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Lew CO, Calabrese E, Chen JV, Tang F, Chaudhari G, Lee A, Faro J, Juul S, Mathur A, McKinstry RC, Wisnowski JL, Rauschecker A, Wu YW, Li Y. Artificial Intelligence Outcome Prediction in Neonates with Encephalopathy (AI-OPiNE). Radiol Artif Intell 2024; 6:e240076. [PMID: 38984984 DOI: 10.1148/ryai.240076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Purpose To develop a deep learning algorithm to predict 2-year neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy using MRI and basic clinical data. Materials and Methods In this study, MRI data of term neonates with encephalopathy in the High-dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial (ClinicalTrials.gov: NCT02811263), who were enrolled from 17 institutions between January 25, 2017, and October 9, 2019, were retrospectively analyzed. The harmonized MRI protocol included T1-weighted, T2-weighted, and diffusion tensor imaging. Deep learning classifiers were trained to predict the primary outcome of the HEAL trial (death or any neurodevelopmental impairment at 2 years) using multisequence MRI and basic clinical variables, including sex and gestational age at birth. Model performance was evaluated on test sets comprising 10% of cases from 15 institutions (in-distribution test set, n = 41) and 10% of cases from two institutions (out-of-distribution test set, n = 41). Model performance in predicting additional secondary outcomes, including death alone, was also assessed. Results For the 414 neonates (mean gestational age, 39 weeks ± 1.4 [SD]; 232 male, 182 female), in the study cohort, 198 (48%) died or had any neurodevelopmental impairment at 2 years. The deep learning model achieved an area under the receiver operating characteristic curve (AUC) of 0.74 (95% CI: 0.60, 0.86) and 63% accuracy in the in-distribution test set and an AUC of 0.77 (95% CI: 0.63, 0.90) and 78% accuracy in the out-of-distribution test set. Performance was similar or better for predicting secondary outcomes. Conclusion Deep learning analysis of neonatal brain MRI yielded high performance for predicting 2-year neurodevelopmental outcomes. Keywords: Convolutional Neural Network (CNN), Prognosis, Pediatrics, Brain, Brain Stem Clinical trial registration no. NCT02811263 Supplemental material is available for this article. © RSNA, 2024 See also commentary by Rafful and Reis Teixeira in this issue.
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Affiliation(s)
- Christopher O Lew
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Evan Calabrese
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Joshua V Chen
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Felicia Tang
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Gunvant Chaudhari
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Amanda Lee
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - John Faro
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Sandra Juul
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Amit Mathur
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Robert C McKinstry
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Jessica L Wisnowski
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Andreas Rauschecker
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Yvonne W Wu
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
| | - Yi Li
- From the Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710 (C.O.L., E.C, A.L., J.F.); Department of Radiology (J.V.C., F.T., G.C., A.R., Y.L.) and Weill Institute for Neurosciences (Y.W.W.), University of California San Francisco, San Francisco, Calif; Department of Pediatrics, University of Washington, Seattle, Wash (S.J.); Department of Pediatrics, Saint Louis University, St Louis, Mo (A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); and Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif (J.L.W.)
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Weeke LC, Groenendaal F, de Vries LS. MRI scoring systems for long-term outcome prediction in Neonatal Encephalopathy due to hypoxia-ischemia: in search of the crystal ball. Pediatr Res 2024:10.1038/s41390-024-03410-1. [PMID: 39009767 DOI: 10.1038/s41390-024-03410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Lauren C Weeke
- Department of Neonatology, Radboud UMC, Nijmegen, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Leiden University Medical Center, Leiden, the Netherlands.
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Cizmeci MN, Martinez-Biarge M, Cowan FM. The predictive role of brain magnetic resonance imaging in neonates with hypoxic-ischemic encephalopathy. Pediatr Res 2024; 95:601-602. [PMID: 37433902 DOI: 10.1038/s41390-023-02732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Mehmet N Cizmeci
- Department of Pediatrics, Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | | | - Frances M Cowan
- Division of Neonatal Neurology, Hammersmith Hospital, Imperial College, London, UK
- Division of Neonatal Neuroscience, Bristol University, Bristol, UK
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Lambing H, Gano D, Li Y, Bach AM, Girvan O, Rogers EE, Ferriero DM, Barkovich AJ, Xu D, McCulloch CE, Glass HC. Using Neonatal Magnetic Resonance Imaging to Predict Gross Motor Disability at Four Years in Term-Born Children With Neonatal Encephalopathy. Pediatr Neurol 2023; 144:50-55. [PMID: 37148603 DOI: 10.1016/j.pediatrneurol.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/07/2022] [Accepted: 03/17/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Children with neonatal encephalopathy (NE) are at risk for basal ganglia/thalamus (BG/T) and watershed patterns of brain injury. Children with BG/T injury are at high risk for motor impairment in infancy, but the predictive validity of a published rating scale for outcome at age four years is not known. We examined a cohort of children with NE and magnetic resonance imaging (MRI) to examine the relationship between BG/T injury and severity of cerebral palsy (CP) in childhood. METHODS Term-born neonates at risk for brain injury due to NE were enrolled from 1993 to 2014 and received MRI within two weeks of birth. Brain injury was scored by a pediatric neuroradiologist. The Gross Motor Function Classification System (GMFCS) level was determined at four years. The relationship between BG/T injury and dichotomized GMFCS (no CP or GMFCS I to II = none/mild versus III to V = moderate/severe CP) was evaluated with logistic regression, and predictive performance was assessed by cross-validated area under the receiver operating characteristic curve (AUROC). RESULTS Among 174 children, higher BG/T scores were associated with more severe GMFCS level. Clinical predictors had a low AUROC (0.599), compared with that of MRI (0.895). Risk of moderate to severe CP was low (<20%) in all patterns of brain injury except BG/T = 4, which carried a 67% probability (95% confidence interval 36% to 98%) of moderate to severe CP. CONCLUSIONS The BG/T injury score can be used to predict the risk and severity of CP at age four years and thereby inform early developmental interventions.
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Affiliation(s)
- Hannah Lambing
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Dawn Gano
- Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Department of Pediatrics and Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Yi Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Ashley M Bach
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Elizabeth E Rogers
- Department of Pediatrics and Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Donna M Ferriero
- Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Department of Pediatrics and Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - A James Barkovich
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Hannah C Glass
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Department of Pediatrics and Benioff Children's Hospital, University of California San Francisco, San Francisco, California.
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Parmentier CEJ, de Vries LS, Groenendaal F. Magnetic Resonance Imaging in (Near-)Term Infants with Hypoxic-Ischemic Encephalopathy. Diagnostics (Basel) 2022; 12:diagnostics12030645. [PMID: 35328199 PMCID: PMC8947468 DOI: 10.3390/diagnostics12030645] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 01/14/2023] Open
Abstract
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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Affiliation(s)
- Corline E. J. Parmentier
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
| | - Linda S. de Vries
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
- Department of Neonatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (C.E.J.P.); (L.S.d.V.)
- Correspondence:
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Ní Bhroin M, Kelly L, Sweetman D, Aslam S, O'Dea MI, Hurley T, Slevin M, Murphy J, Byrne AT, Colleran G, Molloy EJ, Bokde ALW. Relationship Between MRI Scoring Systems and Neurodevelopmental Outcome at Two Years in Infants With Neonatal Encephalopathy. Pediatr Neurol 2022; 126:35-42. [PMID: 34736061 DOI: 10.1016/j.pediatrneurol.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) scoring systems are used in the neonatal period to predict outcome in infants with neonatal encephalopathy. Our aim was to assess the relationship between three MRI scores and neurodevelopmental outcome assessed using Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), at two years in infants with neonatal encephalopathy. METHODS Term-born neonates with evidence of perinatal asphyxia born between 2011 and 2015 were retrospectively reviewed. MRI scanning was performed within the first two weeks of life and scored using Barkovich, National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN), and Weeke systems by a single assessor blinded to the infants clinical course. Neurodevelopmental outcome was assessed using composite scores on the Bayley-III at two years. Multiple linear regression analyses were used to assess the association between MRI scores and Bayley-III composite scores, with postmenstrual age at scan and sex included as covariates. RESULTS Of the 135 recruited infants, 90 infants underwent MRI, and of these, 66 returned for follow-up. MRI abnormalities were detected with the highest frequency using the Weeke score (Barkovich 40%, NICHD NRN 50%, Weeke 77%). The inter-rater agreement was good for the Barkovich score and excellent for NICHD NRN and Weeke scores. There was a significant association between Barkovich, NICHD NRN, and Weeke scores and Bayley-III cognitive and motor scores. Only the Weeke score was associated with Bayley-III language scores. CONCLUSIONS Our findings confirm the predictive value of existing MRI scoring systems for cognitive and motor outcome and suggest that more detailed scoring systems have predictive value for language outcome.
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Affiliation(s)
- Megan Ní Bhroin
- Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland.
| | - Lynne Kelly
- Department of Paediatric and Child Health, Trinity College Dublin, Tallaght University Hospital (TUH), Dublin, Ireland
| | - Deirdre Sweetman
- Department of Neonatology, The National Maternity Hospital, Dublin, Ireland
| | - Saima Aslam
- Department of Neonatology, Children's Hospital Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Mary I O'Dea
- Department of Paediatric and Child Health, Trinity College Dublin, Tallaght University Hospital (TUH), Dublin, Ireland; Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Tim Hurley
- Department of Paediatric and Child Health, Trinity College Dublin, Tallaght University Hospital (TUH), Dublin, Ireland
| | - Marie Slevin
- Department of Neonatology, The National Maternity Hospital, Dublin, Ireland
| | - John Murphy
- Department of Neonatology, The National Maternity Hospital, Dublin, Ireland
| | - Angela T Byrne
- Department of Radiology, Children's Hospital Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Gabrielle Colleran
- Department of Radiology, The National Maternity Hospital, Dublin, Ireland and Children's Hospital Ireland (CHI) at Temple Street, Dublin, Ireland; Department of Paediatrics, Trinity College Dublin, Dublin, Ireland; Women's and Children's Health, University College Dublin (UCD), School of Medicine, University College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Department of Paediatric and Child Health, Trinity College Dublin, Tallaght University Hospital (TUH), Dublin, Ireland; Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Arun L W Bokde
- Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
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Marlow N, Shankaran S, Rogers EE, Maitre NL, Smyser CD. Neurological and developmental outcomes following neonatal encephalopathy treated with therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101274. [PMID: 34330680 DOI: 10.1016/j.siny.2021.101274] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In randomized trials, therapeutic hypothermia (TH) is associated with reduced prevalence of the composite outcome mortality or neurodevelopmental morbidity in infants with neonatal encephalopathy (NE). Following systematic review, the reduction in prevalence of both mortality and infant neuromorbidity is clear. Among three trials reporting school age outcomes, the effects of NE and TH suggest that such benefit persists into middle childhood, but none of the major trials were powered to detect differences in these outcomes. Cognitive, educational and behavioural outcomes are all adversely affected by NE in children without moderate or severe neuromorbidity. High-quality longitudinal studies of neurocognitive and educational outcomes following NE in the era of TH, including studies incorporating multimodal neuroimaging assessments, are required to characterise deficits more precisely so that robust interventional targets may be developed, and resource planning can occur. Understanding the impact of NE on families and important educational, social, and behavioural outcomes in childhood is critical to attempts to optimise outcomes through interventions.
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Affiliation(s)
| | | | | | - Nathalie L Maitre
- Nationwide Children's Hospital, Columbus, OH, USA; Vanderbilt University, Nashville, TN, USA
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Neamțu BM, Visa G, Maniu I, Ognean ML, Pérez-Elvira R, Dragomir A, Agudo M, Șofariu CR, Gheonea M, Pitic A, Brad R, Matei C, Teodoru M, Băcilă C. A Decision-Tree Approach to Assist in Forecasting the Outcomes of the Neonatal Brain Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4807. [PMID: 33946326 PMCID: PMC8124811 DOI: 10.3390/ijerph18094807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
Neonatal brain injury or neonatal encephalopathy (NE) is a significant morbidity and mortality factor in preterm and full-term newborns. NE has an incidence in the range of 2.5 to 3.5 per 1000 live births carrying a considerable burden for neurological outcomes such as epilepsy, cerebral palsy, cognitive impairments, and hydrocephaly. Many scoring systems based on different risk factor combinations in regression models have been proposed to predict abnormal outcomes. Birthweight, gestational age, Apgar scores, pH, ultrasound and MRI biomarkers, seizures onset, EEG pattern, and seizure duration were the most referred predictors in the literature. Our study proposes a decision-tree approach based on clinical risk factors for abnormal outcomes in newborns with the neurological syndrome to assist in neonatal encephalopathy prognosis as a complementary tool to the acknowledged scoring systems. We retrospectively studied 188 newborns with associated encephalopathy and seizures in the perinatal period. Etiology and abnormal outcomes were assessed through correlations with the risk factors. We computed mean, median, odds ratios values for birth weight, gestational age, 1-min Apgar Score, 5-min Apgar score, seizures onset, and seizures duration monitoring, applying standard statistical methods first. Subsequently, CART (classification and regression trees) and cluster analysis were employed, further adjusting the medians. Out of 188 cases, 84 were associated to abnormal outcomes. The hierarchy on etiology frequencies was dominated by cerebrovascular impairments, metabolic anomalies, and infections. Both preterms and full-terms at risk were bundled in specific categories defined as high-risk 75-100%, intermediate risk 52.9%, and low risk 0-25% after CART algorithm implementation. Cluster analysis illustrated the median values, profiling at a glance the preterm model in high-risk groups and a full-term model in the inter-mediate-risk category. Our study illustrates that, in addition to standard statistics methodologies, decision-tree approaches could provide a first-step tool for the prognosis of the abnormal outcome in newborns with encephalopathy.
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Affiliation(s)
- Bogdan Mihai Neamțu
- Clinical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (B.M.N.); (M.L.O.); (M.T.)
- Department of Computer Science and Electrical Engineering, Faculty of Engineering, Lucian Blaga University Sibiu, 550025 Sibiu, Romania; (A.P.); (R.B.)
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
| | - Gabriela Visa
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
| | - Ionela Maniu
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
- Department of Mathematics and Informatics, Faculty of Sciences, Lucian Blaga University Sibiu, 550012 Sibiu, Romania
| | - Maria Livia Ognean
- Clinical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (B.M.N.); (M.L.O.); (M.T.)
- Neonatology Department, Sibiu Clinical and Emergency County Hospital, Lucian Blaga University Sibiu, 550245 Sibiu, Romania
| | - Rubén Pérez-Elvira
- Neuropsychophysiology Lab., NEPSA Rehabilitación Neurológica, 37003 Salamanca, Spain;
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, 280048 Madrid, Spain
| | - Andrei Dragomir
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
- The N.1 Institute for Health, National University of Singapore, 28, Medical Dr. #05-COR, Singapore 117456, Singapore
| | - Maria Agudo
- Neuropsychophysiology Lab., NEPSA Rehabilitación Neurológica, 37003 Salamanca, Spain;
| | - Ciprian Radu Șofariu
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; (G.V.); (I.M.); (A.D.); (C.R.S.)
| | - Mihaela Gheonea
- Neonatology Department, Craiova Clinical and Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Antoniu Pitic
- Department of Computer Science and Electrical Engineering, Faculty of Engineering, Lucian Blaga University Sibiu, 550025 Sibiu, Romania; (A.P.); (R.B.)
| | - Remus Brad
- Department of Computer Science and Electrical Engineering, Faculty of Engineering, Lucian Blaga University Sibiu, 550025 Sibiu, Romania; (A.P.); (R.B.)
| | - Claudiu Matei
- Dental and Nursing Medical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (C.M.); (C.B.)
| | - Minodora Teodoru
- Clinical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (B.M.N.); (M.L.O.); (M.T.)
| | - Ciprian Băcilă
- Dental and Nursing Medical Department, Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (C.M.); (C.B.)
- Dr. Gheorghe Preda Psychiatric Hospital, 550082 Sibiu, Romania
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Lakatos A, Kolossváry M, Szabó M, Jermendy Á, Barta H, Gyebnár G, Rudas G, Kozák LR. Neurodevelopmental effect of intracranial hemorrhage observed in hypoxic ischemic brain injury in hypothermia-treated asphyxiated neonates - an MRI study. BMC Pediatr 2019; 19:430. [PMID: 31718607 PMCID: PMC6849254 DOI: 10.1186/s12887-019-1777-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Identification of early signs of hypoxic ischemic encephalopathy (HIE) with magnetic resonance imaging (MRI) has proven of prognostic significance. Yet, the importance of intracranial hemorrhage (ICH), being present concomitantly had not been investigated yet, despite the known influence of hypothermia on hemostasis. We aimed to determine whether presence of ICH on MRI alongside the signs of HIE have an impact on prognosis in neonates with the clinical diagnosis of HIE. METHODS A retrospective study of consecutively sampled 108 asphyxiated term infants admitted to a tertiary neonatal intensive care unit (between 2007 and 2016), treated with whole body hypothermia and having brain MRI within 1 week of life was conducted. Presence or absence of HIE signs on MRI (basal ganglia-thalamus, watershed pattern and total brain injury) and on MR spectroscopy (lactate peak with decreased normal metabolites measured by Lac/NAA ratio) and/or of the five major types of ICH were recorded. Neurodevelopmental outcome was measured with Bayley Scales of Infant Development-II (BSID-II) test. Death or abnormal neurodevelopment (BSID-II score < 85) was defined as poor outcome in Chi-square test. Multivariate logistic regression analysis was performed on survivors. RESULTS MRI and MR-spectroscopy (MRS) signs of HIE were present in 72% (n = 78). 36% (n = 39) of neonates had ICH, being mainly small in size. Chi-square test showed a relationship between neurodevelopmental outcome and initial MRI. Unadjusted logistic regression showed that neonates presenting MRI and MRS signs of HIE have 6.23 times higher odds for delayed mental development (OR = 6.2292; CI95% = [1.2642; 30.6934], p = 0.0246), than infants without imaging alterations; with no ICH effect on outcome. Adjustment for clinical and imaging parameters did not change the pattern of results, i.e. HIE remained an independent risk factor for delayed neurodevelopment (OR = 6.2496; CI95% = [1.2018; 32.4983], p = 0.0294), while ICH remained to have no significant effect. CONCLUSION HIE related MRI abnormalities proved to be important prognostic factors of poor outcome in cooled asphyxiated infants when present, suggesting that early MRI with MRS is beneficial for prognostication. Interestingly, ICHs present in about one third of all cases had no significant effect on neurodevelopmental outcome, despite the known hemostasis altering effects of hypothermia.
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Affiliation(s)
- Andrea Lakatos
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Márton Kolossváry
- MTA-SE "Lendület" Cardiovascular Imaging Research Group, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Miklós Szabó
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Ágnes Jermendy
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Hajnalka Barta
- First Department of Paediatrics, Semmelweis University, Bókay u. 53-54, Budapest, 1083, Hungary
| | - Gyula Gyebnár
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Gábor Rudas
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary
| | - Lajos R Kozák
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary.
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Counsell SJ, Arichi T, Arulkumaran S, Rutherford MA. Fetal and neonatal neuroimaging. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:67-103. [PMID: 31324329 DOI: 10.1016/b978-0-444-64029-1.00004-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance imaging (MRI) can provide detail of the soft tissues of the fetal and neonatal brain that cannot be obtained by any other imaging modality. Conventional T1 and T2 weighted sequences provide anatomic detail of the normally developing brain and can demonstrate lesions, including those associated with preterm birth, hypoxic ischemic encephalopathy, perinatal arterial stroke, infections, and congenital malformations. Specialized imaging techniques can be used to assess cerebral vasculature (magnetic resonance angiography and venography), cerebral metabolism (magnetic resonance spectroscopy), cerebral perfusion (arterial spin labeling), and function (functional MRI). A wealth of quantitative tools, most of which were originally developed for the adult brain, can be applied to study the developing brain in utero and postnatally including measures of tissue microstructure obtained from diffusion MRI, morphometric studies to measure whole brain and regional tissue volumes, and automated approaches to study cortical folding. In this chapter, we aim to describe different imaging approaches for the fetal and neonatal brain, and to discuss their use in a range of clinical applications.
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Affiliation(s)
- Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sophie Arulkumaran
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Abstract
PURPOSE OF REVIEW Neonatal encephalopathy is the most common condition in neonates encountered by child neurologists. The etiology is most often global hypoxia-ischemia due to failure of cerebral perfusion to the fetus caused by uterine, placental, or umbilical cord compromise prior to or during delivery. Other etiologies of neonatal encephalopathy include ischemic stroke and intracranial hemorrhage, infection, developmental anomalies, and inborn errors of metabolism. RECENT FINDINGS Therapeutic hypothermia is standard of care for the treatment of neonatal encephalopathy presumed to be caused by hypoxia-ischemia. The number needed to treat is approximately 6 to 7 to prevent one child from either death or disability at age 18 to 22 months. EEG monitoring and MRI are important tools in determining the etiology of encephalopathy and prognosis of the infant. SUMMARY Neonatal encephalopathy is a heterogeneous disorder that is characterized by alterations in mental status, hypotonia, seizures, and abnormalities in feeding and respiration. The most common cause of neonatal encephalopathy is hypoxic-ischemic encephalopathy, for which treatment with 72 hours of therapeutic hypothermia is associated with reduced death or disability.
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12
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Lubián López SP, Zuazo Ojeda A, Jimenez Gómez G, Benavente Fernández I. Monitoring of Blood Pressure is not Enough to Avoid Neonatal Postoperative Encephalopathy. AJP Rep 2018; 8:e192-e194. [PMID: 30250759 PMCID: PMC6147745 DOI: 10.1055/s-0038-1668565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/15/2017] [Indexed: 11/30/2022] Open
Abstract
Background Neonatal encephalopathy with seizures after general anesthesia not occurring in infants undergoing cardiac or major neurosurgery is very uncommon. An ischemic origin due to cerebral hypoperfusion from perioperative hypotension has been suggested, but there is a lack of a consensus definition for intraoperatory hypotension in neonates. Case Report We report the first case of neonatal encephalopathy with seizures in a neonate with anorectal malformation. He underwent a colostomy with caudal anesthesia combined with light general anesthesia. Intraoperative systolic blood pressure and mean blood pressure values were considered normal. Thirty-two hours after the intervention, the patient presented electroclinical seizures. Diffusion-weighted imaging showed bilateral involvement with reduced diffusivity in the watershed areas of the middle cerebral artery and posterior cerebral artery. Conclusion Perioperative monitoring of blood pressure is not enough in neonatal surgery. Cerebral magnetic resonance imaging should be considered in infants with noncardiac congenital anomalies after neonatal surgery and long-term follow-up is required.
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Affiliation(s)
- Simón Pedro Lubián López
- Neonatology Department, "Puerta del Mar" University Hospital, Cadiz, Spain. Fundación Nene (Neonatal Neurology Research Group
| | - Amaya Zuazo Ojeda
- Radiology Department, "Puerta del Mar" University Hospital, Cadiz, Spain
| | | | - Isabel Benavente Fernández
- Neonatology Department, "Puerta del Mar" University Hospital, Cadiz, Spain. Fundación Nene (Neonatal Neurology Research Group
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13
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Groenendaal F. The prognostic value of proton magnetic resonance spectroscopy in term newborns treated with therapeutic hypothermia following asphyxia. Magn Reson Imaging 2018; 48:139-140. [DOI: 10.1016/j.mri.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022]
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Al Amrani F, Marcovitz J, Sanon PN, Khairy M, Saint-Martin C, Shevell M, Wintermark P. Prediction of outcome in asphyxiated newborns treated with hypothermia: Is a MRI scoring system described before the cooling era still useful? Eur J Paediatr Neurol 2018; 22:387-395. [PMID: 29439909 DOI: 10.1016/j.ejpn.2018.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/07/2018] [Accepted: 01/20/2018] [Indexed: 11/17/2022]
Abstract
AIM To determine whether an MRI scoring system, which was validated in the pre-cooling era, can still predict the neurodevelopmental outcome of asphyxiated newborns treated with hypothermia at 2 years of age. PATIENTS AND METHOD We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia. An MRI scoring system, which was validated in the pre-cooling era, was used to grade the severity of brain injury on the neonatal brain MRI. Their neurodevelopment was assessed around 2 years of age; adverse outcome included cerebral palsy, global developmental delay, and/or epilepsy. RESULTS One hundred and sixty-nine newborns were included. Among the 131 newborns who survived and had a brain MRI during the neonatal period, 92% were evaluated around 2 years of age or later. Of these newborns, 37% displayed brain injury, and 23% developed an adverse outcome. Asphyxiated newborns treated with hypothermia who had an adverse outcome had a significantly higher MRI score (p <0.001) compared to those without an adverse outcome. CONCLUSION An MRI scoring system that was validated before the cooling era is still able to reliably differentiate which of the asphyxiated newborns treated with hypothermia were more prone to develop an adverse outcome around 2 years of age.
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Affiliation(s)
- Fatema Al Amrani
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Jaclyn Marcovitz
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Priscille-Nice Sanon
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - May Khairy
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada; Neonatal Follow-up Clinic, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Christine Saint-Martin
- Department of Radiology, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Michael Shevell
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada.
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15
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Weeke LC, Groenendaal F, Mudigonda K, Blennow M, Lequin MH, Meiners LC, van Haastert IC, Benders MJ, Hallberg B, de Vries LS. A Novel Magnetic Resonance Imaging Score Predicts Neurodevelopmental Outcome After Perinatal Asphyxia and Therapeutic Hypothermia. J Pediatr 2018; 192:33-40.e2. [PMID: 29246356 PMCID: PMC5743051 DOI: 10.1016/j.jpeds.2017.09.043] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the predictive value of a novel magnetic resonance imaging (MRI) score, which includes diffusion-weighted imaging as well as assessment of the deep grey matter, white matter, and cerebellum, for neurodevelopmental outcome at 2 years and school age among term infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia. STUDY DESIGN This retrospective cohort study (cohort 1, The Netherlands 2008-2014; cohort 2, Sweden 2007-2012) including infants born at >36 weeks of gestational age treated with therapeutic hypothermia who had an MRI in the first weeks of life. The MRI score consisted of 3 subscores: deep grey matter, white matter/cortex, and cerebellum. Primary adverse outcome was defined as death, cerebral palsy, Bayley Scales of Infant and Toddler Development, third edition, motor or cognitive composite scores at 2 years of <85, or IQ at school age of <85. RESULTS In cohort 1 (n = 97) and cohort 2 (n = 76) the grey matter subscore was an independent predictor of adverse outcome at 2 years (cohort 1, OR, 1.6; 95% CI, 1.3-1.9; cohort 2, OR, 1.4; 95% CI, 1.2-1.6), and school age (cohort 1, OR, 1.3; 95% CI, 1.2-1.5; cohort 2, OR, 1.3; 95% CI, 1.1-1.6). The white matter and cerebellum subscore did not add to the predictive value. The positive predictive value, negative predictive value, and area under the curve for the grey matter subscore were all >0.83 in both cohorts, whereas the specificity was >0.91 with variable sensitivity. CONCLUSION A novel MRI score, which includes diffusion-weighted imaging and assesses all brain areas of importance in infants with therapeutic hypothermia after perinatal asphyxia, has predictive value for outcome at 2 years of age and at school age, for which the grey matter subscore can be used independently.
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Affiliation(s)
- Lauren C. Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Kalyani Mudigonda
- Department of Neonatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Blennow
- Department of Neonatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maarten H. Lequin
- Department of Radiology, Wilhelmina Children's Hospital, University Medical Centerer Utrecht, Utrecht University, the Netherlands
| | - Linda C. Meiners
- Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ingrid C. van Haastert
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Manon J. Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Boubou Hallberg
- Department of Neonatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Linda S. de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands,Reprint requests: Linda S. de Vries, MD, PhD, Department of Neonatology, KE.04.123.1, PO Box 85090, Utrecht 3508 AB, The Netherlands.Department of NeonatologyKE.04.123.1PO Box 85090Utrecht3508 ABThe Netherlands
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16
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Shapiro KA, Kim H, Mandelli ML, Rogers EE, Gano D, Ferriero DM, Barkovich AJ, Gorno-Tempini ML, Glass HC, Xu D. Early changes in brain structure correlate with language outcomes in children with neonatal encephalopathy. NEUROIMAGE-CLINICAL 2017; 15:572-580. [PMID: 28924555 PMCID: PMC5593272 DOI: 10.1016/j.nicl.2017.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/29/2017] [Accepted: 06/09/2017] [Indexed: 01/18/2023]
Abstract
Global patterns of brain injury correlate with motor, cognitive, and language outcomes in survivors of neonatal encephalopathy (NE). However, it is still unclear whether local changes in brain structure predict specific deficits. We therefore examined whether differences in brain structure at 6 months of age are associated with neurodevelopmental outcomes in this population. We enrolled 32 children with NE, performed structural brain MR imaging at 6 months, and assessed neurodevelopmental outcomes at 30 months. All subjects underwent T1-weighted imaging at 3 T using a 3D IR-SPGR sequence. Images were normalized in intensity and nonlinearly registered to a template constructed specifically for this population, creating a deformation field map. We then used deformation based morphometry (DBM) to correlate variation in the local volume of gray and white matter with composite scores on the Bayley Scales of Infant and Toddler Development (Bayley-III) at 30 months. Our general linear model included gestational age, sex, birth weight, and treatment with hypothermia as covariates. Regional brain volume was significantly associated with language scores, particularly in perisylvian cortical regions including the left supramarginal gyrus, posterior superior and middle temporal gyri, and right insula, as well as inferior frontoparietal subcortical white matter. We did not find significant correlations between regional brain volume and motor or cognitive scale scores. We conclude that, in children with a history of NE, local changes in the volume of perisylvian gray and white matter at 6 months are correlated with language outcome at 30 months. Quantitative measures of brain volume on early MRI may help identify infants at risk for poor language outcomes. Global volume loss after neonatal brain injury results in poorer language outcome. Variability in language correlates specifically with left perisylvian brain volume. Changes in regional brain volume are not correlated with motor or cognitive outcome.
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Affiliation(s)
- Kevin A Shapiro
- Department of Neurology, University of California, San Francisco, USA.
| | - Hosung Kim
- Department of Radiology, University of California, San Francisco, USA
| | | | | | - Dawn Gano
- Department of Neurology, University of California, San Francisco, USA; Department of Pediatrics, University of California, San Francisco, USA
| | - Donna M Ferriero
- Department of Neurology, University of California, San Francisco, USA; Department of Pediatrics, University of California, San Francisco, USA
| | - A James Barkovich
- Department of Neurology, University of California, San Francisco, USA; Department of Radiology, University of California, San Francisco, USA; Department of Pediatrics, University of California, San Francisco, USA
| | | | - Hannah C Glass
- Department of Neurology, University of California, San Francisco, USA; Department of Pediatrics, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Duan Xu
- Department of Radiology, University of California, San Francisco, USA
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17
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Hirfanoglu T, Serdaroglu A, Capraz I, Bilir E, Arhan EP, Aydin K. Comparison of ILAE 2010 and semiological seizure classification in children with epilepsy. Epilepsy Res 2016; 129:41-50. [PMID: 27894011 DOI: 10.1016/j.eplepsyres.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 10/12/2016] [Accepted: 11/16/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to compare both ILAE 2010 and semiological seizure classification (SSC) in terms of their applicability and utility and to predict epileptogenic zone in children with epilepsy. METHODS Both ILAE 2010 classification and SSC which is a part of five dimensional classification were applied for a total 138 children by dividing into younger (≤6y/o) and older (>6y/o) age groups over the last two years as retrospectively. After the assessment of the seizures types, epilepsy syndromes, and etiologies; the data were also compared to evaluate if having correlation between epileptogenic zone and seizure subtypes in both ILAE 2010 and SSC. RESULTS ILAE 2010 indicated that 66.7% of the patients had focal seizures, 15.9% had generalized seizures, and 14.4% had seizures of unknown origin. The SSC revealed that the most frequent seizure type was simple seizures (56.5%), second frequent one was complex motor seizures (46.4%) and dialeptic seizures (39.9%). To predict epileptogenic zone, SSC was found to be more specific than ILAE in terms of the more subgroups of SSC were related to the more subgroups of epileptogenic zone (p<0.05). Furthermore, there was a clear correlation between focal foci and specific seizure types in older ages, while many foci caused to same seizure types and tend to no clear focal foci with generalized onset in younger ages. On the other hand, the relationship between epileptogenic zone and etiology was more remarkable in the five dimensional classification. SIGNIFICANCE Preference of seizure classification system is unique for each patient and depends on requirements. Therefore, one dimension cannot be sufficient for evaluation the nature of the seizures in some patients. Furthermore, age related evolution of the seizure types should not be ignored due to ongoing maturation state of the brain. ILAE 2010 and SSC have weak and strong points compared to each other. Semiological seizure classification is more informative in terms of identifying the epileptogenic zone which may be important in specific occasions like pre-surgical work up, while ILAE is simple and easier method which can be applied for seizure description and their characteristics in daily practice.
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Affiliation(s)
- Tugba Hirfanoglu
- Department of Pediatric Neurology & Pediatric Video EEG Monitoring Unit, School of Medicine, Gazi University, Ankara, Turkey.
| | - Ayse Serdaroglu
- Department of Pediatric Neurology & Pediatric Video EEG Monitoring Unit, School of Medicine, Gazi University, Ankara, Turkey
| | - Irem Capraz
- Department of Neurology & Adult Video EEG Monitoring Unit, School of Medicine, Gazi University, Ankara, Turkey
| | - Erhan Bilir
- Department of Neurology & Adult Video EEG Monitoring Unit, School of Medicine, Gazi University, Ankara, Turkey
| | - Ebru Petek Arhan
- Department of Pediatric Neurology & Pediatric Video EEG Monitoring Unit, School of Medicine, Gazi University, Ankara, Turkey
| | - Kursad Aydin
- Department of Pediatric Neurology & Pediatric Video EEG Monitoring Unit, School of Medicine, Gazi University, Ankara, Turkey
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18
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Placental pathology and outcome after perinatal asphyxia and therapeutic hypothermia. J Perinatol 2016; 36:977-984. [PMID: 27537858 DOI: 10.1038/jp.2016.110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/27/2016] [Accepted: 06/20/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the relationship between placental pathology, pattern of brain injury and neurodevelopmental outcome in term infants with perinatal asphyxia receiving therapeutic hypothermia. STUDY DESIGN Studies were performed in 76 infants. Death or survival with impairments at 18 to 24 months was used as a composite adverse outcome. Multivariable analysis was performed. RESULTS Among the 75 infants analyzed, the predominant pattern of brain injury was: no injury (n=27), a white matter/watershed pattern (n=14), basal-ganglia-thalamic injury (n=13) or near-total brain injury (n=21). An adverse outcome was seen in 35 of the 76 infants. Elevated nucleated red blood cells were associated with white matter involvement. Small placental infarcts were more common among infants without brain injury. All other placental abnormalities were not related to both outcome measures. CONCLUSION In our population of term infants receiving therapeutic hypothermia, no type of placental pathology was related to extensive brain injury or adverse neurodevelopmental outcome.
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19
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Weeke LC, Boylan GB, Pressler RM, Hallberg B, Blennow M, Toet MC, Groenendaal F, de Vries LS. Role of EEG background activity, seizure burden and MRI in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischaemic encephalopathy in the era of therapeutic hypothermia. Eur J Paediatr Neurol 2016; 20:855-864. [PMID: 27370316 DOI: 10.1016/j.ejpn.2016.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 05/04/2016] [Accepted: 06/11/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the role of EEG background activity, electrographic seizure burden, and MRI in predicting neurodevelopmental outcome in infants with hypoxic-ischaemic encephalopathy (HIE) in the era of therapeutic hypothermia. METHODS Twenty-six full-term infants with HIE (September 2011-September 2012), who had video-EEG monitoring during the first 72 h, an MRI performed within the first two weeks and neurodevelopmental assessment at two years were evaluated. EEG background activity at age 24, 36 and 48 h, seizure burden, and severity of brain injury on MRI, were compared and related to neurodevelopmental outcome. RESULTS EEG background activity was significantly associated with neurodevelopmental outcome at 36 h (p = 0.009) and 48 h after birth (p = 0.029) and with severity of brain injury on MRI at 36 h (p = 0.002) and 48 h (p = 0.018). All infants with a high seizure burden and moderate-severe injury on MRI had an abnormal outcome. The positive predictive value (PPV) of EEG for abnormal outcome was 100% at 36 h and 48 h and the negative predictive value (NPV) was 75% at 36 h and 69% at 48 h. The PPV of MRI was 100% and the NPV 85%. The PPV of seizure burden was 78% and the NPV 71%. CONCLUSION Severely abnormal EEG background activity at 36 h and 48 h after birth was associated with severe injury on MRI and abnormal neurodevelopmental outcome. High seizure burden was only associated with abnormal outcome in combination with moderate-severe injury on MRI.
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Affiliation(s)
- Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands
| | - Geraldine B Boylan
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Wilton, Co. Cork, Ireland
| | - Ronit M Pressler
- Clinical Neurosciences, UCL-Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Boubou Hallberg
- Department of Neonatology, Karolinska University Hospital, SE-171 77 Stockholm, Sweden
| | - Mats Blennow
- Department of Neonatology, Karolinska University Hospital, SE-171 77 Stockholm, Sweden
| | - Mona C Toet
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands.
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Zonnenberg IA, Vermeulen RJ, Rohaan MW, van Weissenbruch MM, Groenendaal F, de Vries LS. Severe Neonatal Anaemia, MRI Findings and Neurodevelopmental Outcome. Neonatology 2016; 109:282-8. [PMID: 26886231 DOI: 10.1159/000443320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Severe neonatal anaemia can impair cerebral oxygen supply. Data on long-term outcomes following severe neonatal anaemia are scarce. METHODS Clinical data and neurodevelopmental outcome of 49 (near) term infants with haemoglobin concentration after birth <6.0 mmol/l were retrospectively collected and analysed. In a subgroup of 28 patients, amplitude-integrated EEG was available and in 25 infants cerebral MRI was obtained. Infants were followed up at 14-35 months of age and assessed with the Griffiths Scale of Mental Development or Bayley Scale of Infant Development. RESULTS Eighteen patients (37%) died during the neonatal period. In 25 patients MRI was performed. A predominant pattern of injury on MRI was seen in the basal ganglia and thalami in 7 patients (28%), whereas some form of white matter injury was present in 16 (64%) and a combination in 3 (12%). Follow-up data were available for 26 patients (84% of survivors). Formal assessment of neurodevelopmental outcome was performed in 20 of 31 (65%) infants who survived (median age: 19 months, range: 14-35). Sixteen infants (80%) had a developmental quotient appropriate for age in the first 2 years after birth. On motor outcome, 1 patient (5%) scored below average (Z-score -1.10). One patient developed cerebral palsy. CONCLUSION Early neurodevelopmental outcome in surviving patients with severe neonatal anaemia was within the normal range in the majority of the survivors. MRI showed mild-to-moderate white matter injury in two thirds of the infants. Prospectively collected data with a longer follow-up period are needed.
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Spring In ''t Veld LG, de Vries LS, Alderliesten T, Benders MJNL, Groenendaal F. Serial 1- and 2-Dimensional Cerebral MRI Measurements in Full-Term Infants after Perinatal Asphyxia. Neonatology 2016; 110:27-32. [PMID: 26968012 DOI: 10.1159/000444121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/18/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cranial magnetic resonance imaging (MRI) is associated with neurodevelopmental outcome in full-term infants with neonatal encephalopathy (NE) following presumed perinatal asphyxia. The aim of this study is to relate 2-dimensional measurements of the basal ganglia and thalami (BGT) and cerebellum in the first week after birth and after 3 months with neurodevelopmental outcome at 18 months. METHODS Retrospectively, 29 full-term infants with NE following presumed perinatal asphyxia who had a cranial MRI in the first week after birth were studied serially. One- and 2-dimensional measurements were obtained and related to different patterns of brain injury, and neurodevelopmental outcome at 18 months. A Griffiths developmental quotient <85 or cerebral palsy was considered adverse. RESULTS On the first MRI, the adverse outcome group showed increased basal ganglia width (42.1 ± 0.1 vs. 40.3 ± 0.3 mm, p < 0.001), thalamic width (40.3 ± 0.1 vs. 39.3 ± 1.0 mm, p < 0.001), and basal ganglia surface (1,230 ± 21 vs. 1,199 ± 36 mm2, p = 0.007) compared to the favorable outcome group. In the BGT lesions group, basal ganglia width and thalamic width were increased compared to the watershed infarction group (42.1 ± 0.1 vs. 40.9 ± 0.8 mm, p < 0.001, and 40.3 ± 0.1 vs. 39.9 ± 0.5 mm, p = 0.01, respectively). On the second MRI, cerebellar width was larger in the favorable outcome group (p = 0.025). There was a greater increase in dimensions between both MRI time points for basal ganglia width (p = 0.014), basal ganglia surface (p = 0.028) and thalamic width (p = 0.012) in the favorable outcome group. CONCLUSIONS One- and 2-dimensional measurements for basal ganglia surface, BGT width and cerebellar width are associated with neurodevelopmental outcome at 18 months.
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Affiliation(s)
- Laura G Spring In ''t Veld
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
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Charon V, Proisy M, Ferré JC, Bruneau B, Tréguier C, Beuchée A, Chauvel J, Rozel C. Comparison of early and late MRI in neonatal hypoxic-ischemic encephalopathy using three assessment methods. Pediatr Radiol 2015. [PMID: 26209958 DOI: 10.1007/s00247-015-3419-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is no consensus on the optimum timing of MRI in neonates with hypoxic-ischemic encephalopathy treated with hypothermia. Reliable early imaging assessment might help managing treatment. OBJECTIVE To assess non-random differences between early and late MRI that might influence intensive-care decisions. MATERIALS AND METHODS This single-center retrospective study included all asphyxiated term neonates eligible for hypothermia treatment November 2009-July 2012. MRI scans were systematically performed at day 4 (early MRI) and day 11 of life as part of routine protocol. Two experienced pediatric radiologists reviewed both scans according to three assessment methods: a pattern classification, a scoring system and a simplified classification. Agreement between early and late imaging findings was assessed using Cohen's kappa coefficients. RESULTS Thirty-three neonates were included. Interobserver agreement was excellent. Early MRI detected all severe injuries. Agreement between early and late MRI was excellent for the simplified classification (κ = 0.82), good for the pattern classification (κ = 0.64), and good to excellent for 3 scores out of 4 in the scoring system (κ = 0.70-0.89). CONCLUSION Early MRI may provide valuable information about brain injury to help parents and neonatologists in intensive-care decisions at the end of hypothermia treatment.
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Affiliation(s)
- Valérie Charon
- Department of Imaging, Hôpital Sud, University Hospital, 16 Boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France.
| | - Maïa Proisy
- Department of Imaging, Hôpital Sud, University Hospital, 16 Boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France
| | - Jean-Christophe Ferré
- Department of Neuroradiology, Hôpital Pontchaillou, University Hospital, Rennes, France
| | - Bertrand Bruneau
- Department of Imaging, Hôpital Sud, University Hospital, 16 Boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France
| | - Catherine Tréguier
- Department of Imaging, Hôpital Sud, University Hospital, 16 Boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France
| | - Alain Beuchée
- Department of Neonatology, Hôpital Sud, University Hospital, Rennes, France
| | - Jennifer Chauvel
- Department of Neonatology, Saint Brieuc Hospital, Saint-Brieuc, France
| | - Céline Rozel
- Department of Imaging, Hôpital Sud, University Hospital, 16 Boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France
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23
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Perinatal brain damage: The term infant. Neurobiol Dis 2015; 92:102-12. [PMID: 26409031 PMCID: PMC4915441 DOI: 10.1016/j.nbd.2015.09.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/27/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022] Open
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Hayes BC, Ryan S, McGarvey C, Mulvany S, Doherty E, Grehan A, Madigan C, Matthews T, King MD. Brain magnetic resonance imaging and outcome after hypoxic ischaemic encephalopathy. J Matern Fetal Neonatal Med 2015; 29:777-82. [PMID: 25754207 DOI: 10.3109/14767058.2015.1018167] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To correlate pattern of injury on neonatal brain magnetic resonance imaging (MRI) with outcome in infants ≥36 + 0 weeks gestation with hypoxic ischaemic encephalopathy. METHODS Prospective cohort study. Images were blindly reviewed. Children were assessed using a variety of standardised assessments. RESULTS MRI brain was performed on 88 infants. Follow up was available in 73(83%) infants. Eight of 25(32%) children with normal imaging had below normal assessment scores. Eight infants (12%) had isolated punctate white matter lesions and five of these had abnormal assessment scores. Death and cerebral palsy were seen only in children with imaging scores ≥3 on basal ganglia/thalami (BGT) score or ≥4 on watershed score. No developmental concerns were raised in 3/7(43%) infants with isolated watershed injury. Ten of 13(77%) infants with isolated BGT injury died or developed cerebral palsy. All 23 children with posterior limb of the internal capsule (PLIC) injury displayed developmental difficulties. CONCLUSIONS Almost one-third of infants with a normal MRI brain may be at risk of developmental problems. Punctate foci of white matter injury are common and not always benign. PLIC involvement is usually associated with neurological sequelae including isolated cognitive deficits. Worst outcomes are associated with basal ganglia injury.
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Affiliation(s)
| | - Stephanie Ryan
- b The Children's University Hospital , Dublin , Ireland , and
| | - Cliona McGarvey
- b The Children's University Hospital , Dublin , Ireland , and
| | | | - Elaine Doherty
- b The Children's University Hospital , Dublin , Ireland , and
| | | | - Cathy Madigan
- b The Children's University Hospital , Dublin , Ireland , and
| | | | - Mary D King
- b The Children's University Hospital , Dublin , Ireland , and.,c School of Medicine and Medical Science, University College , Dublin , Ireland
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Skranes JH, Cowan FM, Stiris T, Fugelseth D, Thoresen M, Server A. Brain imaging in cooled encephalopathic neonates does not differ between four and 11 days after birth. Acta Paediatr 2015; 104:752-8. [PMID: 25824694 DOI: 10.1111/apa.13016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/16/2015] [Accepted: 03/25/2015] [Indexed: 01/01/2023]
Abstract
AIM The optimal timing of magnetic resonance imaging (MRI) in encephalopathic infants treated with hypothermia is unknown, and this study examined whether early scans differed from later scans. METHODS We assessed paired MRI scans carried out on 41 cooled encephalopathic infants at a median of four and 11 days using two scoring systems: the Rutherford injury scores for the basal ganglia and thalami (BGT), white matter and the posterior limb of the internal capsule, and the Bonifacio injury scores for the BGT and watershed area. RESULTS Both systems produced consistent injury severity scores in 37 of 41 infants on both days, with Rutherford scores predicting poor outcome in six early scans and seven later scans (K = 0.91) and Bonifacio doing the same in seven and nine scans (K = 0.85). A white matter/watershed score of two or a BGT score of one indicated severe changes by day 11 in three infants, but lower scores did not. CONCLUSION Magnetic resonance imaging scans indicated that the Rutherford and Bonifacio systems produced similar scores in 37 of 41 cooled encephalopathic infants at a median of four and 11 days. Infants with an early white matter/watershed scores of two or a BGT score of one may worsen and should be rescanned.
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Affiliation(s)
- Janne Helen Skranes
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Neonatal Intensive Care; Oslo University Hospital Ullevål; Oslo Norway
| | - Frances Mary Cowan
- Neonatal Neuroscience; School of Medical Sciences; University of Bristol; Bristol UK
| | - Tom Stiris
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Neonatal Intensive Care; Oslo University Hospital Ullevål; Oslo Norway
| | - Drude Fugelseth
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Neonatal Intensive Care; Oslo University Hospital Ullevål; Oslo Norway
| | - Marianne Thoresen
- Neonatal Neuroscience; School of Medical Sciences; University of Bristol; Bristol UK
- Department of Physiology; Institute of Basic Medical Sciences; University of Oslo; Oslo Norway
| | - Andres Server
- Department of Neuroradiology; Oslo University Hospital; Oslo Norway
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Weeke LC, Groenendaal F, Toet MC, Benders MJNL, Nievelstein RAJ, van Rooij LGM, de Vries LS. The aetiology of neonatal seizures and the diagnostic contribution of neonatal cerebral magnetic resonance imaging. Dev Med Child Neurol 2015; 57:248-56. [PMID: 25385195 DOI: 10.1111/dmcn.12629] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 12/26/2022]
Abstract
AIM The aim of this study was to delineate aetiologies and explore the diagnostic value of cerebral magnetic resonance imaging (MRI) in addition to cranial ultrasonography (cUS) in infants presenting with neonatal seizures. METHOD This retrospective cohort study comprised infants (gestational age 35.0-42.6wks) with seizures, confirmed by either continuous amplitude-integrated electroencephalography (aEEG) or standard EEG and admitted during a 14-year period to a level three neonatal intensive care unit (n=378; 216 males, 162 females; mean [SD] birthweight 3334g [594]). All infants underwent cUS and MRI (MRI on median of 5 days after birth, range 0-58d) within the first admission period. RESULTS An underlying aetiology was identified in 354 infants (93.7%). The most common aetiologies identified were hypoxic-ischaemic encephalopathy (46%), intracranial haemorrhage (12.2%), and perinatal arterial ischaemic stroke (10.6%). When comparing MRI with cUS in these 354 infants MRI showed new findings which did not become apparent on cUS, contributing to a diagnosis in 42 (11.9%) infants and providing additional information to cUS, contributing to a diagnosis in 141 (39.8%). cUS alone would have allowed a diagnosis in only 37.9% of infants (134/354). INTERPRETATION Cerebral MRI contributed to making a diagnosis in the majority of infants. In 11.9% of infants the diagnosis would have been missed if only cUS were used and cerebral MRI added significantly to the information obtained in 39.8% of infants. These data suggest that cerebral MRI should be performed in all newborn infants presenting with EEG- or aEEG-confirmed seizures.
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Affiliation(s)
- Lauren C Weeke
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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27
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Marseglia LM, Nicotera A, Salpietro V, Giaimo E, Cardile G, Bonsignore M, Alibrandi A, Caccamo D, Manti S, D'Angelo G, Mamì C, Di Rosa G. Hyperhomocysteinemia and MTHFR polymorphisms as antenatal risk factors of white matter abnormalities in two cohorts of late preterm and full term newborns. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:543134. [PMID: 25829992 PMCID: PMC4338403 DOI: 10.1155/2015/543134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 12/26/2022]
Abstract
Higher total homocysteine (tHcy) levels, and C677T and A1298C methylenetetrahydrofolate (MTHFR) polymorphisms, have been reported in preterm or full term newborns with neonatal encephalopathy following perinatal hypoxic-ischemic insult. This study investigated the causal role of tHcy and MTHFR polymorphisms together with other acquired risk factors on the occurrence of brain white matter abnormalities (WMA) detected by cranial ultrasound scans (cUS) in a population of late preterm and full term infants. A total of 171 newborns (81 M, 47.4%), 45 (26.3%) born <37 wks, and 126 (73.7%) born ≥37 wks were recruited in the study. cUS detected predominant WMA pattern in 36/171 newborns (21.1%) mainly characterized by abnormal periventricular white matter signal and mild-to-moderate periventricular white matter volume loss with ventricular dilatation (6/36, 16.6%). WMA resulted in being depending on tHcy levels (P < 0.014), lower GA (P < 0.000), lower Apgar score at 1 minutes (P < 0.000) and 5 minutes (P < 0.000), and 1298AC and 677CT/1298AC genotypes (P < 0.000 and P < 0.000). In conclusion, both acquired and genetic predisposing antenatal factors were significantly associated with adverse neonatal outcome and WMA. The role of A1298C polymorphism may be taken into account for prenatal assessment and treatment counseling.
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Affiliation(s)
- Lucia M. Marseglia
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Neonatal Intensive Care, University of Messina, Messina, Italy
| | - Antonio Nicotera
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Child Neurology and Psychiatry, University of Messina, Messina, Italy
| | - Vincenzo Salpietro
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Pediatric Genetics and Immunology, University of Messina, Messina, Italy
| | - Elisa Giaimo
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Child Neurology and Psychiatry, University of Messina, Messina, Italy
| | - Giovanna Cardile
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Child Neurology and Psychiatry, University of Messina, Messina, Italy
| | - Maria Bonsignore
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Child Neurology and Psychiatry, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Daniela Caccamo
- Department of Biomedical Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Sara Manti
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Neonatal Intensive Care, University of Messina, Messina, Italy
| | - Gabriella D'Angelo
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Neonatal Intensive Care, University of Messina, Messina, Italy
| | - Carmelo Mamì
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Neonatology, University of Messina, Messina, Italy
| | - Gabriella Di Rosa
- Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, Unit of Child Neurology and Psychiatry, University of Messina, Messina, Italy
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Hadders-Algra M. Early diagnosis and early intervention in cerebral palsy. Front Neurol 2014; 5:185. [PMID: 25309506 PMCID: PMC4173665 DOI: 10.3389/fneur.2014.00185] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/09/2014] [Indexed: 01/06/2023] Open
Abstract
This paper reviews the opportunities and challenges for early diagnosis and early intervention in cerebral palsy (CP). CP describes a group of disorders of the development of movement and posture, causing activity limitation that is attributed to disturbances that occurred in the fetal or infant brain. Therefore, the paper starts with a summary of relevant information from developmental neuroscience. Most lesions underlying CP occur in the second half of gestation, when developmental activity in the brain reaches its summit. Variations in timing of the damage not only result in different lesions but also in different neuroplastic reactions and different associated neuropathologies. This turns CP into a heterogeneous entity. This may mean that the best early diagnostics and the best intervention methods may differ for various subgroups of children with CP. Next, the paper addresses possibilities for early diagnosis. It discusses the predictive value of neuromotor and neurological exams, neuroimaging techniques, and neurophysiological assessments. Prediction is best when complementary techniques are used in longitudinal series. Possibilities for early prediction of CP differ for infants admitted to neonatal intensive care and other infants. In the former group, best prediction is achieved with the combination of neuroimaging and the assessment of general movements, in the latter group, best prediction is based on carefully documented milestones and neurological assessment. The last part reviews early intervention in infants developing CP. Most knowledge on early intervention is based on studies in high-risk infants without CP. In these infants, early intervention programs promote cognitive development until preschool age; motor development profits less. The few studies on early intervention in infants developing CP suggest that programs that stimulate all aspects of infant development by means of family coaching are most promising. More research is urgently needed.
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Affiliation(s)
- Mijna Hadders-Algra
- Department of Pediatrics - Developmental Neurology, University Medical Center Groningen, University of Groningen , Groningen , Netherlands
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29
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Drury PP, Davidson JO, Mathai S, van den Heuij LG, Ji H, Bennet L, Tan S, Silverman RB, Gunn AJ. nNOS inhibition during profound asphyxia reduces seizure burden and improves survival of striatal phenotypic neurons in preterm fetal sheep. Neuropharmacology 2014; 83:62-70. [PMID: 24726307 DOI: 10.1016/j.neuropharm.2014.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/17/2014] [Accepted: 03/31/2014] [Indexed: 12/01/2022]
Abstract
Basal ganglia injury after hypoxia-ischemia remains common in preterm infants, and is closely associated with later cerebral palsy. In the present study we tested the hypothesis that a highly selective neuronal nitric oxide synthase (nNOS) inhibitor, JI-10, would improve survival of striatal phenotypic neurons after profound asphyxia, and that the subsequent seizure burden and recovery of EEG are associated with neural outcome. 24 chronically instrumented preterm fetal sheep were randomized to either JI-10 (3 ml of 0.022 mg/ml, n = 8) or saline (n = 8) infusion 15 min before 25 min complete umbilical cord occlusion, or saline plus sham-occlusion (n = 8). Umbilical cord occlusion was associated with reduced numbers of calbindin-28k-, GAD-, NPY-, PV-, Calretinin- and nNOS-positive striatal neurons (p < 0.05 vs. sham occlusion) but not ChAT-positive neurons. JI-10 was associated with increased numbers of calbindin-28k-, GAD-, nNOS-, NPY-, PV-, Calretinin- and ChAT-positive striatal neurons (p < 0.05 vs. saline + occlusion). Seizure burden was strongly associated with loss of calbindin-positive cells (p < 0.05), greater seizure amplitude was associated with loss of GAD-positive cells (p < 0.05), and with more activated microglia in the white matter tracts (p < 0.05). There was no relationship between EEG power after 7 days recovery and total striatal cell loss, but better survival of NPY-positive neurons was associated with lower EEG power. In summary, these findings suggest that selective nNOS inhibition during asphyxia is associated with protection of phenotypic striatal projection neurons and has potential to help reduce basal ganglia injury in some premature babies.
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Affiliation(s)
- Paul P Drury
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Joanne O Davidson
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Sam Mathai
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | | | - Haitao Ji
- Department of Chemistry, Department of Molecular Biosciences, Chemistry of Life Processes Institute, Center for Molecular Innovation and Drug Discovery, Northwestern University, Evanston, IL 60208-3113, USA; Department of Chemistry, University of Utah, Salt Lake City, UT, USA
| | - Laura Bennet
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Sidhartha Tan
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Richard B Silverman
- Department of Chemistry, Department of Molecular Biosciences, Chemistry of Life Processes Institute, Center for Molecular Innovation and Drug Discovery, Northwestern University, Evanston, IL 60208-3113, USA
| | - Alistair J Gunn
- Department of Physiology, University of Auckland, Auckland, New Zealand.
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30
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Stoodley N. Every picture does not (always) tell a story. Dev Med Child Neurol 2013; 55:589-90. [PMID: 23550843 DOI: 10.1111/dmcn.12134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Neil Stoodley
- Department of Neuroradiology, North Bristol NHS Trust, Frenchay Hospital, Bristol, UK
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