Impact of therapeutic hypothermia on MRI diffusion changes in neonatal encephalopathy

Bednarek, Nathalie; Mathur, Amit M.; Inder, Terrie E.; Wilkinson, Jared; Neil, Jeff; Shimony, Joshua S.

doi:10.1212/wnl.0b013e318253d589

Cited by 159 publications

(148 citation statements)

References 37 publications

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“…10 In our study, the changes in the cerebellum did not follow this typical pattern. No consistent acute change in ADC values was observed during the first days of life 12,15 ; the only consistent changes in ADC values were the isolated increased ADC around day 10 of life.…”

Section: Fig 1 Term Asphyxiated Neonate Treated With Hypothermia Whocontrasting

confidence: 63%

“…8,9 However, newer advanced MR imaging modalities, such as DTI and subsequent apparent diffusion coefficient and fractional anisotropy (FA) maps, are becoming available tools for use with neonates and may permit an even better definition of brain injury and thus may provide a more accurate prognosis. 10,11 Typical patterns of injury in term asphyxiated neonates are usually described in the cerebrum, including basal ganglia injury, watershed injury, and near-total injury. Until now, injury to the cerebellum has been reported only rarely after birth asphyxia in term neonates.…”

mentioning

confidence: 99%

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Injury to the Cerebellum in Term Asphyxiated Newborns Treated with Hypothermia

Kwan¹,

Boudes²,

Gilbert

et al. 2015

AJNR Am J Neuroradiol

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Section: Fig 1 Term Asphyxiated Neonate Treated With Hypothermia Whocontrasting

confidence: 63%

mentioning

confidence: 99%

Injury to the Cerebellum in Term Asphyxiated Newborns Treated with Hypothermia

Kwan¹,

Boudes²,

Gilbert

et al. 2015

AJNR Am J Neuroradiol

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“…Primary outcome was determined a priori to be 12-month neurodevelopment assessed by 2 34, resolving discrepancies through discussion. Global brain injury score (range, 0-138) was determined by measuring injury severity (0 = normal, 3 = severe) in 8 brain regions in each hemisphere (caudate, putamen/globus pallidus, thalamus, posterior limb of internal capsule, white matter, cortex, brainstem, and cerebellum) and adding these component scores together.…”

Section: Neurodevelopmental Outcomementioning

confidence: 99%

“…Global brain injury score (range, 0-138) was determined by measuring injury severity (0 = normal, 3 = severe) in 8 brain regions in each hemisphere (caudate, putamen/globus pallidus, thalamus, posterior limb of internal capsule, white matter, cortex, brainstem, and cerebellum) and adding these component scores together. 34 Severity of brain injury was categorized as "none" = 0; "mild" = 1-11; "moderate" = 12-32; or "severe" = 33-138.…”

Section: Neurodevelopmental Outcomementioning

confidence: 99%

High-Dose Erythropoietin and Hypothermia for Hypoxic-Ischemic Encephalopathy: A Phase II Trial

Mathur²,

et al. 2016

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OBJECTIVE: To determine if multiple doses of erythropoietin (Epo) administered with hypothermia improve neuroradiographic and short-term outcomes of newborns with hypoxic-ischemic encephalopathy. METHODS:In a phase II double-blinded, placebo-controlled trial, we randomized newborns to receive Epo (1000 U/kg intravenously; n = 24) or placebo (n = 26) at 1, 2, 3, 5, and 7 days of age. All infants had moderate/severe encephalopathy; perinatal depression (10 minute Apgar <5, pH <7.00 or base deficit ≥15, or resuscitation at 10 minutes); and received hypothermia. Primary outcome was neurodevelopment at 12 months assessed by the Alberta Infant Motor Scale and Warner Initial Developmental Evaluation. Two independent observers rated MRI brain injury severity by using an established scoring system. RESULTS:The mean age at first study drug was 16.5 hours (SD, 5.9). Neonatal deaths did not significantly differ between Epo and placebo groups (8% vs 19%, P = .42). Brain MRI at mean 5.1 days (SD, 2.3) showed a lower global brain injury score in Epo-treated infants (median, 2 vs 11, P = .01). Moderate/severe brain injury (4% vs 44%, P = .002), subcortical (30% vs 68%, P = .02), and cerebellar injury (0% vs 20%, P = .05) were less frequent in the Epo than placebo group. At mean age 12.7 months (SD, 0.9), motor performance in Epotreated (n = 21) versus placebo-treated (n = 20) infants were as follows: Alberta Infant Motor Scale (53.2 vs 42.8, P = .03); Warner Initial Developmental Evaluation (28.6 vs 23.8, P = .05).CONCLUSIONS: High doses of Epo given with hypothermia for hypoxic-ischemic encephalopathy may result in less MRI brain injury and improved 1-year motor function.

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“…Injury was scored by a single reader (Dr Mathur) experienced in MRI scoring, and who was blinded to the group allocation, by using standardized methods described previously. 23 …”

Section: Mri Scoringmentioning

confidence: 99%

Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial

Srinivasakumar¹,

Zempel²,

et al. 2015

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BACKGROUND: The impact of treating electrographic seizures in hypoxic ischemic encephalopathy (HIE) is unknown. METHODS:Neonates $36 weeks with moderate or severe HIE were randomly assigned to either treatment of electrographic seizures alone (ESG) or treatment of clinical seizures (CSG). Conventional EEG video was monitored in both groups for up to 96 hours. Cumulative electrographic seizure burden (SB) was calculated in seconds and converted to log units for analysis. MRI scans were scored for severity of brain injury. Infants underwent neurodevelopmental evaluation at 18 to 24 months. Statistical analyses were performed by using SAS 9.3 version (SAS Institute, Inc, Cary, NC).RESULTS: Thirty-five of 69 neonates (51%) who were randomly assigned and included in the study developed seizures (15 in ESG and 20 in CSG). Excluding infants with status epilepticus, median SB (interquartile range) in seconds in ESG (n = 10) was lower than in CSG (n = 16) (449 [113-2070] vs 2226 [760-7654]; P = .02). ESG had fewer seizures with shorter time to treatment (P = .04). Twenty-four of 30 (80%) surviving infants with seizures underwent neurodevelopmental evaluation at 18 to 24 months. Increasing SB in the combined cohort was significantly associated with higher brain injury scores (P , .03) and lower performance scores across all 3 domains on BSID III (P = .03). CONCLUSIONS:In neonates with HIE, EEG monitoring and treatment of electrographic seizures results in significant reduction in SB. SB is associated with more severe brain injury and significantly lower performance scores across all domains on BSID III. WHAT'S KNOWN ON THIS SUBJECT:Continuous conventional EEG video is currently gold standard for identifying neonatal seizures and a substantial proportion of neonatal seizures are electrographic. Currently there is no direct evidence that EEG monitoring, seizure identification, or treatment impacts long-term outcomes. WHAT THIS STUDY ADDS:In neonates with hypoxic ischemic encephalopathy, EEG monitoring and treatment of electrographic seizures results in significant reduction in seizure burden. Increasing seizure burden is associated with more severe brain injury and significantly lower performance scores on Bayley Scales of Infant Development III.

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Impact of therapeutic hypothermia on MRI diffusion changes in neonatal encephalopathy

Abstract: TH slows the evolution of diffusion abnormalities on MRI following HIE in term infants.

Cited by 159 publications

References 37 publications

Injury to the Cerebellum in Term Asphyxiated Newborns Treated with Hypothermia

Injury to the Cerebellum in Term Asphyxiated Newborns Treated with Hypothermia

High-Dose Erythropoietin and Hypothermia for Hypoxic-Ischemic Encephalopathy: A Phase II Trial

Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial

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