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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Impaired cerebral cortical gray matter growth after treatment with dexamethasone for neonatal chronic lung disease.
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Impaired cerebral cortical gray matter growth after treatment with dexamethasone for neonatal chronic lung disease.

机译：地塞米松治疗新生儿慢性肺部疾病后脑皮质灰质生长受损。

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OBJECTIVE: The specific aim of this study was to quantify at term the influence of postnatal systemic dexamethasone treatment for neonatal chronic lung disease on subsequent brain growth and development in premature infants without evidence of severe intraventricular hemorrhage or white matter injury. METHODS: Eighteen premature (23 to 31 weeks) infants, 7 treated with dexamethasone and 11 not treated, were studied at term, ie, 38 to 41 postconceptional weeks, by an advanced quantitative volumetric 3-dimensional magnetic resonance imaging (MRI) technique to quantify cerebral tissue volumes. Fourteen healthy term infants also were studied for comparison. A sequence of image processing algorithms was used to segment each of the MRI slices into the following separate tissue classes: cerebral cortical gray matter, basal ganglia/thalami, unmyelinated white matter, myelinated white matter, and cerebrospinal fluid, all classified based on magnetic resonance signal intensity and anatomic location. A final summing of voxels for each tissue class was performed to compute absolute volumes in milliliters. RESULTS: Cerebral cortical gray matter volume in premature infants treated with dexamethasone was reduced 35% when compared with gray matter volume in premature infants not treated with dexamethasone (mean +/- standard deviation, 130.3 +/- 54.0 vs 200.6 +/- 35.1 mL, respectively). Subcortical gray matter volumes (basal ganglia and thalami) and myelinated and unmyelinated white matter volumes were not significantly different among the treated and untreated groups. However, premature infants treated with dexamethasone exhibited a reduction (30%) in total cerebral tissue volume compared with total cerebral tissue volume in both the premature infants not treated with dexamethasone and the control term infants (312.7 +/- 43.7 vs 448.2 +/- 50.2 and 471.6 +/- 36.4 mL respectively). This latter finding relates primarily to the decrease in cerebral cortical gray matter volume. CONCLUSIONS: The data suggest an impairment in brain growth, principally affecting cerebral cortical gray matter, secondary to systemic dexamethasone therapy. Although the premature infants who received dexamethasone were smaller with more severe respiratory disease, these findings are consistent with growing evidence of a potential deleterious effect of dexamethasone on neonatal brain and subsequent neurodevelopmental outcome. This apparent deleterious effect should be taken into consideration by clinicians when weighing the potential risks and benefits of this therapy for low birth weight infants with neonatal chronic lung disease.
机译：目的：本研究的特定目的是量化足月后全身性地塞米松治疗新生儿慢性肺疾病对早产儿随后脑生长和发育的影响，而无严重脑室内出血或白质损伤的证据。方法：在足月即受孕后38至41周，采用先进的定量3维磁共振成像技术对18例早产儿（23至31周）进行了研究，其中7例接受地塞米松治疗，另11例未接受治疗。量化脑组织体积。还研究了十四个健康足月婴儿以进行比较。一系列图像处理算法用于将每个MRI切片分割为以下独立的组织类别：大脑皮层灰质，基底神经节/丘脑，无髓白质，有髓白质和脑脊髓液，所有这些均基于磁共振进行分类信号强度和解剖位置。对每个组织类别进行体素的最终求和，以计算绝对体积（以毫升为单位）。结果：与未接受地塞米松治疗的早产儿的灰质体积相比，地塞米松治疗的早产儿的大脑皮层灰质体积减少了35％（平均+/-标准偏差，130.3 +/- 54.0和200.6 +/- 35.1 mL ， 分别）。在治疗组和未治疗组之间，皮层下灰质体积（基底神经节和丘脑）以及髓质和未髓质白质体积均无显着差异。但是，与未接受地塞米松治疗的早产儿和对照组足月儿相比，地塞米松治疗的早产儿总脑组织量减少了（30％）（312.7 +/- 43.7 vs 448.2 +/-分别为50.2和471.6 +/- 36.4 mL）。后一个发现主要与大脑皮层灰质体积的减少有关。结论：数据表明，脑部发育受损，主要影响全身地塞米松治疗后的大脑皮层灰质。尽管接受地塞米松的早产儿较小，呼吸系统疾病更为严重，但这些发现与越来越多的证据表明地塞米松对新生儿大脑和随后的神经发育结局具有潜在的有害作用。临床医师在权衡该疗法对新生儿慢性肺病的低出生体重婴儿的潜在风险和益处时，应考虑这种明显的有害作用。

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