohort of extremely preterm infants.

To define magnetic resonance imaging (MRI) appearances of the brain in extremely preterm infants between birth and term, a sequential cohort of infants born at a gestational age <30 weeks was studied with a dedicated neonatal magnetic resonance scanner. Images of infants (n = 41) with a median gestational age of 27 weeks (range 23 to 29 weeks) were initially obtained at a median age of 2 days (range 1 to 20 days) and then repeatedly studied; 29 (71%) infants had MRI at a median gestational age of 43 weeks (range 38 to 52 weeks) (term MRI). On the initial MRI scan 28 of 41 infants had abnormalities: either intraventricular hemorrhage, germinal layer hemorrhage, ventricular dilatation, or diffuse and excessive high signal intensity in the white matter on T(2)-weighted images. When magnetic resonance images for preterm infants at term gestation were compared with those of infants in the control group born at term, 22 of 29 infants had dilatation of the lateral ventricles, 24 of 29 had squaring of the anterior or posterior horns of the lateral ventricles, 11 of 29 had a widened interhemispheric fissure or extracerebral space, and 22 of 29 had diffuse and excessive high signal intensity in the white matter. There were no cases of cystic periventricular leukomalacia. We conclude that MRI abnormalities are commonly seen in the brain of preterm infants on whom images are obtained within 48 hours of birth and that further abnormalities develop between birth and term. A characteristic appearance of diffuse and excessive high signal intensity in the white matter on T(2)-weighted images is associated with the development of cerebral atrophy and may be a sign of white matter disease. These MRI appearances may help account for the high incidence of neurodevelopmental impairment in extremely preterm infants.     

Cranial ultrasound abnormalities in full term infants in a postnatal ward: outcome at 12 and 18 months

OBJECTIVE: To investigate whether cranial ultrasound abnormalities found in low risk full term infants had any influence on neurodevelopmental outcome. METHODS: For 103 infants who had a neurological assessment, a cranial ultrasound examination, and for whom antenatal and perinatal data were collected within 48 hours of delivery, neurodevelopmental status was evaluated at 12 and 18 months. The results of a scored neurological examination and the Griffiths mental developmental scale were correlated with the presence and type of ultrasound abnormality found in the neonatal period. RESULTS: None of the infants with ultrasound abnormalities showed any signs of cerebral palsy or severe developmental delay. There was also no significant difference between the overall neurological and neurodevelopmental scores of the infants with normal and abnormal ultrasound findings. However, when the individual subscales of the Griffiths test were analysed, all infants with bulky choroid or intraventricular haemorrhage had normal scores in all subscales, four of eight with periventricular white matter lesions had low scores on the locomotor subscale, and three of five with asymmetrical ventricles had low scores on the performance subscale. The presence of adverse antenatal and perinatal factors did not affect the outcome in this group. CONCLUSION: Incidental ultrasound abnormality in full term neonates, in particular intraventricular haemorrhage, although common, appear to have a good prognosis. Longer follow up studies are needed to see whether some of these infants, in particular those with white matter lesions, develop dyspraxia or other minor neurological impairments at school age.     

Brain imaging findings in very preterm infants throughout the neonatal period: Part II. Relation with perinatal clinical data

This study describes the relation between frequent and clinically relevant brain imaging findings in very preterm infants (GA < 32 weeks), assessed with sequential cranial ultrasonography throughout the neonatal period and MRI around term age, and several potential perinatal risk factors.For ultrasound findings during admission the following independent risk factors were identified: male gender for periventricular echodensities and intraventricular haemorrhage, postnatal corticosteroid treatment for cystic white matter lesions, and lower gestational age for post-haemorrhagic ventricular dilatation. For MRI findings around term age, including punctate white matter lesions, ventricular dilatation, decreased cortical complexity, and diffuse and excessive high signal intensity, no independent risk factors were found.In very preterm infants, the risk factors for frequently found changes on cranial ultrasound have largely remained unchanged over the last decades, while no risk factors could be identified for subtle and diffuse white matter injury as seen on MRI around term age.     

Brain imaging findings in very preterm infants throughout the neonatal period: Part I. Incidences and evolution of lesions, comparison between ultrasound and MRI

This study describes the incidence and evolution of brain imaging findings in very preterm infants (GA < 32 weeks), assessed with sequential cranial ultrasound (cUS) throughout the neonatal period and MRI around term age. The accuracy of both tools is compared for findings obtained around term.Periventricular echodensities and intraventricular haemorrhage were the most frequent cUS findings during admission. Frequent findings on both cUS and MRI around term included ventricular dilatation, widened extracerebral spaces, and decreased cortical complexity. MRI additionally showed punctate white matter lesions and diffuse and excessive high signal intensity, but did not depict lenticulostriate vasculopathy and calcifications, and was less reliable for germinolytic and plexus cysts.cUS detected most abnormalities that have been associated with abnormal neurodevelopmental outcome.     

White matter damage and intraventricular hemorrhage in very preterm infants: the EPIPAGE study

OBJECTIVE: To evaluate the prevalence of cranial ultrasound abnormalities in very preterm infants as a function of gestational age, plurality, intrauterine growth restriction, and death before discharge. STUDY DESIGN: A prospective, population-based cohort of 2667 infants born between 22 and 32 weeks of gestation in 1997 in nine regions of France, transferred to a neonatal intensive care unit, for whom at least one cranial ultrasound scan was available. RESULTS: The frequencies of white matter damage (WMD), major WMD, cystic periventricular leukomalacia (PVL), periventricular parenchymal hemorrhagic involvement, and intraventricular hemorrhage with ventricular dilatation were 21%, 8%, 5%, 3%, and 3%, respectively. The risk of WMD increased with decreasing gestational age. Mean age at diagnosis of cystic PVL was older for the most premature infants. Intraventricular hemorrhage with ventricular dilatation was associated with a higher risk of cystic PVL. Intrauterine growth restriction was not associated with a lower prevalence of cystic PVL. CONCLUSION: The frequency of WMD is high in very preterm babies and is strongly related to gestational age. The incidence of cystic PVL did not differ between babies with intrauterine growth restriction and babies who were appropriate for gestational age.     

MRI brain imaging in neonates

MRI is now commonly used in the assessment of neonates for diagnosis and prognosis. The advantages over ultrasound are increased contrast resolution, complete coverage and multiplanar imaging. MRI is most commonly used for the assessment of neonatal encephalopathy to determine an underlying cause such as hypoglycaemia, neonatal infarction, or viral encephalitis, and may also be useful in determining complications of meningitis and planning surgical treatment. In hypoxic-ischaemic injury, where the diagnosis is typically made clinically, MRI has conventionally confirmed the diagnosis and provided prognostic information. However advanced techniques such as magnetic resonance spectroscopy and arterial spin labelling allow for earlier diagnosis and may guide treatment options. MRI may also detect less common patterns of brain injury in term infants such as punctuate white matter lesion. Imaging of preterm infants at term equivalent age can demonstrate complications such as periventricular leucomalacia or periventricular haemorrhagic infarction and provide information on neurological outcome.     

应用弥散张量成像评价支气管肺发育不良早产儿脑白质发育的研究

目的 应用磁共振弥散张量成像（DTI）的各项异性分数（FA）和表观弥散系数（ADC）评价支气管肺发育不良（BPD）早产儿的脑白质发育。方法 以2016年8月至2019年4月生后24 h内收住NICU的出生胎龄≤32周、出生体重<1 500 g,且出院前完成头颅MRI及DTI检查的96例早产儿为研究对象。根据出院诊断分为BPD组（n=48）和非BPD组（n=48）,比较两组DTI相同感兴趣区的FA值和ADC值。结果 两组早产儿脑室周围-脑室内出血、脑室周围白质软化、局灶性脑白质损伤等发生率差异无统计学意义（P > 0.05）。BPD组早产儿内囊后肢、胼胝体压部、枕叶白质、小脑、大脑脚的FA值低于非BPD组（P < 0.05）,各ADC值高于非BPD组（P < 0.05）。与非BPD组相比,BPD组早产儿呼吸暂停次数更多、肺炎发生率和机械通气比例更高、辅助通气时间更长（P < 0.05）。结论 BPD对早产儿脑白质发育具有潜在影响,可导致脑白质发育延迟,因此,需关注该类患儿的神经功能。     

Changes in care and short-term outcome for very preterm infants in Estonia

Aim: To identify recent changes in short‐term outcome and care for very preterm infants in Estonia. Methods: Comparison of two population‐based cohorts of very preterm infants born alive at 22–31 gestational weeks. In 2007–2008, data were recorded prospectively in a neonatal register. For the cohort born in 2002–2003, the same variables were extracted retrospectively from the hospital records. Infants were followed up to discharge or death. Results: The cohort of 2007−2008 contained a higher proportion of infants born by caesarean section and of infants who received antenatal corticosteroids, maternal antibiotics, or surfactant therapy than the earlier cohort. A higher proportion of infants was admitted for care in 2007–2008 (98% vs. 94%; p = 0.013). During the study period, survival until discharge increased (85% vs. 78%; p = 0.041), although the length of hospital stay was unchanged. The use of mechanical ventilation, inotropes, and postnatal antibiotics decreased. Neonatal morbidity remained unchanged, except for a decrease in severe periventricular/intraventricular hemorrhage. Conclusion: The outcome for very preterm infants in Estonia has improved since 2002. With proactive perinatal management and less invasive neonatal care, survival until discharge increased without concomitant increases in neonatal morbidity and the length of hospital stay.     

早产儿暂时性低甲状腺素血症与脑损伤及神经行为学相关性研究

目的 通过对早产儿甲状腺素水平测定及脑、神经行为发育测评,分析甲状腺素水平与脑损伤、神经行为学的相关性.方法 选取2009年11月至2010年4月,上海交通大学附属上海市儿童医院新生儿科收治的早产儿52例,生后6 h内留取血清样本,放射免疫法测定T3、T4、TSH值.所有患儿出生后3 d行头颅B超检查,每周复查1次,出院前行头颅MRI检查.根据头颅MRI结果将患儿分为3组:无脑损伤组(33例)、脑室内出血组(10例)、脑白质损伤组(9例).所有患儿于纠正胎龄40±2周时行新生儿20项行为神经测定.结果 3组患儿TSH均正常,排除先天性甲状腺功能减低症;共8例早产儿甲状腺功能正常,占15.4%(8/52);另44例早产儿甲状腺功能均低下,占84.6%(44/52).无脑损伤组T3、T4水平高于脑室内出血组及脑白质损伤组,并以脑白质损伤组T3、T4水平最为低下,3组间比较差异有统计学意义(P＜0.05).无脑损伤组患儿行为能力、被动肌张力、主动肌张力及总分4项得分显著高于有脑损伤的两组患儿,且脑室内出血组患儿得分又高于脑白质损伤组患儿,3组间比较差异有统计学意义(P＜0.05).结论 早产儿脑损伤越严重,甲状腺素水平越低.有脑损伤的早产儿神经行为学评分较无脑损伤的早产儿低.     

应用弥散张量成像评价支气管肺发育不良早产儿脑白质发育的研究

目的 应用磁共振弥散张量成像（DTI）的各项异性分数（FA）和表观弥散系数（ADC）评价支气管肺发育不良（BPD）早产儿的脑白质发育。方法 以2016年8月至2019年4月生后24 h内收住NICU的出生胎龄≤32周、出生体重<1 500 g,且出院前完成头颅MRI及DTI检查的96例早产儿为研究对象。根据出院诊断分为BPD组（n=48）和非BPD组（n=48）,比较两组DTI相同感兴趣区的FA值和ADC值。结果 两组早产儿脑室周围-脑室内出血、脑室周围白质软化、局灶性脑白质损伤等发生率差异无统计学意义（P > 0.05）。BPD组早产儿内囊后肢、胼胝体压部、枕叶白质、小脑、大脑脚的FA值低于非BPD组（P < 0.05）,各ADC值高于非BPD组（P < 0.05）。与非BPD组相比,BPD组早产儿呼吸暂停次数更多、肺炎发生率和机械通气比例更高、辅助通气时间更长（P < 0.05）。结论 BPD对早产儿脑白质发育具有潜在影响,可导致脑白质发育延迟,因此,需关注该类患儿的神经功能。