Neurodevelopmental Outcomes According to Brain Injury Patterns in Neonates with Postasphyxial Hypoxic Ischemic Encephalopathy.

Jeong,  Seung Yeon; Choi,  Seo Yeol; Chang,  Young Pyo; Lee,  Young Seok

doi:2017.24.1.32

Neonatal Med > Volume 24(1); 2017 > Article

Original Article

Neonatal Medicine 2017;24(1):32-39.
DOI: https://doi.org/10.5385/nm.2017.24.1.32 Published online February 28, 2017.

Neurodevelopmental Outcomes According to Brain Injury Patterns in Neonates with Postasphyxial Hypoxic Ischemic Encephalopathy.

Seung Yeon Jeong, Seo Yeol Choi, Young Pyo Chang, Young Seok Lee

¹Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea. ychang@dankook.ac.kr
²Department of Radiology, Dankook University College of Medicine, Cheonan, Korea.

Abstract

PURPOSE
To investigate the relationship between brain injury patterns on magnetic resonance imaging (MRI) and neurodevelopmental outcomes in neonates with postasphyxial hypoxic ischemic encephalopathy (HIE).
METHODS
Clinical characteristics and brain MRI findings of 49 term neonates with postasphyxial HIE were retrospectively reviewed. Brain injury patterns in MRI were classified into five categories, along with evaluation of the posterior limb of internal capsule (PLIC). Neurodevelopmental outcomes were assessed by neurological examination combined with the Bayley Scales of Infant Development II between 1 and 2 years of age.
RESULTS
Twenty-three neonates (46.9%) showed abnormal brain MRI finding associated with poor neurodevelopmental outcomes (odds ratio 9.7, 95% confidence interval 1.4, 67.4, P=0.022). The following injury patterns were seen in MRI: abnormality in the basal ganglia-thalamus (BGT) in 4 neonates (17.4%), watershed predominant (WP) pattern in 5 (21.7%), extensive global injury (EGI) in 3 (13.0%), lesions restricted to periventricular white matter (LPWM) in 4 (17.4%), and perinatal arterial ischemic stroke (PAIS) in 2 (8.7%). Additionally, 6 neonate (26.1%) showed lesion in the PLIC. Neonate with BGT and EGI injury patterns showed worse neurodevelopmental outcomes than those with WP and LPWM patterns (P<0.05). Neonate with PLIC lesion also showed poor outcomes (100%).
CONCLUSION
Abnormal brain MRI findings in neonates with postasphyxial HIE were associated with the poor neurodevelopmental outcomes. BGT, EGI and PLIC patterns of injury are expected to have worse outcomes than white matter predominant injury patterns such as those in the WP and LPWM.

Key Words: Neonatal hypoxic ischemic encephalopathy; Brain injury; Brain magnetic resonance imaging; Neurodevelopmental outcome