| Objective: The aim of this study was to explore the outcomes ofthe cranial magnetic resonance imaging(cMRI)findings for premature infants from corrected gestational age(CGA)36-40 week to CGA10-12 month and the relationship between the findings of cMRI changes for premature infants at CGA 36-40 w and the behavioural neurological assessment(BNA)results at the CGA10-12 month by retrospective case-control analysis,to disscuss the predictive value of cMRI on prognosis of brain injury in premature infants,and in order to provide an objective and reliable theory basis on early rehabilitation for premature infants with brain injury.Methods:(1)188 cases of very low birth weight infants were enrolled in this study from 758 preterm infants admitted to NICU of Shanghai Children’s Hospital within postnatal 12 hours and length of stay for more than 30 days,from January 2010 to January2015.They were divided into two groups according to the changes of cMRI imaging whether abnormity at CGA36-40w: brain injury in premature infants(BIPI)group and control group.BIPI group,168 cases with abnormal cMRI findings conformed to the diagnostic criteria of BIPI [5];the control group of 20 cases,cMRI showed normal and with no clinical performance on BIPI.(2)The BIPI group was further divided into six subgroups according to the the types of cMRI abnormality[5]: Punctate white matter damage(PWMD)、Diffuse white matter damage(DWMD)、Periventricular leukomalacia(PVL)、 cerebral infarction(CI)、 periventricular-Intraventricular hemorrhages(PIVH-IVH)、cerebellum hemorrhage(CH);all 188 cases were divided into normal group and abnormal group according to cMRI changes at 10-12 moths old after CGA term(CGA10-12M).(3)We collected and compared with the general data of the two groups infants: gender,gestational age(GA),age,birth weight(BW),gravidity,parity,cesarean section or not,maternal obstetric disease during pregnancy,and children’s basic diseases,complications,hospitalization process,and length of hospital stay,etc.were compared between two groups.(4)The two groups were performed cMRI at CGA36-40 W,and performed cranial Ultrasonography(cUS)earlier 1 week than cMRI,and then we re-checked cMRI and examined BNA measurement at follow-up to CGA10-12 M.(5)Compared and analyzed the results of cMRI and cUS for two groups at CGA36-40W;compared and analyzed cMRI outcomes of two groups at CGA10-12M;compared with the relationship between cMRI changes of two groups at CGA36-40 w and BNA results of them at CGA10-12M;comparedthe relationshipon cMRI changes and BNA resultsbetween two groups follow-up to CGA10-12 M.Result:1.Comparison of general information between the two groups: BIPI group of 168 cases,male 101 cases,female 67 cases,107 cases of first pregnancy,cesarean section in114 cases,58 cases of twins,the average age(2.97 ± 1.40)h,the average GA(31.57 ± 3.76)W,the BW(1232.97 + 206.38)g,131 cases had maternal obstetric disease during pregnancy;the control group of 20 cases,male 9cases,female 11 cases,13cases of first pregnancy,cesarean section in 12 cases,6cases of twins,the average age(2.95±2.61)h,the average GA(30.22 ± 4.31)W,the BW(1281.50±129.10)g,11 cases had maternal obstetric disease during pregnancy.There was no statistically significant difference between general data of the two groups(P>0.05).2.Comparison of the clinical data in hospitalization between the two groups:There were no significant differences between two groups of infants in asphyxia,apnea,electrolyte disorders,hypoglycemia,PDA,PPHN,pneumonia,sepsis,shock and noninvasive mechanical ventilation and the averagelength of hospital stay(P>0.05),and there were significant differences between two groups of infants in NRDS,respiratory failure,the occurrence of BPD,Whether oxygen inhalation,and the use of invasive mechanical ventilation(P <0.05).3.Comparison of cMRI and cUS results of two groups at CGA36-40w: The abnormal cases been detected by cUS were 168/188(89.4%),the abnormal cases been detected by cMRI were 97/188(51.6%),there was a significant difference between them.Diagnosis of PVL and PIVH-IVH was complete consistent,CI、WMD had not been detected by cUS,the number of CH cases detected by cUS was only 5 cases(25%).4.Two groups were followed up to CGA10-12 M to review the outcomes of cMRI: the abnormal rate of cMRI outcomes of BIPI group at CGA10-12 M was 51.2%(86/168),the abnormal rate of the control group was 5.0%(1/20).There was a significant differencebetween them(P<0.05),the cMRI outcome of each subgroup was significantly different(P<0.05),the cMRI outcome of PVL was the worst,the second was DWMD.5.The relationship between cMRI changes and BNA results of the two groups at CGA10-12 M during follow-up: The BNA abnormal rate of BIPI group was 46.4%(78/168)when followed up to CGA10-12 M,and that of control group was 5%(1/20),there was a significant differences between them.The BNA abnormal rate of PVL group was 100%,which was the hightest in all subgroups,followed by DWMD group with normal rate79.1%,there was a statistically significant difference among different subgroups.6.The relationship between cMRI change types and BNA results at CGA10-12M: The BNA abnormal rate of cMRI abnormal group was 72.4% when follow-up to CGA10-12 M,and that of cMRI normal group was 14.9%,their difference was significant(P<0.05).Different cMRI results showed different BNA abnormal rates,their difference was significant,BNA abnormal rate of brain atrophy and that of PVL were highly consistent,both of them was 100%.Conclusion:The abnormal detection rate of BIPI by cMRI was higher than that by cUS at CGA36-40W;cMRI outcomes of BIPI varied follow-up to CGA10-12 M,the outcome of PVL was the worst.BNA results at CGA10-12 M of the premature infants with different cMRI changes at CGA36-40 Wwere significantly abnormal.Especially,the abnormal rate of BNA was the highest in PVL and DWMD,so it can provide objective basis for evaluating the prognosis of BIPI. |
PDF Full Text Request