en پیش‌بینی کم‌وزنی، کوتاه‌قدی و میکروسفالی بر اساس توالی تصویربرداری d‌iffusion weighted imaging مغز در نوزادان با مرحله 2 انسفالوپاتی هیپوکسیک-ایسکمیک: یک مطالعه از نوع پیگیری Perinatology Original Article Original Article <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">کاهش اکسیژن&shy;رسانی و جریان خون مغز طبق تعریف انسفالوپاتی هیپوکسیک-ایسکمیک (</span></span><span dir="LTR" style="font-size:10.0pt">HIE</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) در 1 تا 8 تولد از هر 1000 تولد کامل در کشورهای توسعه&shy;یافته و تا 26 مورد در هر 1000 در کشورهای در حال توسعه رخ می&shy;دهد.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">وضعیت رشد بازماندگان تولد </span></span><span dir="LTR" style="font-size:10.0pt">HIE</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">به اندازه کافی ارزیابی نشده است. در این مطالعه پارامترهای رشد (وزن، قد و دور سر) نوزادان مبتلا به سرنات مرحله 2 </span></span><span dir="LTR" style="font-size:10.0pt">HIE</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در ماه‌های 6، 10 و 12 و ارتباط آن با یافته‌های تصویربرداری وزنی با انتشار مغز نوزادان (</span></span><span dir="LTR" style="font-size:10.0pt">DWI</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) مورد بررسی قرار گرفت.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"></span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مواد و روش&shy; ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">پارامترهای رشد 35 نوزاد با سن حاملگی بالاتر از 34 هفته که با مرحله 2 </span></span><span dir="LTR" style="font-size:10.0pt">HIE</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در بخش مراقبت‌های ویژه نوزادان بیمارستان شهید صدوقی یزد از اسفند 1399 تا اسفند 1400 بستری شده بودند، از پرونده بیماران استخراج شد. ارتباط با یافته&shy;های توالی </span></span><span dir="LTR" style="font-size:10.0pt">DWI</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مغز نوزادان ارزیابی شد.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">15 دختر و 20 پسر با میانگین وزن هنگام تولد 8/221 </span></span><span lang="FA" style="font-size:10.0pt">&plusmn;</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> 3/2880 گرم مورد بررسی قرار گرفتند. تصویربرداری رزونانس مغناطیسی معمولی (</span></span><span dir="LTR" style="font-size:10.0pt">MRI</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) و </span></span><span dir="LTR" style="font-size:10.0pt">DWI</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در 6 نوزاد (1/%17) و 18 نوزاد (4/%51) غیرطبیعی بود. غیرطبیعی&shy;ترین یافته </span></span><span dir="LTR" style="font-size:10.0pt">DWI</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">سیگنال بالا در گانگلیون قاعده/تالاموس در 9 نوزاد (7/%25) بود. </span></span><span dir="LTR" style="font-size:10.0pt">DWI</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">غیرطبیعی در نوزادان مبتلا به تشنج و در نوزادان کم&shy;وزن بیشتر است. روزهای بستری در نوزادان با </span></span><span dir="LTR" style="font-size:10.0pt">DWI</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">غیرطبیعی طولانی&shy;تر بود. میکروسفالی در&nbsp;&nbsp;&nbsp; &nbsp;12 ماهگی در کودکان مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt">DWI</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">غیرطبیعی بیشتر بود.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"></span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتیجه&shy; گیری: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در بازماندگان </span></span><span dir="LTR" style="font-size:10.0pt">HIE</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نوزادان متوسط، توالی غیرطبیعی </span></span><span dir="LTR" style="font-size:10.0pt">DWI</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مغز ممکن است رشد نامناسب سر را پیش‌بینی کند و برای بهبود رشد نیاز به مداخلات پزشکی و تغذیه‌ای دقیق دارند.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"></span></span></b></span></span></span></span></span><br> &nbsp; <div style="text-align: justify;"><span style="font-family:Times New Roman;"><span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Background:</span></b><span style="font-size:12.0pt"> Hypoxic-ischemic encephalopathy (HIE), caused due to reduced oxygenation and brain blood flow, occurs in 1-8 per 1000 live full-term births in developed countries and up to 26 per 1000 live in the developing world. The growth status of survivors of birth HIE has not been evaluated sufficiently.</span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Objective:</span></b> <span style="font-size:12.0pt">This study evaluated<a name="_Hlk136764063">, the </a></span><span style="font-size:12.0pt">growth parameters (weight, height, and head circumference</span><span style="font-size:12.0pt">) of neonates with Sarnat stage.2 of HIE at 6, 10, and 12 months and <a name="_Hlk136762437">its relationship with findings of neonatal brain </a></span><span style="font-size:12.0pt">diffusion-weighted imaging (</span><span style="font-size:12.0pt">DWI) sequence.</span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Materials and Methods:</span></b><span style="font-size:12.0pt"> Medical records and growth parameters of 35 neonates </span><span lang="EN" style="font-size:12.0pt">with gestational age > 34 wk </span><span style="font-size:12.0pt">who </span><span lang="EN" style="font-size:12.0pt">were admitted</span><span style="font-size:12.0pt"> with</span> <span style="font-size:12.0pt">stage.2 of HIE</span><span lang="EN" style="font-size:12.0pt"> in </span><span style="font-size:12.0pt">Neonatal Intensive Care Unit of Shahid Sadoughi hospital, Yazd, Iran from March 2021-March 2022</span><span lang="EN" style="font-size:12.0pt">, </span><span style="font-size:12.0pt">and its relationship with neonatal brain DWI sequence finding was evaluated.</span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Results:</span></b> <span style="font-size:12.0pt">15 girls and 20 boys with a mean birth weight of 2880.3 &plusmn; 221.8 gr were evaluated.</span><span lang="EN" style="font-size:12.0pt"> Conventional</span> <span style="font-size:12.0pt">magnetic resonance imaging</span> <span style="font-size:12.0pt">and DWI </span><span style="font-size:12.0pt">were found to be abnormal in 6 (17.1%) and 18 neonates (51.4%). The most abnormal finding of DWI was </span><span style="font-size:12.0pt">high signal in basal ganglia/thalamus in 9 neonates (25.7%). Abnormal DWI is more frequent in neonates with seizures and low birth weight. </span><span style="font-size:12.0pt">Hospital stay days were more prolonged in neonates with abnormal DWI.</span> <span style="font-size:12.0pt">Microcephaly at 12 months was more frequent in children with abnormal DWI.<span style="font-family:"Times New Roman",serif"></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Conclusion:</span></b> <span style="font-size:12.0pt">In </span><span style="font-size:12.0pt">survivors of moderate neonatal HIE, abnormal brain DWI sequence might predict inappropriate</span> <span style="font-size:12.0pt">head growth, and need close medical and nutritional interventions for growth improvement. </span></span></span></span></div> هایپوکسیک ایسکمیک انسفالوپاتی, تصویربرداری رزونانس مغناطیسی, تصویربرداری با وزن انتشار, میکروسفالی, کم وزنی. Hypoxic ischemia encephalopathy, Magnetic resonance imaging, Diffusion weighted imaging, Microcephaly, Underweight. 1 8 http://ijrm.ir/browse.php?a_code=A-10-2543-1&slc_lang=en&sid=1 Mohammad Golshan Tafti mgolshan035@gmail.com 0000-0003-0323-7436 No Department of Pediatrics, Ali-ebn-Abitaleb School of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran. Marjan Jafari dr.marjanjafari@gmail.com 0000-0002-6829-1882 Yes Department of Neonatology, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Seyed Reza Mirjalili dr_sr_mirjalili@yahoo.com 0000-0002-9324-1529 No Department of Neonatology, Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Razieh Fallah dr.raziehfallah@yahoo.com 0000-0003-0363-6533 No Department of Pediatrics, Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Farimah Shamsi farimahshamssi@gmail.com 0000-0002-8812-0765 No Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.