囊性纤维化婴儿的运动延迟

study is part of an ongoing longitudinal study' aimed at documenting the evolution of brain lesions in neonatal MRI.
Permission for the study was obtained from the Royal Postgraduate Medical School E t h i c s Committee and informed consent was obtained from a parent in each case. Ninety Full-lerm infants born between 1993 and 1997 who suffered hypoxic ixhaemic encephalopathy at birth were enrolled in this study. As the aim of this study was to evaluate the value of the neurological examinations in full-tern infants who suffered HIE, eight children, who were subsequently diagnosed as suffering from genetic or metabolic syndromes or who presented with other neonatal complications, such as neonatal meningitis, were excluded from the study. Seven children were in a very unstable clinical a n d t i o n and ched before a structured neurological examination could be completed. Zn seventeen c h d h the forms were incomplete for various reasons, such as infants under strong sedation etc. The remaining cohort consisted of 58 infants. lbenty of the 58 were born or transferred soon after birth to the Hammersmith Hospital. The remaining 38 were referred in the neonatal period for a neurological opinion. The term HIE is used to describe term infants (gestation >37 weeks) who show signs of fetal distress prior to delivery, who have abnormal Apgar scores and require resuscitation at birth and who show specific neurological abnormalities during the first 24 hours aff.er delivery. Signs of fetal distress include abnormal cardiotocograph recordings such as decreased variability, late decelerations and a baseline bradycardia, with or without meconiurn-stained liquor. A fetal scalp pH of less than 7.20 is also indicative of fetal hypoxia. All these data were obtained from the neonatal and paediatric notes. According to the classification provided by Sarnat and Sarnat (19), 16 of them had grade 1 HIE, 37 grade 2 and 5 grade 3.
Abstract
Neurological examination and magnetic resonance imaging were performed i n the neonatal period in 58 full-term infants who presented w i t h hypoxic-ischaemic encephalopathy. The aim of this study was t o evaluate the patterns of neurological abnormalities and their correlation to brain lesions on MRI. The prognostic value of the neurological examination at different times in the neonatal period was also evaluated. Our results showed that specific clinical patterns can be observed i n infants with HIE and these can be related t o the pattern of lesion on brain MRI. In particular. while infants with normal MRI or minimal changes tend t o show only minor tone abnormalities after the first week of life, infants w i t h more severe lesions such as basal ganglia lesions show persistent and diffuse neurological abnormalities. Infants w i t h white matter changes but intact basal ganglia show a different clinical pattern with improved sucking reflex and behaviour and less severe tone abnormalities. Our results also suggested that the neurological examination performed after the second week of life is a reliable indicator of outcome in these infants. Key words: Neurological examination MRI
Original article
Mercuri' A. ~ u u e t t a ~ ~eena ~aat.1.'
Frances cowan' a ~ urt h e~ rfordl Serena ~ o u n s e l l * Maria ~ a p a d i m i t r i o u ' G. cioni3 Lilly Dubowit.'
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Neonatal Neurological Examination in lnfants with Hypoxic lschaemic Encephalopathy: Correlation with MRI Findings
'~epartmentof Paediatrics, Hammersmith Campus, Imperial College, London, '~obert ~teinerMRI Unit, Hammersmith Campus, Imperial College, London, and 'stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Italy
- Newborn - HIE -
Introduction
The advent of new imaging and neurophysiological techniques in the last two decades has not reduced the value of the clinical examination in the neurological assessment of the newborn but has actually enhanced it. The integrated use of clinical and imaging findings has improved our knowledge on the relationship between brain structure and function allowing the identification of specific clinical patterns associated with brain lesions seen on imaging (5, 6, 8, 9, 21). Most of the previous studies which have correlated clinical and imaging findings in the neonatal period, however, have mainly focused on preterm i n f a n t s and on the patterns of lesions that are more commonly observed in them, such as intraventricular haemorrhages or periventricular leukornalacia (5, 6, 8, 9, 21). Less is known on the relationship between imaging findings and the evolution of clinical signs in the neonatal period in full-term infants who suffered perinatal asphyxia. The aim of this study has been to evaluate whether the neurological examination performed at different times after birth can 1)identify clirucal patterns which can be related to specific patterns of brain lesions; 2) provide prognostic information on the neurodevelopment of these i n f a n t s .