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Additional Value of 3-Month Cranial Magnetic Resonance Imaging in Infants with Neonatal Encephalopathy following Perinatal Asphyxia.
- Source :
-
The Journal of pediatrics [J Pediatr] 2023 Jul; Vol. 258, pp. 113402. Date of Electronic Publication: 2023 Apr 03. - Publication Year :
- 2023
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Abstract
- Objective: 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.<br />Methods: 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.<br />Results: 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.<br />Conclusions: 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.<br /> (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Infant, Newborn
Pregnancy
Female
Infant
Humans
Retrospective Studies
Asphyxia complications
Magnetic Resonance Imaging methods
Atrophy pathology
Brain diagnostic imaging
Brain pathology
Infant, Newborn, Diseases
Asphyxia Neonatorum complications
Asphyxia Neonatorum diagnostic imaging
Brain Injuries pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6833
- Volume :
- 258
- Database :
- MEDLINE
- Journal :
- The Journal of pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 37019329
- Full Text :
- https://doi.org/10.1016/j.jpeds.2023.113402