An Updated Overview of MRI Injuries in Neonatal Encephalopathy: LyTONEPAL Cohort

Abstract

Background: Brain magnetic resonance imaging (MRI) is a key tool for the prognostication of encephalic newborns in the context of hypoxic−ischemic events. The purpose of this study was to finely characterize brain injuries in this context. Methods: We provided a complete, descriptive analysis of the brain MRIs of infants included in the French national, multicentric cohort LyTONEPAL. Results: Among 794 eligible infants, 520 (65.5%) with MRI before 12 days of life, grade II or III encephalopathy and gestational age ≥36 weeks were included. Half of the population had a brain injury (52.4%); MRIs were acquired before 6 days of life among 247 (47.5%) newborns. The basal ganglia (BGT), white matter (WM) and cortex were the three predominant sites of injuries, affecting 33.8% (n = 171), 33.5% (n = 166) and 25.6% (n = 128) of participants, respectively. The thalamus and the periventricular WM were the predominant sublocations. The BGT, posterior limb internal capsule, brainstem and cortical injuries appeared more frequently in the early MRI group than in the late MRI group. Conclusion: This study described an overview of brain injuries in hypoxic−ischemic neonatal encephalopathy. The basal ganglia with the thalamus and the WM with periventricular sublocation injuries were predominant. Comprehensive identification of brain injuries in the context of HIE may provide insight into the mechanism and time of occurrence.

Neonatal well‐being and timing of brain injury in persons with cerebral palsy born at term or late preterm

“…Two patterns of predominant white matter injury have been associated with mild degrees of encephalopathy and acute insults near term: term-type parasagittal watershed lesions only affecting the white matter and punctate lesions typically seen in neonates born preterm. 19,32,[37][38][39][40] Venous infarction can occur in association with a complicated delivery, cerebral sinovenous thrombosis, and early seizures. 34,41 Thirteen per cent of the cohort had no discernible imaging abnormality and 62% of this group had an uncomplicated neonatal course, implying that the timing might often be antenatal and/or that the brain injury is subtle.…”

“…Our data support the idea that, although predominant white matter injury is more likely to occur antenatally in children born at term, it may also represent perinatal injury. Two patterns of predominant white matter injury have been associated with mild degrees of encephalopathy and acute insults near term: term‐type parasagittal watershed lesions only affecting the white matter and punctate lesions typically seen in neonates born preterm 19,32,37–40 . Venous infarction can occur in association with a complicated delivery, cerebral sinovenous thrombosis, and early seizures 34,41 …”

Interdisciplinary fetal-neonatal neurology training improves brain health across the lifespan

“…Supervised assessments using each testing modality are performed. Trainees need to learn current peer-reviewed classifications regarding neonatal encephalopathy (NE) ( 19 ), EEG ( 20 ), MRI ( 21 ), and placental abnormalities ( 22 ) to improve their understanding of disease mechanisms, interventions, and prognosis as they improve their historical and examination skills. Clinical mimicry must be anticipated individually or with different combinations expressed as the “great neonatal neurological syndromes.” This analytic approach will help improve recognize and reduce bias to promote effective shared decisions with families.…”