PDF(Pubmed)
Abstract：
Necrotizing enterocolitis (NEC) and periventricular leukomalacia (PVL) are relatively common conditions in premature infants with low birth weight (VLBW). However, in the current literature, there are limited case reports of patients with concomitant NEC and PVL. We report a case of a premature female born at a gestational age of 25 weeks and five days who developed cystic intracranial lesions after emergent bowel resection due to NEC. Transcranial ultrasound and magnetic resonance imaging confirmed the presence of cystic PVL in the right middle cerebral artery distribution. Several observational studies note the association between spontaneous intestinal perforation, surgical NEC, and the presence of cystic PVL. When infants are unresponsive to medical management for NEC, exploratory laparotomy with resection of the necrotic or perforated intestine is indicated. However, infants treated surgically have poorer neurodevelopmental outcomes than those with medical therapy. Pathogenesis of neurodevelopmental impairment in preterm infants undergoing surgery involves dysfunctional cerebrovascular autoregulation (CAR), which is associated with harmful changes in cerebral perfusion that lead to neuronal injury. Ill preterm infants, such as those with NEC, cannot regulate cerebral perfusion appropriately, and impaired CAR may be present in more than half the preterm infants during laparotomy. Impaired CAR leads to poor cerebral perfusion that potentiates neuronal injury, such as PVL. This case also brings awareness to the need for adherence to screening practices for white matter injury in critical NICU patients through cost-effective transcranial ultrasound.
摘要：
坏死性小肠结肠炎（NEC）和脑室周围白质软化（PVL）是低出生体重（VLBW）早产儿中相对常见的疾病。然而,在当前的文献中，合并NEC和PVL患者的病例报告有限.我们报告了一例早产女性，胎龄为25周零5天，由于NEC而在紧急肠切除术后出现了颅内囊性病变。经颅超声和磁共振成像证实右侧大脑中动脉分布存在囊性PVL。一些观察性研究注意到自发性肠穿孔之间的关联，NEC外科,和囊性PVL的存在。当婴儿对NEC的医疗管理没有反应时，建议剖腹探查术切除坏死或穿孔的肠。然而,与接受药物治疗的婴儿相比,接受手术治疗的婴儿神经发育结局较差.接受手术的早产儿神经发育障碍的发病机制涉及功能失调的脑血管自动调节（CAR），这与导致神经元损伤的脑灌注的有害变化有关。早产儿，比如那些有NEC的人，不能适当调节脑灌注，在剖腹手术中，超过一半的早产儿可能存在CAR受损。受损的CAR导致脑灌注不良，从而增强神经元损伤，例如PVL。此病例还使人们意识到，通过具有成本效益的经颅超声检查，必须遵守NICU危重患者白质损伤的筛查方法。
