White Matter and Cortical Injury in Hypoxic-Ischemic Encephalopathy: Antecedent Factors and 2-Year Outcome

Martinez‐Biarge, Miriam; Bregant, Tina; Wusthoff, Courtney J.; Chew, Andrew; Díez‐Sebastián, Jesús; Rutherford, Mary; Cowan, Frances

doi:10.1016/j.jpeds.2012.04.054

Cited by 114 publications

(104 citation statements)

References 31 publications

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“…A total of 54 infants were included in the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial; these infants were scanned, with few exceptions, within the first 4 weeks (71% in the first 2 weeks) 23 ; 77% of the infants not included in the TOBY trial were scanned within the first 3 weeks. 24,25 The images in all these infants were consistent with an acute hypoxic-ischemic insult. 6 Twelve infants were not scanned because they died before the scan could be done (7), because parents refused (2), or because the encephalopathy was mild and the ultrasound scans consistently showed no abnormalities (3).…”

Section: Resultsmentioning

confidence: 76%

“…In addition, most cases were followed by us or in the TOBY trial, and hence we know that later problems suggestive of non-HIE diagnoses did not come to light and that early MRI findings were predictive of outcome. [23][24][25] Our control infants were carefully examined and a detailed antenatal and perinatal history was taken; a significant proportion of them were also followed by our experienced team for at least 12 to 18 months by using standardized examinations. 16 …”

Section: Figurementioning

confidence: 99%

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Antepartum and Intrapartum Factors Preceding Neonatal Hypoxic-Ischemic Encephalopathy

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Etiology and timing of onset of neonatal hypoxic-ischemic encephalopathy continue to be controversial. Previous studies suggest antepartum events are the main contributing factors, but have used a broad definition of encephalopathy and included infants with genetic, congenital, and developmental abnormalities.WHAT THIS STUDY ADDS: Our study suggests that when strict criteria defining hypoxic-ischemic encephalopathy are applied with supporting neuroimaging evidence of an acute hypoxicischemic insult, intrapartum events are the final and necessary pathway leading to this condition. abstract OBJECTIVE: To determine whether antepartum factors alone, intrapartum factors alone, or both in combination, are associated with term neonatal hypoxic-ischemic encephalopathy (HIE). METHODS:A total of 405 infants $35 weeks' gestation with early encephalopathy, born between 1992 and 2007, were compared with 239 neurologically normal infants born between 1996 and 1997. All cases met criteria for perinatal asphyxia, had neuroimaging findings consistent with acute hypoxia-ischemia, and had no evidence for a non-hypoxic-ischemic cause of their encephalopathy.RESULTS: Both antepartum and intrapartum factors were associated with the development of HIE on univariate analysis. Case infants were more often delivered by emergency cesarean delivery (CD; 50% vs 11%, P , .001) and none was delivered by elective CD (vs 10% of controls). On logistic regression analysis only 1 antepartum factor (gestation $41 weeks) and 7 intrapartum factors (prolonged membrane rupture, abnormal cardiotocography, thick meconium, sentinel event, shoulder dystocia, tight nuchal cord, failed vacuum) remained independently associated with HIE (area under the curve 0.88; confidence interval 0.85-0.91; P , .001). Overall, 6.7% of cases and 43.5% of controls had only antepartum factors; 20% of cases and 5.8% of controls had only intrapartum factors; 69.5% of cases and 31% of controls had antepartum and intrapartum factors; and 3.7% of cases and 19.7% of controls had no identifiable risk factors (P , .001). CONCLUSIONS:Our results do not support the hypothesis that HIE is attributable to antepartum factors alone, but they strongly point to the intrapartum period as the necessary factor in the development of this condition. Pediatrics 2013;132:e952-e959

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Section: Resultsmentioning

confidence: 76%

Section: Figurementioning

confidence: 99%

Antepartum and Intrapartum Factors Preceding Neonatal Hypoxic-Ischemic Encephalopathy

et al. 2013

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“…We hypothesize that the mechanisms that cause basal ganglia and white matter injury following severe anaemia might be similar to the mechanisms responsible for cerebral injury in full-term infants with perinatal asphyxia due to other causes. White matter injury has been described in animals as well as in humans after moderate prolonged foetal or neonatal asphyxia, as well as after neonatal hypoglycaemia [3,4]. It is important to note that a substantial percentage (31%) of our anaemic patients also had a period of hypoglycaemia.…”

Section: Discussionmentioning

confidence: 90%

“…MRI is a well-established method to assess brain injury in infants suffering from perinatal asphyxia, and these findings are closely related to later neurodevelopmental outcome [5,6,7,8,9,10,11]. Data on the long-term outcome of patients with severe acute anaemia combined with a less severe component of perinatal asphyxia are still limited.…”

Section: Discussionmentioning

confidence: 99%

Severe Neonatal Anaemia, MRI Findings and Neurodevelopmental Outcome

Zonnenberg¹,

Vermeulen

Rohaan³

et al. 2016

Neonatology

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Background and Objective: Severe neonatal anaemia can impair cerebral oxygen supply. Data on long-term outcomes following severe neonatal anaemia are scarce. Methods: Clinical data and neurodevelopmental outcome of 49 (near) term infants with haemoglobin concentration after birth <6.0 mmol/l were retrospectively collected and analysed. In a subgroup of 28 patients, amplitude-integrated EEG was available and in 25 infants cerebral MRI was obtained. Infants were followed up at 14-35 months of age and assessed with the Griffiths Scale of Mental Development or Bayley Scale of Infant Development. Results: Eighteen patients (37%) died during the neonatal period. In 25 patients MRI was performed. A predominant pattern of injury on MRI was seen in the basal ganglia and thalami in 7 patients (28%), whereas some form of white matter injury was present in 16 (64%) and a combination in 3 (12%). Follow-up data were available for 26 patients (84% of survivors). Formal assessment of neurodevelopmental outcome was performed in 20 of 31 (65%) infants who survived (median age: 19 months, range: 14-35). Sixteen infants (80%) had a developmental quotient appropriate for age in the first 2 years after birth. On motor outcome, 1 patient (5%) scored below average (Z-score -1.10). One patient developed cerebral palsy. Conclusion: Early neurodevelopmental outcome in surviving patients with severe neonatal anaemia was within the normal range in the majority of the survivors. MRI showed mild-to-moderate white matter injury in two thirds of the infants. Prospectively collected data with a longer follow-up period are needed.

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“…This is also known as the white cerebellar sign. In term infants, this type of injury, particularly in patients with internal capsule involvement, commonly precedes global developmental delay, visual impairment, and seizures [3]. However, this must be correlated to clinical findings when diagnosed with US as outcomes can be variable [42].…”

Section: Acute Phasementioning

confidence: 99%

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

et al. 2018

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Hypoxic-ischemic injury (HII) of the neonatal brain and resulting clinical hypoxic-ischemic encephalopathy remains a significant cause of morbidity and mortality in the neonatal population. Ultrasound (US) has emerged as a powerful screening tool for evaluation of a neonate with suspected HII. The pattern of injury on brain imaging has crucial implications in therapies and predicted neurodevelopmental outcomes. US has become increasingly effective at determining the pattern, timing, and extent of injury in HII as well as differentiating these findings from a host of diagnoses that can result in a similarly appearing clinical picture. Repeated US studies over a patient’s course can define the evolution of findings from the acute through chronic phase in addition to identifying any complications of therapy. US also has the added benefits of easy portability, no need for patient sedation, and a relatively low cost when compared to other imaging modalities like magnetic resonance imaging (MRI). It is crucial that clinicians understand the full capabilities of advanced US in identifying an underlying diagnosis, directing appropriate therapy, monitoring disease progress, and finally in predicting outcomes, thus improving the care of neonates with encephalopathy. The following article demonstrates the breadth of uses for US in the full-term neonate with encephalopathy, its limitations, the patterns of injury seen, and their evolution over time. We will also briefly review several clinical mimickers of HII for comparison.

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White Matter and Cortical Injury in Hypoxic-Ischemic Encephalopathy: Antecedent Factors and 2-Year Outcome

Cited by 114 publications

References 31 publications

Antepartum and Intrapartum Factors Preceding Neonatal Hypoxic-Ischemic Encephalopathy

Antepartum and Intrapartum Factors Preceding Neonatal Hypoxic-Ischemic Encephalopathy

Severe Neonatal Anaemia, MRI Findings and Neurodevelopmental Outcome

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

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