Диагностические критерии формирования морфологических изменений головного мозга у детей с перинатальным гипоксическим поражением нервной системы

Abstract

Objective. To determine the diagnostic criteria of morphological changes in children with perinatal hypoxic brain injury. Patients and Methods. The study included 58 full-term newborns with severe hypoxic brain damages who, according to MRI of brain performed on 2–10 days of life, had low rates of diffusion processes of the white matter of the cerebral hemispheres – diffusion coefficient (Ds) of less than 1.35 × 10–3 mm2/s. Children received treatment in the intensive care unit of the regional perinatal center of Krasnodar Children's Clinical Hospital. Follow-up MRI was performed at the 4th week of life. Observation of children was carried out up to 2 years of age. Results. Denominated destructive changes in the nervous tissue with multicystic encephalomalacia were identified in 23 (40%) newborns (group 1). The range of values of Ds of the white matter of cerebral hemispheres in children of the 1st group was 0.60–1.11 × 10–3 m2/s. In the remaining 35 (60%) children (group 2), hypoxic brain damage was manifested by the expansion of the subarachnoid space, the interhemispheric fissure, and the lateral ventricles. These changes were reflected in a decrease in the volume of brain parenchyma with the persistent neurological deficiency in the future (disorders of psycho-speech development, cerebral palsy, structural epilepsy). The range of values of the Ds of the white matter of the cerebral hemispheres in children of the second group was 1.14–1.35 × 10–3 mm2/s. Conclusions. Using the modern high-tech methods of neuroimaging makes it possible to determine the diagnostic criteria for damaging effects of hypoxia in children with perinatal brain injury and in early stage to identify morphological changes in brain tissue. Key words: hypoxia, brain, children, magnetic resonance imaging, neurological outcome