Effect of gestational age on cerebral lesions in neonatal encephalopathy.

IF 3.9 2区医学 Q1 PEDIATRICS Archives of Disease in Childhood - Fetal and Neonatal Edition Pub Date : 2024-08-16 DOI:10.1136/archdischild-2023-326131

Lauren Binet, Thierry Debillon, Jonathan Beck, Antoine Vilotitch, Isabelle Guellec, Anne Ego, Marie Chevallier

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Abstract

Objective: To determine the risk on brain lesions according to gestational age (GA) in neonates with neonatal encephalopathy.

Design: Secondary analysis of the prospective national French population-based cohort, Long-Term Outcome of NeonataL EncePhALopathy.

Setting: French neonatal intensive care units.

Patients: Neonates with moderate or severe neonatal encephalopathy (NE) born at ≥34 weeks' GA (wGA) between September 2015 and March 2017.

Main outcome measures: The results of MRI performed within the first 12 days were classified in seven injured brain regions: basal ganglia and thalami, white matter (WM), cortex, posterior limb internal capsule, corpus callosum, brainstem and cerebellum. A given infant could have several brain structures affected. Risk of brain lesion according to GA was estimated by crude and adjusted ORs (aOR).

Results: MRI was available for 626 (78.8%) of the 794 included infants with NE. WM lesions predominated in preterm compared with term infants. Compared with 39-40 wGA neonates, those born at 34-35 wGA and 37-38 wGA had greater risk of WM lesions after adjusting for perinatal factors (aOR 4.0, 95% CI (1.5 to 10.7) and ORa 2.0, 95% CI (1.1 to 3.5), respectively).

Conclusion: WM is the main brain structure affected in late-preterm and early-term infants with NE, with fewer WM lesions as GA increases. This finding could help clinicians to estimate prognosis and improve the understanding of the pathophysiology of NE.

Trial registration number: NCT02676063, ClinicalTrials.gov.

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胎龄对新生儿脑病脑损伤的影响

目的根据胎龄（GA）确定新生儿脑病患儿脑损伤的风险：对法国前瞻性全国人群队列 "新生儿脑病的长期结果 "进行二次分析：法国新生儿重症监护病房：主要结果测量指标：在头12天内进行的核磁共振成像结果按七个受伤脑区分类：基底节和丘脑、白质（WM）、皮质、后肢内囊、胼胝体、脑干和小脑。一个婴儿可能有多个大脑结构受到影响。通过粗略ORs和调整ORs (aOR)估算GA导致脑损伤的风险：在纳入的 794 例 NE 婴儿中，有 626 例（78.8%）可进行 MRI 检查。与足月儿相比，早产儿以WM病变为主。调整围产期因素后，与39-40 wGA的新生儿相比，34-35 wGA和37-38 wGA出生的新生儿发生WM病变的风险更高（aOR分别为4.0，95% CI (1.5至10.7)和ORa分别为2.0，95% CI (1.1至3.5)）：结论：早产晚儿和早产儿中，WM是受NE影响的主要脑结构，随着GA的增加，WM病变也会减少。这一发现有助于临床医生估计预后并加深对 NE 病理生理学的了解：试验注册号：NCT02676063，ClinicalTrials.gov.

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来源期刊

Archives of Disease in Childhood - Fetal and Neonatal Edition 医学-小儿科

CiteScore

9.00

自引率

4.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.