Early versus late MRI in asphyxiated newborns treated with hypothermia

Abstract

Objective The purposes of this feasibility study are to assess: (1) the potential utility of early brain magnetic resonance imaging (MRI) in asphyxiated newborns treated with hypothermia; (2) whether early MRI predicts later brain injury observed in these newborns after hypothermia is completed; and (3) whether early MRI indicators of brain injury in these newborns represent reversible changes. Patients and Methods All consecutive asphyxiated term newborns meeting the criteria for therapeutic hypothermia were enrolled prospectively. Each of them underwent 1–2 “early” MRI scans while receiving hypothermia, on day of life (DOL) 1 and DOL 2–3, and also 1–2 “late” MRI scans on DOL 8–13 and at 1 month of age. Results Thirty-seven MRI scans were obtained in twelve asphyxiated neonates treated with induced hypothermia. Four newborns did develop MRI evidence of brain injury, already visible on early MRI scans. The remaining eight newborns did not develop significant MRI evidence of brain injury on any of the MRI scans. In addition, two patients displayed unexpected findings on early MRIs, leading to early termination of hypothermia treatment. Conclusions MRI scans obtained on DOL 2–3 during hypothermia seem to predict later brain injuries in asphyxiated newborns in this feasibility study. Brain injuries identified during this early time appear to represent irreversible changes. Early MRI scans might also be useful to demonstrate unexpected findings not related to hypoxic-ischemic encephalopathy, which could potentially be exacerbated by induced hypothermia. Additional studies with larger numbers of patients will be useful to more definitively confirm these results.

Evolution of pattern of injury and quantitative MRI on days 1 and 3 in term newborns with hypoxic–ischemic encephalopathy

“…Whereas one normothermic newborn had minor focal white matter injury detected on day 10 after normal imaging, there was a delay in the development of BN-predominant injury on day 10 in two hypothermic newborns. The delayed development in the features of acute, profound asphyxia on the 10th day of life in these two hypothermic newborns suggests that the process of injury continues to evolve after cessation of hypothermia at 72 h. In term newborns with HIE not treated with hypothermia, the predominant pattern of brain injury is robustly detected on the third day of life (15), but in those treated with hypothermia, the earliest time at which that predominant pattern is fully established still needs to be determined (16).…”

Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time

“…There were also frequent comparisons of early US to MRI done several days later. The injury typically becomes more apparent with time, partially explaining why MRI appears to be more diagnostic than US [66,67]. High-end US done concurrently with MRI has 95% diagnostic accuracy compared to MRI [68].…”

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

“…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.…”