Neuroimaging in the Evaluation of Neonatal Encephalopathy

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Computed tomography is commonly used for neuroimaging in newborn infants with neonatal encephalopathy despite concerns over potential harm from radiation exposure. Alternative neuroimaging options include MRI and cranial ultrasound.WHAT THIS STUDY ADDS: Using a very large, international, multicenter database, we demonstrate utilization rates and compare diagnostic findings of computed tomography, MRI, and cranial ultrasound in the evaluation of neonatal encephalopathy. abstract BACKGROUND AND OBJECTIVE: Computed tomography (CT) is still used for neuroimaging of infants with known or suspected neurologic disorders. Alternative neuroimaging options that do not expose the immature brain to radiation include MRI and cranial ultrasound. We aim to characterize and compare the use and findings of neuroimaging modalities, especially CT, in infants with neonatal encephalopathy. METHODS:The Vermont Oxford Network Neonatal Encephalopathy Registry enrolled 4171 infants ($36 weeks' gestation or treated with therapeutic hypothermia) between 2006 and 2010 who were diagnosed with encephalopathy in the first 3 days of life. Demographic, perinatal, and medical conditions were recorded, along with treatments, comorbidities, and outcomes. The modality, timing, and results of neuroimaging were also collected. RESULTS:CT scans were performed on 933 of 4107 (22.7%) infants, and 100 of 921 (10.9%) of those received multiple CT scans. Compared with MRI, CT provided less detailed evaluation of cerebral injury in areas of prognostic significance, but was more sensitive than cranial ultrasound for hemorrhage and deep brain structural abnormalities.CONCLUSIONS: CT is commonly used for neuroimaging in newborn infants with neonatal encephalopathy despite concerns over potential harm from radiation exposure. The diagnostic performance of CT is inferior to MRI in identifying neonatal brain injury. Our data suggest that using cranial ultrasound for screening, followed by MRI would be more appropriate than CT at any stage to evaluate infants with neonatal encephalopathy.

Ensuring Quality in the NICU

“…28,29 Two additional groups have developed registries and published reports on the use of TH: the United Kingdom (UK) TOBY Cooling Registry 30 and the linked registries from the statewide California Perinatal Quality Care Collaborative (CPQCC) and California Perinatal Transport System (CPeTS). 31 Data from VON 28 and CHND 29 as well as these published reports detail an increase in the use of TH since the publication of findings from large RCTs.…”

“…28,29 Two additional groups have developed registries and published reports on the use of TH: the United Kingdom (UK) TOBY Cooling Registry 30 and the linked registries from the statewide California Perinatal Quality Care Collaborative (CPQCC) and California Perinatal Transport System (CPeTS). 31 Data from VON 28 and CHND 29 as well as these published reports detail an increase in the use of TH since the publication of findings from large RCTs. [32][33][34][35][36][37] The California-linked registries (CPQCC and CPeTS) 31 reported an increase in the number of infants with a diagnosis of HIE of any severity during the study period 2010-2012 (N = 238; N = 280; and N = 311, respectively, total P value <.0001), with more than two-thirds of the infants receiving cooling.…”

Whats and Whys With Neonatal CT

“…This investigation by Barnette et al 1 points out what we do with imaging in neonates with encephalopathy and provokes exploration of why.…”

“…2 The authors also found a decline (of 59%) in the number of CT examinations in the study population from 2006 to 2010. 1 Another fact has been implied or outright stated when discussing CT, especially in children, which warrants some additional discussion. The fact is radiation is necessary for a CT examination, and radiation in high doses can cause cancer.…”

Biomarkers of Multiorgan Injury in Neonatal Encephalopathy

“…MRI [11][12][13] and aEEG [14,15] are currently in clinical use but biochemical biomarkers are needed for early detection of patients in need of hypothermia and for outcome prediction. There are several comprehensive reviews on the use of MRI for early assessment of long-term neurodevelopmental outcome [16][17][18]. This review only focuses on the use of the biomarkers for early detection of NE as well as long-term outcomes.…”