超早产儿脑病危险因素的病例对照研究

目的：了解超早产儿（胎龄＜28周）脑病的发生状况并探讨其发生的危险因素。方法：收集复旦大学附属儿科医院NICU 2009年1月1日至2015年12月31日期间住院的、出生胎龄＜28周的、于纠正胎龄足月时或出院前完成MRI检查的超早产儿，排除纠正胎龄或出院时MRI单纯脑出血的病例。根据头颅MRI影像学报告结果分为单纯EOP组、EOP+出血组和正常组，采集与发生EOP可能相关的母亲和新生儿影响因素，三组之间进行单因素比较。结果：115例超早产儿进入本文分析，单纯EOP 组20例，EOP+出血组15例，正常组80例。35例EOP患儿中，白质损伤31例（88.6%），灰质损伤4例（11.4%），小脑损伤3例（8.6%），多发广泛损伤1例（2.9%），白质合并小脑损伤2例（5.7%）。脑白质损伤中，脑室周围白质损伤17例，其中非囊性损伤16例，囊性PVL1例；皮层下白质损伤14例，其中额叶损伤7例。单因素分析显示，单纯EOP组、EOP+出血组、正常组3组比较，母亲因素和新生儿因素差异均无统计学意义（P均＞0.05）。结论：超早产儿EOP与早产儿脑病一样最多见于脑白质损伤，影响超早产儿脑病为非单一危险因素起作用。

The risk factors in extremely preterm infants' encephalopathy of prematurity: A case-control study

Objective: To investigate neurological status and the risk factors of perinatal encephalopathy of prematurity (EOP) in extremely preterm infants.Methods: Clinical data of extremely preterm infants from January 1st 2009 to December 31st 2015 were collected in Children's Hospital of Fudan University. Gestational ages of infants were all younger than 28 weeks, and all infants underwent magnetic resonance imaging at term-equivalent age or before discharge, and single intracranial hemorrhage infants were taken out. Infants were divided into single EOP group, EOP with intracranial hemorrhage group and normal brain group according to MRI findings at term-equivalent age or before discharge. Univariate analysis was used to determine factors associated with the risk of EOP. Results: Of 115 extremely preterm infants, 20 had single EOP, 15 had EOP with intracranial hemorrhage and 80 were normal brain infants. Among the 35 EOP infants, 31(88.6%) had white matter injury, 4(11.4%) had gray matter injury, 3(8.6%) had cerebellar injury, 1(2.9%) had white matter and gray matter injury and 2(5.7%) had white matter and cerebellar injury. There were 17(48.6%) periventricular white matter injury infants, of them 16(45.7%) were noncystic, and 1(2.9%) was cystic. Fourteen (40%) infants had subcortical white matter injury, and half of them were located in lobe. No significant difference in any factors among the three groups were found (all P>0.05). Conclusion: The most common type of EOP in extremely preterm infants was white matter injury, which was similar to EOP in preterm infants. EOP in extremely preterm infants was not a result of single factor.