期刊
PEDIATRIC NEUROLOGY
卷 49, 期 6, 页码 401-405出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.pediatrneurol.2013.08.007
关键词
brain imaging; hypoxic-ischemic encephalopathy; magnetic resonance; neonatal; infantile spasms
资金
- SickKids Foundation
- Institute of Human Development, Child and Youth Health-Canadian Institutes of Health Research
- Bloorview Children's Hospital Chair in Paediatric Neuroscience
- Canada Research Chair
- Michael Smith Foundation for Health Research
- University of British Columbia
- National Institutes of Health/National Institute of Neurological Disorders and Stroke [K23NS066137]
- Neonatal Brain Research Institute at University of California at San Francisco
BACKGROUND: To evaluate the predominant pattern of brain injury and the anatomic areas of injury in children with infantile spasms following neonatal hypoxic-ischemic encephalopathy. METHODS: A nested case-control study of infantile spasms in children with term neonatal hypoxic-ischemic encephalopathy was performed. All patients had T-1/T-2-weighted magnetic resonance imaging with diffusion-weighted imaging performed on the third day of life. Using a validated scoring system, the magnetic resonance imaging was classified as: normal, watershed, basal ganglia/thalamus, total, or focal-multifocal. Two study investigators scored additional anatomic areas of injury (cortical extent, levels of the brainstem, hypothalamus) on T-1/T-2-weighted magnetic resonance imaging and diffusion-weighted imaging blinded to the outcome. The predominant pattern of brain injury and anatomic areas of injury were compared between patients who developed infantile spasms and randomly selected controls. RESULTS: Eight patients who developed infantile spasms were identified among a cohort of 176 term newborns with hypoxic-ischemic encephalopathy (4.5%). There were no significant differences in the perinatal and neonatal course between newborns who developed infantile spasms and controls who did not. The development of infantile spasms after neonatal hypoxic-ischemic encephalopathy was significantly associated with basal ganglia/thalamus and total brain injury (P = 0.001), extent of cortical injury greater than 50% (odds ratio = 11.7, 95% confidence interval = 1.1-158.5, P = 0.01), injury to the midbrain (odds ratio = 13, 95% confidence interval = 1.3-172, P = 0.007) and hypothalamic abnormalities (P = 0.01). CONCLUSIONS: The development of infantile spasms after hypoxic-ischemic encephalopathy is associated with injury to the basal ganglia and thalami on neonatal magnetic resonance imaging, particularly when extensive cortical injury and/or injury to the midbrain is present.
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