新生儿脑梗死19例临床分析

Clinical analysis of 19 preterm and term infants with cerebral infarction

目的探讨早产儿及足月儿脑梗死的临床特征。方法回顾分析2013年1月1日至2018年1月31日经影像学确诊的19例新生儿脑梗死患者的临床资料,并比较早产儿及足月儿脑梗死的临床特征、影像学及预后的差异。结果19例脑梗死新生儿中足月儿8例、早产儿11例。8例足月儿均为缺血性脑梗死;早产儿中3例为缺血性脑梗死,8例为出血性脑梗死。11例缺血性梗死患儿中,9例梗死部位为大脑中动脉;8例出血性脑梗死则均为脑室旁静脉性梗死。发病因素包括血管发育异常6例、围生期缺氧6例、重症感染3例、先天凝血因子缺乏2例,4例病因不明,5例为多因素。8例足月儿脑梗死患者中6例表现为惊厥,发生在生后4天内;11例早产儿起病无特异性,仅2例表现为惊厥,发生于生后7天内。好转出院12例;家属放弃治疗7例,放弃治疗后死亡5例。结论足月儿和早产儿均可发生新生儿脑梗死,临床表现无特异性,影像学检查有助确诊。

Objective To explore the etiology,clinical manifestation,imaging and outcome of preterm and term infants with cerebral infarction.Methods Medical records of the newborn in our hospital during January 1st,2013 to January 31th,2018 were retrospectively analyzed.Meanwhile,differences of clinical features,imaging and outcome of neonatal cerebral infarction between preterm and term infants were compared.Results Among 19 infants with cerebral infarction,8 cases were term infants,and 11 were preterm infants.All of term infants were with ischemic cerebral infarction(8/8),while preterm infants are mostly affected with hemorrhagic cerebral infarction(8/11).The ischemic infarction is frequently found in the middle cerebral artery(9/11,81.8%),and the hemorrhagic cerebral infarction often occurred in the cerebral ventricular venous infarction for prematuem infants(8/8,100%).Causes include vascular dysplasia(6),perinatal hypoxia(6),severe infection(3),congenital lack of clotting factors(2),multiple causes participation(5)and unknown etiology(4).There was no significant difference between the preterm group and term group in perinatal risk factor analysis.The cerebral infarction of the term infants mostly manifested convulsion(6/8)within 4 days after birth.There was no specificity in the onset of preterm infants,2 cases were characterized by convulsions,and the remaining had no specific clinical manifestations,(9/11)occurred within 7 days after birth.Among the 19 cases,12 patients were in remission and then discharged from the hospital,while 7 cases didn’t receive the treatment as their parents gave up the treatment,5 of them died shortly.Conclusions Neonatal cerebral infarction may both occur in full term and preterm infants,but their clinical manifestations are different.In particular,preterm infants do not have any specific clinical manifestations that require imaging examination to confirm diagnosis.The clinical complications are usually severe with large scope of infarction and poor prognosis.