Cerebral Magnetic Resonance Biomarkers in Neonatal Encephalopathy: A Meta-analysis

Thayyil, Sudhin; Chandrasekaran, M; Bainbridge, Alan; Cady, Ernest B.; Chong, W.K.; Murad, Shahed; Omar, Rumana; Robertson, Nicola J.

doi:10.1542/peds.2009-1046

Cited by 326 publications

(283 citation statements)

References 69 publications

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“…With CBMRI brain lesions developed in infants with HIE can be determined at an early time (14). Therefore, imaging is recommended on the 2-8 th days (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

Difüzyon ağırlıklı ve konvansiyonel manyetik rezonans görüntülemenin hipoksik iskemik ansefalopatili yenidoğanlarda seyrin belirlenmesindeki etkinliğinin karşılaştırılması

Kalay¹,

Öztekin²,

Tezel³

et al. 2011

tpa

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Aim:The aim of the study was to compare the conventional brain MR imaging and diffusion-weighted MR imaging performed during the first 48 postnatal hours in their relevance to predict the long-term neurodevelopmental outcome in patients with hypoxic ischemic encephalopathy Sarnat Stage II. Material and Method: Medical records of 69 patients with HIE between January 2006 and January 2010 were studied retrospectively. Twentyone patients whose data were consistent with Sarnat Stage II and for whom conventional MRI and diffusion-weighted MRI had been performed in the first 48 postnatal hours were included the study. Neurodevelopmental assessment of these patients was based on Ankara Developmental Screening Inventory (AGTE-GG). Patients whose overall developmental age was 30% below, within the 20-30% range and above 20% the chronologic age were classified as poor, moderate and good prognosis, respectively. Results: Based on the results of the AGTE-GG, 11 (52.3%) out of 21 patients included in the study had good and 10 (47.7%) had poor prognoses. In terms of the predictivity for long-term prognosis, the conventional brain MRI had an OR value of 6.22 (0.94-41.3), while the same value for the diffusionweighted MRI was 4.8 (0.68-33.9). The positive predictivity, negative predictivity, sensitivity and specificity of the conventional brain MRI were 61.5, 75, 80 and 54%, respectively, whilst the same values for the diffusion MRI were 70, 72.7, 70 and 72.7%, respectively. Conclusions: No statistically significant difference was noted between the two imaging methods in terms of the predictive value for long-term neurologic prognosis (p>0.05). The present study showed that both the conventional brain MRI and diffusion MRI may be used for long-term neurologic prognosis in patients with stage II HIE, with neither of the methods being superior to the other. (Turk Arch Ped 2011; 46: 283-6)

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“…With CBMRI brain lesions developed in infants with HIE can be determined at an early time (14). Therefore, imaging is recommended on the 2-8 th days (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

Difüzyon ağırlıklı ve konvansiyonel manyetik rezonans görüntülemenin hipoksik iskemik ansefalopatili yenidoğanlarda seyrin belirlenmesindeki etkinliğinin karşılaştırılması

Kalay¹,

Öztekin²,

Tezel³

et al. 2011

tpa

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“…la ecografía cerebral juega un importante rol en los primeros días de vida, especialmente durante períodos inestables y/o de hipotermia, entregando información, en la misma cuna del enfermo, sobre hemorragias, lesiones de nú-cleos basales y con doppler cerebral evidenciar signos de vasodilatación cerebral y/o perdida de la regulación del flujo cerebral.modalidad 36 . la espectroscopia por resonancia magnética (MRs) es el predictor más sensible de resultado en los neonatos con encefalopatía, por lo tanto se debe considerar adicionar a RNM, si ello es posible 37 .…”

Section: Neuroimágenesunclassified

Consenso sobre manejo integral del neonato con encefalopatía hipóxico isquémica

et al. 2012

Rev. chil. pediatr.

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Consensus statement on integral management of the newborn with hypoxic-ischemic encephalopathyNeonatal encephalopathy secondary to birth asphyxia, the hypoxic ischemic encephalopathy, remains a major cause of postnatal death and neurological sequelae worldwide. supportive therapy has been the mainstay of treatment. Recently series of multicenter clinical trials show the benefits of therapeutic hypothermia in this high risk population. The International liaison Committee on Resuscitation (IlCOR) has recommended hypothermia as a standard of care and a beneficial therapy using the protocols followed in large clinical trials. Our objective was to develop a practical guide to be used at a national level in Chile, compatible with published protocols and standardized on an international basis, practical and compatible with the country's situation, and considering an integral management of the asphyxiated neonates, rescue and neuroprotective therapies. In summary, to establish rescue therapies, with the aim objective of support measures that promote cerebral and systemic oxygenation/perfusion, ensuring optimal cellular homeostasis, which are the basis of the rescue measures in asphyxiated neonates. Along with these rescue therapies, the objective is to perform the more beneficial neuroprotective therapy known today, hypothermia. Hypothermia should be conducted in a level 3 Neonatal Intensive Care unit, with multidisciplinary care and standardized protocols and also multidisciplinary follow-up and rehabilitation therapies.

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“…Thayyil et al 10 used recently developed Cochrane methodology for performing systematic reviews of diagnostic tests. They carefully reviewed studies that related MR findings in infants with HIE to neurodevelopmental outcome at 12 months or later.…”

Section: Meta-analysismentioning

confidence: 99%

“…Thayyil et al 10 identified 32 studies that included a total of 860 newborn infants with HIE. Their detailed analysis revealed MR spectroscopy to be more specific and sensitive for predicting neurodevelopmental impairment than conventional imaging.…”

Section: Meta-analysismentioning

confidence: 99%

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MRI and Withdrawal of Life Support From Newborn Infants With Hypoxic-Ischemic Encephalopathy

Wilkinson

2010

Pediatrics

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The majority of deaths in infants with hypoxic-ischemic encephalopathy (HIE) follow decisions to withdraw life-sustaining treatment. Clinicians use prognostic tests including MRI to help determine prognosis and decide whether to consider treatment withdrawal. A recently published meta-analysis provided valuable information on the prognostic utility of magnetic resonance (MR) biomarkers in HIE and suggested, in particular, that proton MR spectroscopy is the most accurate predictor of neurodevelopmental outcome. How should this evidence influence treatment-limitation decisions? In this article I outline serious limitations in existing prognostic studies of HIE, including small sample size, selection bias, vague and overly inclusive outcome assessment, and potential self-fulfilling prophecies. Such limitations make it difficult to answer the most important prognostic question. Reanalysis of published data reveals that severe abnormalities on conventional MRI in the first week have a sensitivity of 71% (95% confidence interval: 59%-91%) and specificity of 84% (95% confidence interval: 68%-93%) for very adverse outcome in infants with moderate encephalopathy. On current evidence, MR biomarkers alone are not sufficiently accurate to direct treatment-limitation decisions. Although there may be a role for using MRI or MR spectroscopy in combination with other prognostic markers to identify infants with very adverse outcome, it is not possible from meta-analysis to define this group clearly. There is an urgent need for improved prognostic research into HIE. Pediatrics 2010;126:e451-e458Hypoxic-ischemic encephalopathy (HIE) is a major contributor to global child mortality and morbidity. 1 Although therapeutic hypothermia has recently emerged as a means of neuroprotection for infants with HIE, many infants still have an adverse outcome. Almost 50% of infants enrolled in recent trials and treated with hypothermia either died or were found to have severe disability at the 18-month follow-up. 2,3 In developed countries the majority of deaths of infants with HIE follow decisions to withdraw life-sustaining treatment. 4,5 Two-thirds of the deaths in the recent cooling trials followed treatment withdrawal. 3,6 One important factor that clinicians use in making such decisions is the severity of encephalopathy. In particular, infants with severe (Sarnat stage 3) 7 encephalopathy are generally believed to have a uniformly dire prognosis. 8,9 However, prognostication in infants with moderate encephalopathy is more difficult. 9-11 A variety of clinical, electrophysiological, and radiologic tools have been used to help prognosticate. 9 In particular, MRI has emerged as potentially one of the most useful tools for prognostication in HIE, 8,[12][13][14]

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Cerebral Magnetic Resonance Biomarkers in Neonatal Encephalopathy: A Meta-analysis

Cited by 326 publications

References 69 publications

Difüzyon ağırlıklı ve konvansiyonel manyetik rezonans görüntülemenin hipoksik iskemik ansefalopatili yenidoğanlarda seyrin belirlenmesindeki etkinliğinin karşılaştırılması

Difüzyon ağırlıklı ve konvansiyonel manyetik rezonans görüntülemenin hipoksik iskemik ansefalopatili yenidoğanlarda seyrin belirlenmesindeki etkinliğinin karşılaştırılması

Consenso sobre manejo integral del neonato con encefalopatía hipóxico isquémica

MRI and Withdrawal of Life Support From Newborn Infants With Hypoxic-Ischemic Encephalopathy

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