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]

Benjak, Vesna (2011) 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]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

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.

Abstract in Croatian

U nedonoščadi postoji visoka incidencija periventrikularne leukomalacije. Ta oštećenja odnose se na križanja komisuralnih, projekcijskih i asocijativnih putova koji su u bliskom topografskom odnosu s lateralnim komorama. Procjenjivali smo u kojoj mjeri abnormalnosti ultrazvučnih nalaza u glavnom, frontalnom i okcipitalnom križanju putova u nedonoščadi koreliraju s promjenama površine mediosagitalnog presjeka korpusa kalozuma kvantitativno procjenjenih magnetskom rezonancom u terminskoj dobi i kliničkim parametrima skupljenim u bodovni sustav SNAP-II i SNAPPE-II. Istraživana skupina sastojala se od 54 nedonoščeta čija je prosječna težina iznosila 1140 g (st.dev. 350,944) i gestacijska dob bila 28,28 tj (st.dev. 2,543) i 12 novorođenčadi rođene na termin s perinatalnim oštećenjem mozga. Korelirali smo ultrazvučni nalaz ehogenosti križanja putova u prvih 7 dana, te drugi ultrazvučni pregled s nalazom magnetske rezonance u postnatalnoj dobi koja odgovara terminu i kliničkim parametrima u prvom postnatalnom danu pomoću bodovnog sustava SNAP-II i SNAPPE-II. Korpus kalozum u mediosagitalnom presjeku MR smo vlastoručno obcrtali te pomoću naprednog računalnog programa podijelili u 99 segmenata i izračunali površinu. Naši rezultati potvrdili su naša očekivanja. Presjek površine korpus kalozuma je dobar pokazatelj ukupnih promjena periventrikularnih križanja putova, proširenja ventrikularnog sustava i stanjenja bijele tvari. Za procjenu oštećenja pojedinih periventrikularnih lezija i korpus kalozuma i topografski povezanih kalozalnih projekcija potrebno je korpus kalozum podijeliti u segmente a „grupiranje „ u sedam komponenti za potrebe statistike pokazalo se značajnim pokazateljem za analizu oštećenja periventrikularne bijele tvari u prematurusa. Istodobno klinički nalazi bodovanja po SNAP-II i SNAPPE-II nisu posve pouzdan pokazatelj budućeg strukturnog oštećenja mozga, SNAPPE-II niskih vrijednosti ukazuje na značajnu korelaciju s nalazom površina presjeka korpus kalozuma i ultrazvučnim nalazom. Ukoliko se izdvoji skupina djece koja zahtijeva strojnu ventilaciju (zbog težeg stanja i nezrelosti dišnog sustava) u tom slučaju postoji povezanost s nalazom ukupne površine presjeka korpus kalozuma. To ukazuje na složenost patogeneze hipoksičnih i hipoksično ishemičnih oštećenja mozga u prijevremeno rođene djece. Nalaz magnetske rezonance u terminskoj dobi za djecu rođenu prijevremena je zlatni standard za kliničke ustanove i preduvjet uspješnog praćenja i habilitacijskih postupaka za perinatalno oštećenu novorođenčad.

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