Relationship Between MRI Scoring Systems and Neurodevelopmental Outcome at Two Years in Infants With Neonatal Encephalopathy

Bhroin, Megan Ní; Kelly, Lynne; Sweetman, Deirdre; Aslam, Saima; O’Dea, Mary; Hurley, Tim; Slevin, Marie; Murphy, John F.; Byrne, Angela T.; Colleran, Gabrielle; Molloy, Eleanor J.; Bokde, Arun L.W.

doi:10.1016/j.pediatrneurol.2021.10.005

Cited by 23 publications

(18 citation statements)

References 50 publications

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“…Additional findings, including intraventricular and subdural hemorrhage, are also scored. A recent study comparing the Barkovich, NICHD and Weeke scoring systems in relation to the neurodevelopmental outcome at 2 years of age, demonstrated that each of these approaches had good predictive value for cognitive and motor outcome in infants with HIE, but only the Weeke score was associated with language scores at 2 years [87].…”

Section: Scoring Systemsmentioning

confidence: 99%

Magnetic Resonance Imaging in (Near-)Term Infants with Hypoxic-Ischemic Encephalopathy

2022

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Hypoxic-ischemic encephalopathy (HIE) is a major cause of neurological sequelae in (near-)term newborns. Despite the use of therapeutic hypothermia, a significant number of newborns still experience impaired neurodevelopment. Neuroimaging is the standard of care in infants with HIE to determine the timing and nature of the injury, guide further treatment decisions, and predict neurodevelopmental outcomes. Cranial ultrasonography is a helpful noninvasive tool to assess the brain before initiation of hypothermia to look for abnormalities suggestive of HIE mimics or antenatal onset of injury. Magnetic resonance imaging (MRI) which includes diffusion-weighted imaging has, however, become the gold standard to assess brain injury in infants with HIE, and has an excellent prognostic utility. Magnetic resonance spectroscopy provides complementary metabolic information and has also been shown to be a reliable prognostic biomarker. Advanced imaging modalities, including diffusion tensor imaging and arterial spin labeling, are increasingly being used to gain further information about the etiology and prognosis of brain injury. Over the past decades, tremendous progress has been made in the field of neonatal neuroimaging. In this review, the main brain injury patterns of infants with HIE, the application of conventional and advanced MRI techniques in these newborns, and HIE mimics, will be described.

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Section: Scoring Systemsmentioning

confidence: 99%

Magnetic Resonance Imaging in (Near-)Term Infants with Hypoxic-Ischemic Encephalopathy

2022

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“…The NICHD scoring system has been validated for use in multicenter studies, has excellent interrater reliability (and our radiology investigators had high agreement with their scoring), and has been related to school-age neurodevelopmental outcomes [32]. While other scoring systems have been described [50-52], a recent comparative study demonstrated that scores were highly correlated and predictive abilities for motor and cognitive outcomes were comparable across systems [53]. Thus, we do not feel that our results would differ based on the selection of MRI scoring system used in this study.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Cerebral Autoregulation Indices in Detecting Severe Brain Injury Varies by Cooling Treatment Phase in Neonates with Hypoxic-Ischemic Encephalopathy

et al. 2022

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Identifying the hemodynamic range that best supports cerebral perfusion using near infrared spectroscopy (NIRS) autoregulation monitoring is a potential physiological marker for neonatal hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia. However, an optimal autoregulation monitoring algorithm has not been identified for neonatal clinical medicine. We tested whether the hemoglobin volume phase (HVP), hemoglobin volume (HVx), and pressure passivity index (PPI) identify changes in autoregulation that are associated with brain injury on MRI or death. The HVP measures the phase difference between a NIRS metric of cerebral blood volume, the total hemoglobin (THb), and mean arterial blood pressure (MAP) at the frequency of maximum coherence. The HVx is the correlation coefficient between MAP and THb. The PPI is the percentage of coherent MAP-DHb (difference between oxygenated and deoxygenated hemoglobin, a marker of cerebral blood flow) epochs in a chosen time period. Neonates cooled for HIE were prospectively enrolled in an observational study in two neonatal intensive care units. In analyses adjusted for study site and encephalopathy level, all indices detected relationships between poor autoregulation in the first 6 h after rewarming with a higher injury score on MRI. Only HVx and PPI during hypothermia and the PPI during rewarming identified autoregulatory dysfunction associated with a poor outcome independent of study site and encephalopathy level. Our findings suggest that the accuracy of mathematical autoregulation algorithms in detecting the risk of brain injury or death may depend on temperature and postnatal age. Extending autoregulation monitoring beyond the standard 72 hours of therapeutic hypothermia may serve as a method to provide personalized care by assessing the need for and efficacy of future therapies extending past the hypothermia treatment phase.

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“…The Barkovich score was the first scale validated for the stratification of brain injury severity in relation to neuromotor outcome [ 4 ]. The Barkovich score was associated with cognitive and motor outcomes at 2 years but failed to detect language difficulties at 2 years and mild brain lesions in comparison with the more detailed Weeke score, which requires diffusion-weighted imaging and proton MRS [ 33 , 34 , 35 ]. Due to the lack of proton MRS data in our cohort, the Weeke score could not be applied for the MRI analysis.…”

Section: Discussionmentioning

confidence: 99%

Early Plasma Magnesium in Near-Term and Term Infants with Neonatal Encephalopathy in the Context of Perinatal Asphyxia

et al. 2022

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Magnesium ions are implicated in brain functioning. The disruption of brain metabolism subsequent to a perinatal hypoxic-ischaemic insult may be reflected by plasma magnesium. Infants at 36 weeks after birth or later with neonatal encephalopathy and who were admitted to our neonatal unit from 2011 to 2019 were retrospectively included. The kinetics of plasma magnesium were investigated for the first 72 h of life and correlated to the Barkovich MRI score. Among the 125 infants who met the inclusion criteria, 45 patients (36%) had moderate to severe brain lesions on neonatal MRI. Plasma magnesium values were not strongly associated with the severity of clinical encephalopathy, initial EEG background and brain lesions. Intriguingly, higher plasma magnesium values during the 0–6 h period were linked to the presence of brain injuries that predominated within the white matter (p < 0.001) and to the requirement of cardiac resuscitation in the delivery room (p = 0.001). The occurrence of seizures was associated with a lower mean magnesium value around the 24th hour of life (p = 0.005). This study supports that neonatal encephalopathy is a complex and multifactorial condition. Plasma magnesium could help to better identify the subtypes of neonatal encephalopathy. Further studies are needed to confirm these results in this prospect.

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Relationship Between MRI Scoring Systems and Neurodevelopmental Outcome at Two Years in Infants With Neonatal Encephalopathy

Cited by 23 publications

References 50 publications

Magnetic Resonance Imaging in (Near-)Term Infants with Hypoxic-Ischemic Encephalopathy

Magnetic Resonance Imaging in (Near-)Term Infants with Hypoxic-Ischemic Encephalopathy

The Utility of Cerebral Autoregulation Indices in Detecting Severe Brain Injury Varies by Cooling Treatment Phase in Neonates with Hypoxic-Ischemic Encephalopathy

Early Plasma Magnesium in Near-Term and Term Infants with Neonatal Encephalopathy in the Context of Perinatal Asphyxia

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