英国医学会：胎龄对新生儿脑病脑损伤的影响

Effect of gestational age on cerebral lesions in neonatal encephalopathy

1. Lauren Binet1,  http://orcid.org/0000-0001-9947-270X Thierry Debillon1,2, Jonathan Beck3, Antoine Vilotitch4,  http://orcid.org/0000-0002-6330-5085 Isabelle Guellec5, Anne Ego2,6,  http://orcid.org/0000-0002-1589-0144 Marie Chevallier1,2 on behalf of the LYTONEPAL research group
2. Correspondence to Dr Marie Chevallier, Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France; MChevallier3@chu-grenoble.fr

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.