Additional Value of 3-Month Cranial Magnetic Resonance Imaging in Infants with Neonatal Encephalopathy following Perinatal Asphyxia

Corline E J Parmentier; Maarten H Lequin; Thomas Alderliesten; Henriëtte F N Swanenburg de Veye; Niek E van der Aa; Jeroen Dudink; Manon J N L Benders; Johanna C Harteman; Corine Koopman-Esseboom; Floris Groenendaal; Linda S de Vries

doi:10.1016/j.jpeds.2023.113402

Additional Value of 3-Month Cranial Magnetic Resonance Imaging in Infants with Neonatal Encephalopathy following Perinatal Asphyxia

J Pediatr. 2023 Jul:258:113402. doi: 10.1016/j.jpeds.2023.113402. Epub 2023 Apr 3.

Affiliations

¹ Department of Neonatology, Wilhelmina Children's Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
² Department of Radiology, Wilhelmina Children's Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
³ Department of Medical Psychology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁴ Department of Child Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁵ Department of Neonatology, Wilhelmina Children's Hospital and Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands. Electronic address: F.Groenendaal@umcutrecht.nl.

PMID: 37019329
DOI: 10.1016/j.jpeds.2023.113402

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.

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.

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.

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.

Keywords: brain injury; magnetic resonance imaging; neonatal encephalopathy; neurodevelopmental outcome; perinatal asphyxia.

MeSH terms

Asphyxia / complications
Asphyxia Neonatorum* / complications
Asphyxia Neonatorum* / diagnostic imaging
Atrophy / pathology
Brain / diagnostic imaging
Brain / pathology
Brain Injuries* / pathology
Female
Humans
Infant
Infant, Newborn
Infant, Newborn, Diseases*
Magnetic Resonance Imaging / methods
Pregnancy
Retrospective Studies