РАННЯЯ ДИАГНОСТИКА ПОСЛЕДСТВИЙ НАРУШЕНИЯ МОЗГОВОГО КРОВООБРАЩЕНИЯ У ДЕТЕЙ С ПЕРИНАТАЛЬНЫМ ГИПОКСИЧЕСКИМ ПОРАЖЕНИЕМ ГОЛОВНОГО МОЗГА

Abstract

Exposure to hypoxia in the perinatal period leads to significant structural changes in the brain (B), which are reflected in the further neuropsychic development of the child. In this regard, the assessment of the state of brain structures and cerebral circulation in young children using high-tech diagnostic methods is of particular importance. Objective of the study: to analyze the indicators of magnetic resonance imaging (MRI) of B structures for early diagnosis of the consequences of cerebrovascular accident in children who underwent hypoxia in the perinatal period. Materials and methods of research: single-center prospective open non-randomized longitudinal observational uncontrolled study were included in 144 newborns, who were stationed in the intensive care unit and intensive therapy units (ICU) of the Regional Perinatal Center of the Krasnodar Regional Clinical Hospital for severe asphyxia and/or intrauterine hypoxia. Among those included in the study were 76 full-term babies (FTBs) (group 1) and 68 premature newborns (PNs) (group 2). The gestational age (GA) of PNs was 29–37 (32.7±2.6) weeks. The sex composition of the groups (boys/girls) did not differ statistically significantly: n=41/35 – 54%/46% in the 1st group versus n=38/30 – 56%/44% in the 2nd group (p=0.816). All children underwent MRI of the B on 2–10 day of life with the determination of the measurement of diffusion coefficient (DC) in the mode of diffusion-weighted images. Children were observed up to 3 years of age in the follow-up department of the Krasnodar Krai Regional Children's Clinical Hospital. Results: in the PNs group, 35 (51%) GA was 29–32 weeks, in 33 (49%) children – 33–37 weeks. The revealed consequences of hypoxic B damage in children were determined by morphological changes in the nervous tissue and were characterized by objective MRI indicators. Analysis of the data obtained made it possible to identify the ranges of B ADI values, reflecting the subsequent neurological outcome. Further formation of neurological deficits (infantile cerebral palsy, disorders of psychoverbal development, symptomatic epilepsy) was noted in PNs with relatively low DC values 0.69–1.30×10–3mm2/s and 0.64–1.07×10–3mm2/s – for white and gray matter of the large hemispheres of the B, respectively; in PNs with relatively low and relatively high DC values of the white matter of the large hemispheres of the B 1.05–1.24×10–3mm2/s and 1.88–2.00×10–3mm2/s, gray matter of the B cerebral hemispheres 0, 93–1.06×10–3mm2/s and 1.36–1.47×10–3mm2/s. The effect of hypoxia in the intrapartum period was manifested by low DC indices, reflecting manifestations of cerebral ischemia. A significant increase in DC indicators was observed in hypoxic brain damage in the antenatal period and characterized atrophic changes in the nervous tissue. Based on the results of the analysis of B DC indices, reflecting manifestations of cerebral ischemia, statistically significant (p<0.01) direct highly correlated relationships were revealed between the DC indices of the white matter of the cerebral hemispheres and the indices of the DC of the gray matter of the cerebral hemispheres (rxy=0.975), the indices of the DC of the midbrain (rxy=0.714) in FTBs, between the indicators of the DC of the white matter of the cerebral hemispheres and the indicators of the DC of the gray matter (rxy=0.923), the indicators of the DC of the midbrain (rxy=0.787) in the PBs, which indicates the global nature of the hypoxic damage to the B. Conclusions: early diagnosis of cerebrovascular accidents in children using MRI data makes it possible to predict the further neurological outcome of perinatal hypoxic brain injures, contributes to the timely implementation of therapeutic and rehabilitation measures based on an objective assessment of the identified disorders.