Abstract
Background: Neonatal hyperbilirubinemia is indeed common. However, severe nerve injuries and bilirubin encephalopathy are rare and only occur in the unusual cases of extreme hyperbilirubinemia. Objectives: To investigate brain magnetic resonance imaging (MRI) changes and their correlations with perinatal predisposing factors in neonates with indirect hyperbilirubinemia, via regions of interest (ROIs) analysis. Methods: Seventy-six neonates with a gestational age of ≥35 weeks diagnosed with neonatal indirect hyperbilirubinemia or bilirubin encephalopathy all underwent brain MRI during hospitalization. Depending on peak total serum bilirubin (TSB), they were assigned to group A ( μmol/L), C (≥42 μmol/L μmol/L), or D (≥428 μmol/L). The globus pallidus and the white matter around the anterior horn of the lateral ventricle and posterior horn of the lateral ventricle were selected as the ROIs. Average optical densities (AODs) of the ROIs and the cerebrospinal fluid region were measured. The ratio between the AODs was designated as the relative optical density (ROD), and used to determine relative signal intensity. Results: RODs of the globus pallidus were significantly lower in group D than in all other groups. TSB and the ratio of TSB to serum albumin concentration (B/A) was significantly negatively correlated with ROD in theglobus pallidus. Corrected age was significantly negatively correlated with the ROD of the ROIs. Conclusions: Semi-quantitative image analysis is a feasible method to assess conventional brain MRI for neonatal indirect hyperbilirubinemia. The signal intensity of the globus pallidus in T1-weighted images was significantly correlated with TSB level and B/A.
Highlights
As one of the most common clinical conditions occurring during the neonatal period, neonatal indirect hyperbilirubinemia has attracted substantial attention as it may cause bilirubin encephalopathy, which describes the clinical central nervous system findings caused by bilirubin toxicity to the basal ganglia and various brainstem nuclei, a kind of severe neonatal brain injuries
1536 patients who were initially diagnosed with neonatal indirect hyperbilirubinemia or bilirubin encephalopathy and admitted to the Second XiangYa Hospital of Central South University between October 2009 and October 2013 were screened according to the following inclusion criteria: 1) The patient was initially diagnosed with neonatal indirect hyperbilirubinemia or bilirubin encephalopathy; 2) complete and thorough clinical data and laboratory data were available; 3) informed consent for magnetic resonance imaging (MRI) was given by the parents of the patients and a conventional MRI scan was performed during hospitalization(average gestational age was 40.6 ± 1.7 weeks); 4) the patient was of a GA ≥35 weeks
T2-weighted image (T2WI) images of conventional brain MRI were analyzed in this study and no differences in the Average optical densities (AODs) of the cerebrospinal fluid (CSF), which was used as control, were found among all subjects in this study, this analysis could not be used to objectively calculate the relative optical density (ROD) of regions of interest (ROIs)
Summary
As one of the most common clinical conditions occurring during the neonatal period, neonatal indirect hyperbilirubinemia has attracted substantial attention as it may cause bilirubin encephalopathy, which describes the clinical central nervous system findings caused by bilirubin toxicity to the basal ganglia and various brainstem nuclei, a kind of severe neonatal brain injuries. With increased scientific understanding of bilirubin encephalopathy, the clinical significance of conventional brain magnetic resonance imaging (MRI) for the diagnosis of bilirubin encephalopathy has increased [1]. Objectives: To investigate brain magnetic resonance imaging (MRI) changes and their correlations with perinatal predisposing factors in neonates with indirect hyperbilirubinemia, via regions of interest (ROIs) analysis. Methods: Seventy-six neonates with a gestational age of ≥35 weeks diagnosed with neonatal indirect hyperbilirubinemia or bilirubin encephalopathy all underwent brain MRI during hospitalization. TSB and the ratio of TSB to serum albumin concentration (B/A) was significantly negatively correlated with ROD in theglobus pallidus. Corrected age was significantly negatively correlated with the ROD of the ROIs. Conclusions: Semi-quantitative image analysis is a feasible method to assess conventional brain MRI for neonatal indirect hyperbilirubinemia. The signal intensity of the globus pallidus in T1-weighted images was significantly correlated with TSB level and B/A
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