Serial magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy

doi:10.1016/S0022-3476(05)83323-2

The Journal of Pediatrics

Volume 117, Issue 5, November 1990, Pages 694-700

https://doi.org/10.1016/S0022-3476(05)83323-2 Get rights and content

We prospectively performed magnetic resonance imaging (MRI) studies during the neonatal period, and at 4 and 8 months of age, on 15 term infants with hypoxic-ischemic encephalopathy, and compared the results with their neurodevelopmental outcome at 18 months of age. Cerebral palsy developed in nine infants, two infants were classified as having abnormalities of fone and delayed motor milestones that were suggestive of cerebral palsy, and four infants were normal. Structural abnormalities, delayed myelination, or a combination of the two were detected with MRI at 8 months of age in all nine infants with later development of cerebral palsy. Three of the four normal infants and one infant with suggestive abnormallties had normal serial MRI findings. Each of the remaining two infants (one normal, one with suggestive abnormalities) had isolated persistent ventricular dilation on all three MRI studies. Our results suggest that 8 months appears to be the earllest time at which MRI findings correlate well with later adverse neurodevelopmental outcome in this population.

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Additional Value of 3-Month Cranial Magnetic Resonance Imaging in Infants with Neonatal Encephalopathy following Perinatal Asphyxia
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To assess the evolution of neonatal brain injury noted on magnetic resonance imaging (MRI), develop a score to assess brain injury on 3-month MRI, and determine the association of 3-month MRI with neurodevelopmental outcome in neonatal encephalopathy (NE) following perinatal asphyxia.
This was a retrospective, single-center study including 63 infants with perinatal asphyxia and NE (n = 28 cooled) with cranial MRI <2 weeks and 2-4 months after birth. Both scans were assessed using biometrics, a validated injury score for neonatal MRI, and a new score for 3-month MRI, with a white matter (WM), deep gray matter (DGM), and cerebellum subscore. The evolution of brain lesions was assessed, and both scans were related to 18- to 24-month composite outcome. Adverse outcome included cerebral palsy, neurodevelopmental delay, hearing/visual impairment, and epilepsy.
Neonatal DGM injury generally evolved into DGM atrophy and focal signal abnormalities, and WM/watershed injury evolved into WM and/or cortical atrophy. Although the neonatal total and DGM scores were associated with composite adverse outcomes, the 3-month DGM score (OR 1.5, 95% CI 1.2-2.0) and WM score (OR 1.1, 95% CI 1.0-1.3) also were associated with composite adverse outcomes (occurring in n = 23). The 3-month multivariable model (including the DGM and WM subscores) had higher positive (0.88 vs 0.83) but lower negative predictive value (0.83 vs 0.84) than neonatal MRI. Inter-rater agreement for the total, WM, and DGM 3-month score was 0.93, 0.86, and 0.59.
In particular, DGM abnormalities on 3-month MRI, preceded by DGM abnormalities on the neonatal MRI, were associated with 18- to 24-month outcome, indicating the utility of 3-month MRI for treatment evaluation in neuroprotective trials. However, the clinical usefulness of 3-month MRI seems limited compared with neonatal MRI.
Fifty Percent Effective Dose of Intranasal Dexmedetomidine Sedation for Transthoracic Echocardiography in Children With Cyanotic and Acyanotic Congenital Heart Disease
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Third, unrepaired cyanotic congenital heart disease decreases cerebral oxygen delivery21 and may affect brain development. Studies have reported that chronic hypoxemia may cause a delay in the myelination process22-24 and significant retardation of brainstem maturation, especially in infants younger than 1 year old.25 Therefore, the authors speculate that the poorly developed brain may be more susceptible to the external environment and stimulation and that cyanotic patients more easily awaken during the examination.
To determine the 50% and 95% effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in children with cyanotic and acyanotic congenital heart disease.
A prospective, nonrandomized study.
A tertiary care teaching hospital.
Patients younger than 18 months with known or suspected congenital heart disease scheduled for transthoracic echocardiography with sedation.
Patients were divided into a cyanotic group (blood oxygen saturation <85%) or an acyanotic group (blood oxygen saturation ≥85%). This study used Dixon's up-and-down method sequential allocation design. In both groups, the initial dose of intranasal dexmedetomidine was 2 μg/kg and the gradient of increase or decrease was 0.25 μg/kg.
The 50% effective dose (95% confidence interval) of intranasal dexmedetomidine sedation for transthoracic echocardiography was 3.2 (2.78-3.55) μg/kg and 1.9 (1.69-2.06) μg/kg in the cyanotic and acyanotic groups, respectively. None of the patients experienced significant adverse events.
The 50% (95% confidence intervals) effective doses of intranasal dexmedetomidine sedation for transthoracic echocardiography were 3.2 (2.78-3.55) μg/kg and 1.9 (1.69-2.06) μg/kg in children with cyanotic and acyanotic congenital heart disease, respectively.
Hypoxic-Ischemic Injury in the Term Infant
2018, Volpe's Neurology of the Newborn
Neonatal encephalopathy occurs in 2 to 5/1000 live births and is principally related to hypoxic-ischemic injury to the newborn brain in the immediate peripartum period. In the last decade, there have been significant advances in neuroprotection that have been successful in reducing the risk of death and disability in infants who have suffered from a potential hypoxic-ischemic cerebral injury. The advent of therapeutic hypothermia has led to a major focus on the early clinical recognition of infants that may benefit from such therapies. In addition, optimal recognition and therapeutic targeting of neonatal seizures, with other neuroprotective approaches, have been emphasized. This chapter will summarize the clinical presentation, neuropathological correlates, neurodiagnostic evaluation, prognosis, and management of this condition.
MR Imaging of the Term and Preterm Neonate with Diffuse Brain Injury
2011, Magnetic Resonance Imaging Clinics of North America
Magnetic resonance biomarkers of neuroprotective effects in infants with hypoxic ischemic encephalopathy
2010, Seminars in Fetal and Neonatal Medicine
Citation Excerpt :
Following moderate/severe HIE, abnormal signal intensity is most commonly detected in the basal ganglia and thalami, corticospinal tracts, the white matter and cortex (Fig. 6).55,56 These abnormalities correlate closely with pathology at autopsy and with the pattern of neurological abnormalities that develop in survivors, and have high predictive values for detecting adverse outcomes.57–91 Several studies have examined the prognostic accuracy of conventional T1- and T2-weighted MRI following HIE.
Evaluation of infants with hypoxic ischemic encephalopathy by magnetic resonance spectroscopy and imaging is useful to direct clinical care, and may assist the evaluation of candidate neuroprotective therapies. Cerebral metabolites measured by magnetic resonance spectroscopy, and visual analysis of magnetic resonance images during the first 30 days after birth accurately predict later neurological outcome and are valid biomarkers of the key physiological processes underlying brain injury in neonatal hypoxic ischemic encephalopathy. Visual assessment of magnetic resonance images may also be a suitable surrogate outcome in studies of neuroprotective therapies but current magnetic resonance methods are relatively inefficient for use in early phase, first in human infant studies of novel neuroprotective therapies. However, diffusion tensor imaging and analysis of fractional anisotropy with tract-based spatial statistics promises to be a highly efficient biomarker and surrogate outcome for rapid preliminary evaluation of promising therapies for neonatal hypoxic ischemic injury. Standardisation of scanning protocols and data analysis between different scanners is essential.
Serial MRI and neurodevelopmental outcome in 9- to 10-year-old children with neonatal encephalopathy
2010, Journal of Pediatrics
To assess the relation between patterns of brain injury on neonatal and childhood magnetic resonance imaging (MRI) and long-term neurodevelopmental outcome.
Neonatal (n = 34) and childhood MRIs (n = 77) were analyzed for 80 children with neonatal encephalopathy and for 51 control subjects during childhood. MRIs were graded as normal, mildly abnormal (white matter lesions), or moderately/severely abnormal (watershed injury, lesions in basal ganglia/thalamus or focal infarction). Severity of brain injury was related to different aspects of neurologic outcome: Total impairment score of the Movement Assessment Battery for Children, intelligence quotient score, cerebral palsy, postneonatal epilepsy, and need for special education. Seven children with neonatal encephalopathy required extracorporeal membrane oxygenation treatment.
Neonatal and childhood MRI were comparable in 25/33 children (75.8%, P < .001). Children with moderate/severe lesions on neonatal or childhood MRI more often had a total impairment score ≤ 15th percentile, an intelligence quotient ≤ 85, and cerebral palsy, and attended special education.
Different patterns of injury seen on neonatal MRI after neonatal encephalopathy can still be recognized on childhood MRI. Children with moderate to severe brain lesions on neonatal or childhood MRI significantly more often have impaired motor and cognitive outcomes.

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^*: Supported by grants from Special Services and Research, University of Alberta Hospitals, Central Research Fund, University of Alberta, and the National Institute for Mental Retardation.

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Original articleSerial magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy*

Clinical NMR imaging of the brain in children: normal and neurologic disease

AJNR

Developmental features of the neonatal brain: MR imaging. Part I. Gray-white matter differentiation and myelination

Radiology

Developmental features of the neonatal brain: MR imaging. Part II. Ventricle size and extracerebral space

Radiology

Serial MR imaging in neonatal cerebral injury

AJNR

Abnormalities of the neonatal brain: MR imaging. Part I. Intracranial hemorrhage

Radiology

Abnormalities of the neonatal brain: MR imaging. Part II. Hypoxic-ischemic brain injury

Radiology

MR evaluation of early myelination patterns in normal and developmentally delayed infants

Am J Roentgenol

Normal maturation of the neonatal and infant brain: MR imaging at 1.5T

Radiology

Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study

Arch Neurol

Factors affecting outcome in hypoxic-ischemic encephalopathy in term infants

Am J Dis Child

Term infants with hypoxic-ischemic encephalopathy: outcome at 3.5 years

Dev Med Child Neurol

The first year of life: the Collaborative Perinatal Project of the National Institute of Neuological and Communicative Disorders and Stroke

Original article
Serial magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy*