PDF(Pubmed)
Abstract：
UNASSIGNED: Congenital heart disease (CHD) is the most common birth defect, affecting 1% of children who are born in the United States each year. Children with hypoplastic left heart syndrome, a type of critical CHD, are at high risk for neurodevelopmental disabilities, which are conditions that can affect motor, language, and cognitive development. In children with critical CHD, the severity and prevalence of their motor delays is most pronounced in infancy.
UNASSIGNED: We present a case of a former late preterm male with hypoplastic left heart syndrome and history of hypoxic ischemic encephalopathy, who was diagnosed with spastic diplegic cerebral palsy in the setting of periventricular leukomalacia. Like many children with critical CHD, this child had gross motor delays and tone abnormalities in infancy. However, unlike many children with CHD, he continued to have neurologic differences that prompted additional evaluation through a Cardiac Neurodevelopmental Program. He was diagnosed with spastic diplegic cerebral palsy based upon clinical history and physical examination. Ancillary testing showed periventricular leukomalacia on brain magnetic resonance imaging (MRI); this finding was consistent with his clinical diagnosis.
UNASSIGNED: This is an interesting case report of spastic diplegic cerebral palsy in a late preterm infant with critical CHD. When making a diagnosis of cerebral palsy, it is important to consider the etiology of the motor impairment. Selective vulnerability may have played a factor in this child\'s condition. The most vulnerable part of the neonatal brain is the periventricular white matter; cerebral hypoxia can lead to periventricular leukomalacia. Children with CHD have brain dysmaturity beginning in-utero. Thus, it is possible that this child\'s brain dysmaturity may have increased his susceptibility to periventricular leukomalacia. Because most children with CHD have gross motor delays in infancy, it may be challenging to make a definitive diagnosis of cerebral palsy in an infant with critical CHD. Children with cerebral palsy have early motor delays that persist throughout life. It is the identification of persistent motor impairments through repeat evaluations that enabled this child\'s cerebral palsy diagnosis. This illustrates the importance of developmental surveillance in children with critical CHD.
UNASSIGNED: We present a case of a former late preterm male with hypoplastic left heart syndrome and history of hypoxic ischemic encephalopathy, who was diagnosed with spastic diplegic cerebral palsy in the setting of periventricular leukomalacia. Like many children with critical CHD, this child had gross motor delays and tone abnormalities in infancy. However, unlike many children with CHD, he continued to have neurologic differences that prompted additional evaluation through a Cardiac Neurodevelopmental Program. He was diagnosed with spastic diplegic cerebral palsy based upon clinical history and physical examination. Ancillary testing showed periventricular leukomalacia on brain magnetic resonance imaging (MRI); this finding was consistent with his clinical diagnosis.
UNASSIGNED: This is an interesting case report of spastic diplegic cerebral palsy in a late preterm infant with critical CHD. When making a diagnosis of cerebral palsy, it is important to consider the etiology of the motor impairment. Selective vulnerability may have played a factor in this child\'s condition. The most vulnerable part of the neonatal brain is the periventricular white matter; cerebral hypoxia can lead to periventricular leukomalacia. Children with CHD have brain dysmaturity beginning in-utero. Thus, it is possible that this child\'s brain dysmaturity may have increased his susceptibility to periventricular leukomalacia. Because most children with CHD have gross motor delays in infancy, it may be challenging to make a definitive diagnosis of cerebral palsy in an infant with critical CHD. Children with cerebral palsy have early motor delays that persist throughout life. It is the identification of persistent motor impairments through repeat evaluations that enabled this child\'s cerebral palsy diagnosis. This illustrates the importance of developmental surveillance in children with critical CHD.
摘要：
先天性心脏病（CHD）是最常见的出生缺陷，影响每年在美国出生的儿童的1％。左心发育不良综合征患儿,一种严重的冠心病,神经发育障碍的风险很高，这些条件会影响电机，语言,和认知发展。在患有严重冠心病的儿童中，其运动延迟的严重程度和患病率在婴儿期最为明显。
■我们介绍一例前晚期早产男性左心发育不全综合征，有缺氧缺血性脑病病史，在脑室周围白质软化的情况下被诊断为痉挛型双瘫性脑瘫。像许多患有严重冠心病的孩子一样，这个孩子在婴儿期有严重的运动延迟和音调异常。然而,与许多患有冠心病的儿童不同，他仍然存在神经系统差异,这促使通过心脏神经发育计划进行额外评估.根据临床病史和体格检查，他被诊断为痉挛型双瘫性脑瘫。辅助检查在脑磁共振成像（MRI）上显示脑室周围白质软化；这一发现与他的临床诊断一致。
■这是一个有趣的病例报告，报告了患有严重冠心病的晚期早产儿的痉挛型双瘫性脑瘫。在诊断脑瘫时，重要的是要考虑运动损害的病因。选择性漏洞可能是这个孩子状况的一个因素。新生儿大脑中最脆弱的部位是脑室周围白质；脑缺氧可导致脑室周围白质软化。患有CHD的儿童在子宫内开始脑发育障碍。因此，这个孩子的大脑发育异常可能增加了他对脑室周围白质软化的易感性。因为大多数患有冠心病的儿童在婴儿期有严重的运动延迟，对于患有危重CHD的婴儿,明确诊断脑瘫可能具有挑战性.脑瘫儿童的早期运动延迟持续一生。通过重复评估来识别持续性运动障碍，从而可以诊断该儿童的脑瘫。这说明了在患有严重CHD的儿童中进行发育监测的重要性。
■我们介绍一例前晚期早产男性左心发育不全综合征，有缺氧缺血性脑病病史，在脑室周围白质软化的情况下被诊断为痉挛型双瘫性脑瘫。像许多患有严重冠心病的孩子一样，这个孩子在婴儿期有严重的运动延迟和音调异常。然而,与许多患有冠心病的儿童不同，他仍然存在神经系统差异,这促使通过心脏神经发育计划进行额外评估.根据临床病史和体格检查，他被诊断为痉挛型双瘫性脑瘫。辅助检查在脑磁共振成像（MRI）上显示脑室周围白质软化；这一发现与他的临床诊断一致。
■这是一个有趣的病例报告，报告了患有严重冠心病的晚期早产儿的痉挛型双瘫性脑瘫。在诊断脑瘫时，重要的是要考虑运动损害的病因。选择性漏洞可能是这个孩子状况的一个因素。新生儿大脑中最脆弱的部位是脑室周围白质；脑缺氧可导致脑室周围白质软化。患有CHD的儿童在子宫内开始脑发育障碍。因此，这个孩子的大脑发育异常可能增加了他对脑室周围白质软化的易感性。因为大多数患有冠心病的儿童在婴儿期有严重的运动延迟，对于患有危重CHD的婴儿,明确诊断脑瘫可能具有挑战性.脑瘫儿童的早期运动延迟持续一生。通过重复评估来识别持续性运动障碍，从而可以诊断该儿童的脑瘫。这说明了在患有严重CHD的儿童中进行发育监测的重要性。
