Strukturne promjene korpus kalozuma i periventrikularnih križanja putova u terminskoj dobi u nedonoščadi s abnormalnim kliničko-laboratorijskim nalazima u prvom postnatalnom tjednu Structural changes of the corpus callosum and periventricular crossroads of pathways at term-equivalent age in preterm born infants with abnormal clinical and laboratory findings during the first postnatal week

摘要

There is a high incidence of periventricular leukomalacia in preterm infants. These lesions effect the crossroads of commissural, projectional and associative pathways which are in close topographical connection with the lateral ventricles. We analyzed to which degree abnormalities on brain ultrasound of the main, frontal and occipital crossroads of pathways in preterm infants correlate with changes in the midsagittal area of the corpus callosum at term-equivalent age and clinical parameters collected within the points system SNAP-II and SNAPPE-II. The study group consisted of 54 preterm infants whose average weight was 1140g (SD 350,94) and whose gestational age was 28,28 weeks (SD 2,54) and 12 term-born neonates. The brain ultrasound performed in the first 7 days after birth shows that it is a less trustworthy method for the estimate of periventricular damage of the white matter than magnetic resonance. However, with the second ultrasound performed at the same time as magnetic resonance, we showed a correlation to the damage of the corpus callosum. The midsagittal area of the corpus callosum is a good indicator of overall changes of periventricular crossroads of pathways, widened ventricular system and thinning of white matter. To measure the correlation of individual periventricular lesions and the corpus callosum, it is necessary to divide the corpus callosum into segments which were subsequently grouped into seven components using principal component analysis. This was shown to be a significant indicator for analysis of the damage to the periventricular white matter in the preterm born infant. At the same time, SNAP-II and SNAPPE-II scores are not a trustworthy indicator of future structural damage of the brain. A low SNAPPE-II score points to a significant correlation between results of the midsagittal area of the corpus callosum and the ultrasound results. We additionally analyzed the effects of mechanical ventilation on midsagittal corpus callosum area, and showed a correlation between duration of mechanical ventilation and corpus callosum area. This points to the multifactorial nature of pathogenesis of hypoxic-ischemic lesions of the brain in prematurely born children. Magnetic resonance at term-equivalent age for children born prematurely is the golden standard for clinical institutions and a pre-requisite of successful follow-up and habilitation for perinataly lesioned newborns.