Neonatal Magnetic Resonance Imaging Pattern of Brain Injury as a Biomarker of Childhood Outcomes following a Trial of Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

• Published in: The Journal of pediatrics Vol. 167; no. 5; pp. 987 - 993.e3
• Main Authors: Shankaran, Seetha, MD, McDonald, Scott A., BS, Laptook, Abbot R., MD, Hintz, Susan R., MD, Barnes, Patrick D., MD, Das, Abhik, PhD, Pappas, Athina, MD, Higgins, Rosemary D., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2015
• Subjects: Brain Injuries - diagnosis; Brain Injuries - pathology; Child; Cognition Disorders - complications; Cognition Disorders - diagnosis; Cohort Studies; Female; Follow-Up Studies; Humans; Hyperthermia, Induced; Hypoxia-Ischemia, Brain - diagnosis; Hypoxia-Ischemia, Brain - pathology; Infant; Infant, Newborn; Intelligence Tests; Magnetic Resonance Imaging; Male; Maternal Age; Motor Skills; Pediatrics; Predictive Value of Tests; Treatment Outcome; Cerebral palsy; WPPSI; Gross Motor Function Classification System; MRI; NICHD; NRN; Neonatal Research Network; NPV; WM; Wechsler Preschool and Primary Scale of Intelligence; PPV; Watershed; ALIC; GMFCS; WS; Hypoxic-ischemic encephalopathy; HIE; Negative predictive value; CP; White matter; BGT; Anterior limb of the internal capsule; Basal ganglia or thalamus; PLIC; Magnetic resonance imaging; Posterior limb of the internal capsule; Positive predictive value; National Institute of Child Health and Human Development
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2015.08.013

Objective To examine the ability of magnetic resonance imaging (MRI) patterns of neonatal brain injury defined by the National Institute of Child Health and Human Development Neonatal Research Network to predict death or IQ at 6-7 years of age following hypothermia for neonatal encephalopathy. Study design Out of 208 participants, 124 had MRI and primary outcome (death or IQ <70) data. The relationship between injury pattern and outcome was assessed. Results Death or IQ <70 occurred in 4 of 50 (8%) of children with pattern 0 (normal MRI), 1 of 6 (17%) with 1A (minimal cerebral lesions), 1 of 4 (25%) with 1B (extensive cerebral lesions), 3 of 8 (38%) with 2A (basal ganglia thalamic, anterior or posterior limb of internal capsule, or watershed infarction), 32 of 49 (65%) with 2B (2A with cerebral lesions), and 7 of 7 (100%) with pattern 3 (hemispheric devastation), P  < .001; this association was also seen within hypothermia and control subgroups. IQ was 90 ± 13 among the 46 children with a normal MRI and 69 ± 25 among the 50 children with an abnormal MRI. In childhood, for a normal outcome, a normal neonatal MRI had a sensitivity of 61%, specificity of 92%, a positive predictive value of 92%, and a negative predictive value of 59%; for death or IQ <70, the 2B and 3 pattern combined had a sensitivity of 81%, specificity of 78%, positive predictive value of 70%, and a negative predictive value of 87%. Conclusions The Neonatal Research Network MRI pattern of neonatal brain injury is a biomarker of neurodevelopmental outcome at 6-7 years of age. Trial registration ClinicalTrials.gov : NCT00005772.