Early identification of brain injury in infants with hypoxic ischemic encephalopathy at high risk for severe impairments: accuracy of MRI performed in the first days of life

Abstract

BackgroundDespite therapeutic hypothermia 30-70% of newborns with moderate or severe hypoxic ischemic encephalopathy will die or survive with significant long-term impairments. Magnetic resonance imaging (MRI) in the first days of life is being used for early identification of these infants and end of life decisions are relying more and more on it. The purpose of this study was to evaluate how MRI performed around day 4 of life correlates with the ones obtained in the second week of life in infants with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia.MethodsProspective observational cohort study between April 2009 and July 2011. Consecutive newborns with HIE evaluated for therapeutic hypothermia were included. Two sequential MR studies were performed: an •early’ study around the 4th day of life and a •late’ study during the second week of life. MRI were assessed and scored by two neuroradiologists who were blinded to the clinical condition of the infants.ResultsForty-eight MRI scans were obtained in the 40 newborns. Fifteen infants underwent two sequential MR scans. The localization, extension and severity of hypoxic-ischemic injury in early and late scans were highly correlated. Hypoxic-ischemic injury scores from conventional sequences (T1/T2) in the early MRI correlated with the scores of the late MRI (Spearman ρ = 0.940; p < .001) as did the scores between diffusion-weighted images in early scans and conventional images in late MR studies (Spearman ρ = 0.866; p < .001). There were no significant differences in MR images between the two sequential scans.ConclusionsMRI in the first days of life may be a useful prognostic tool for clinicians and can help parents and neonatologist in medical decisions, as it highly depicts hypoxic-ischemic brain injury seen in scans performed around the second week of life.

Early MRI in neonatal hypoxic-ischaemic encephalopathy treated with hypothermia: Prognostic role at 2-year follow-up

“…In this study, we confirmed that early MRI had a predictive value at least as good as late MRI, as was expected given the excellent agreement between early and late MRIs [8][9][10][11]. Our results were inconsistent with the results of a meta-analysis which suggested that the discriminatory power of late MRI (days 8-30) was higher than that In our study, the ADC measurements added little to the visual analysis as a prognostic tool.…”

“…Recent studies demonstrated that early MRI (performed in the first week of life) could reliably predict the extent and severity of brain injury observed on later MRI (performed after day 7, considering the first day of life as day 1) in asphyxiated neonates treated with hypothermia [7][8][9][10][11]. Nevertheless, to our knowledge, the prognostic value of early and late MRI had not been compared in these neonates.…”

Diffusion-Weighted MRI and Urinary Activin-A are Correlated with the Degree of Hypoxic Ischemic Encephalopathy in Neonates

“…Diffusion-weighted MRI has been shown to be generally sensitive to early ischemic brain changes 4 . Generation of apparent diffusion coefficient (ADC) maps and calculating ADC values allow obtaining an objective measure of diffusion abnormality 5 .…”

MR-patterns of brain’s hypoxic-ischemic lesions in term newborns

“…МР-исследование детям периода новорожденности обязательно выполняется с реанимационным сопро-вождением, применяется седация, предпочтительно проведение исследования во время физиологиче-ского сна [30]. С целью своевременного проведения терапии ГИЭ у доношенных новорожденных реко-мендуется выполнять МРТ головного мозга в пер-вые 3-5 суток жизни [2].…”