ABSTRACT
Objective:To study the clinical features of enlarged subarachnoid space (ESS) and its effects on brain parenchymal volume in preterm infants.Methods:From November 2014 to November 2021, a retrospective case-control study was performed on preterm infants admitted to neonatal intensive care unit of our hospital with gestational age (GA)<32 w and having brain MR imaging. At full-term of corrected GA, the superior sagittal sinus-cortical spacing (sinocortical width, SCW) was measured on brain MR imaging. The infants were assigned into ESS and non-ESS groups according to whether SCW was greater than 3.5 mm. Perinatal factors, preterm-related complications and the brain volumetric indices were compared between the two groups.Results:A total of 160 preterm infants with GA<32 w were included, 76 (47.5%) were in the ESS group, SCW:(4.48±1.47) mm, and 84 were in the non-ESS group, SCW: (2.49±0.68) mm. GA and birth weight (BW) of the ESS group were significantly smaller than the non-ESS group [(28.7±2.6) weeks vs.(29.8±2.5) weeks, (1 114±279)g vs. (1 208±290)g]( P<0.05). Small GA was an independent risk factor for the development of ESS in preterm infants with GA<32w ( OR=1.217,95% CI 1.017~1.457, P=0.032). On MR imaging, the ESS group had significantly higher total cranial cavity volume than the non-ESS group [(354.1±33.6)ml vs. (316.9±36.3) ml] ( P<0.05). No significant differences existed on head circumference, gray matter volume and white matter volume between the two groups ( P>0.05). Conclusions:ESS is common in premature infants and correlated with GA and BW. Small GA is an independent risk factor for ESS in preterm infants. ESS shows little effects on head circumference and brain parenchymal volume during early postnatal period.
ABSTRACT
Objective To study the influence of optimization of parenteral nutrition strategy on the head circumference and brain volume in very low birth weight infants.Method Very low birth weight infants admitted to NICU of University of Hong Kong-Shen Zhen Hospital from January 2014 to June 2016 were assigned to optimized group and conventional group according to early nutritional strategies.Early parenteral nutrition intakes were increased in infants assigned to optimizated group.Nutrition intakes and parenteral nutrition related complications within 28 days after birth were compared between groups.All participants underwent brain MRI at corrected gestational age (CGA) 36 weeks.Head circumference and brain volume measured by MRI were also compared between groups.Result A total of 40 preterm infants were recruited,with 20 infants in each group.There were no significant differences in the gestational age,birth weight,brain injury and intrauterine growth retardation rate between the two groups (P ＞ 0.05).The average daily total calories and protein intake of optimization group during the first 4 weeks were significantly higher than those of conventional group,respectively [(101.5 ± 3.1) kcal/ (kg · d) vs.(96.1 ± 3.2)kcal/(kg·d),(3.07±0.16) g/(kg·d) vs.(2.90±0.11) g/(kg· d),P＜ 0.05].Theaverage daily calorie intake and protein intake of optimization group was increased by 4.7％ and 5.5％,compared with those of conventional group.Compared with the conventional group,head circumference and total brain volume of optimized group at CGA 36 weeks was improved by 3.3％ and 4.1％,and the differences were both statistically significant (P ＜ 0.05).Cerebral cortex gray matter volume of optimized group was significantly higher than that of conventional group [(102.4 ± 4.9) ml vs.(96.4 ± 4.6) ml,P ＜ 0.05].There was no significant difference in brain white matter,deep gray matter and cerebrospinal fluid volume between the two groups (P ＞ 0.05).Conclusion The optimization of parenteral nutrition within the framework of active nutrition strategy of preterm infants can further improve the early nutritional intake of preterm infants,leading to the increase of the head circumference and the gray matter volume of the cerebral cortex.