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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia.
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Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia.

机译：有症状新生儿低血糖症后脑损伤和神经发育结局的模式。

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BACKGROUND: Symptomatic neonatal hypoglycemia may be associated with later neurodevelopmental impairment. Brain injury patterns identified on early MRI scans and their relationships to the nature of the hypoglycemic insult and neurodevelopmental outcomes are poorly defined. METHODS: We studied 35 term infants with early brain MRI scans after symptomatic neonatal hypoglycemia (median glucose level: 1 mmol/L) without evidence of hypoxic-ischemic encephalopathy. Perinatal data were compared with equivalent data from 229 term, neurologically normal infants (control subjects), to identify risk factors for hypoglycemia. Neurodevelopmental outcomes were assessed at a minimum of 18 months. RESULTS: White matter abnormalities occurred in 94% of infants with hypoglycemia, being severe in 43%, with a predominantly posterior pattern in 29% of cases. Cortical abnormalities occurred in 51% of infants; 30% had white matter hemorrhage, 40% basal ganglia/thalamic lesions, and 11% an abnormal posterior limb of the internal capsule. Three infants had middle cerebral artery territory infarctions. Twenty-three infants (65%) demonstrated impairments at 18 months, which were related to the severity of white matter injury and involvement of the posterior limb of the internal capsule. Fourteen infants demonstrated growth restriction, 1 had macrosomia, and 2 had mothers with diabetes mellitus. Pregnancy-induced hypertension, a family history of seizures, emergency cesarean section, and the need for resuscitation were more common among case subjects than control subjects. CONCLUSIONS: Patterns of injury associated with symptomatic neonatal hypoglycemia were more varied than described previously. White matter injury was not confined to the posterior regions; hemorrhage, middle cerebral artery infarction, and basal ganglia/thalamic abnormalities were seen, and cortical involvement was common. Early MRI findings were more instructive than the severity or duration of hypoglycemia for predicting neurodevelopmental outcomes.
机译：背景：有症状的新生儿低血糖症可能与以后的神经发育障碍有关。在早期MRI扫描中发现的脑损伤模式及其与降血糖的本质和神经发育结局的关系还不清楚。方法：我们研究了35例有症状的新生儿低血糖（平均葡萄糖水平：1 mmol / L）后无早期缺氧缺血性脑病证据的足月婴儿。将围产期数据与229名足月神经学正常婴儿（对照对象）的等效数据进行比较，以确定低血糖的危险因素。至少18个月评估神经发育结局。结果：94％的低血糖婴儿发生白质异常，其中43％的婴儿严重，其中29％的病例以后部为主。 51％的婴儿发生皮质异常; 30％的患者有白质出血，40％的基底节/丘脑病变和11％的内囊后肢异常。 3例婴儿患有脑中动脉区域梗塞。 23例婴儿（65％）在18个月时表现出损伤，这与白质损伤的严重程度和内囊后肢的受累有关。 14名婴儿表现出生长受限，1名患有巨大儿，2名母亲患有糖尿病。怀孕引起的高血压，癫痫发作的家族史，紧急剖宫产和需要复苏的情况在病例组中比对照组更常见。结论：与症状性新生儿低血糖有关的损伤模式比以前描述的多。白质损伤不局限于后部区域。可见出血，脑中动脉梗塞和基底节/丘脑异常，皮层受累常见。 MRI早期发现比低血糖的严重程度或持续时间更能预测神经发育结果。

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