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Randomized Controlled Trial
. 2012 Nov;97(6):F398-404.
doi: 10.1136/archdischild-2011-301524.

Brain injury following trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy

Seetha Shankaran  1 , Patrick D Barnes, Susan R Hintz, Abbott R Laptook, Kristin M Zaterka-Baxter, Scott A McDonald, Richard A Ehrenkranz, Michele C Walsh, Jon E Tyson, Edward F Donovan, Ronald N Goldberg, Rebecca Bara, Abhik Das, Neil N Finer, Pablo J Sanchez, Brenda B Poindexter, Krisa P Van Meurs, Waldemar A Carlo, Barbara J Stoll, Shahnaz Duara, Ronnie Guillet, Rosemary D Higgins; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Randomized Controlled Trial

Brain injury following trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy

Seetha Shankaran et al. Arch Dis Child Fetal Neonatal Ed. 2012 Nov.

Erratum in

  • Arch Dis Child Fetal Neonatal Ed. 2014 Mar;99(3):301

Abstract

Objective: The objective of our study was to examine the relationship between brain injury and outcome following neonatal hypoxic-ischaemic encephalopathy treated with hypothermia.

Design and patients: Neonatal MRI scans were evaluated in the National Institute of Child Health and Human Development (NICHD) randomised controlled trial of whole-body hypothermia and each infant was categorised based upon the pattern of brain injury on the MRI findings. Brain injury patterns were assessed as a marker of death or disability at 18-22 months of age.

Results: Scans were obtained on 136 of 208 trial participants (65%); 73 in the hypothermia and 63 in the control group. Normal scans were noted in 38 of 73 infants (52%) in the hypothermia group and 22 of 63 infants (35%) in the control group. Infants in the hypothermia group had fewer areas of infarction (12%) compared to infants in the control group (22%). Fifty-one of the 136 infants died or had moderate or severe disability at 18 months. The brain injury pattern correlated with outcome of death or disability and with disability among survivors. Each point increase in the severity of the pattern of brain injury was independently associated with a twofold increase in the odds of death or disability.

Conclusions: Fewer areas of infarction and a trend towards more normal scans were noted in brain MRI following whole-body hypothermia. Presence of the NICHD pattern of brain injury is a marker of death or moderate or severe disability at 18-22 months following hypothermia for neonatal encephalopathy.

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Conflict of interest statement

Competing interests Dr Cotten reports having served on the data and safety monitoring board for the Inhibitex phase 3 study of Vernonate for the prevention of infections in preterm infants. Dr Donovan reports having received support from the Environmental Protection Agency (Lanphear) and the Gerber Foundation. Dr Carlo reports holding stock options at the Pediatrix Medical Group. Dr Stevenson reports having received research support from Pfizer.

Figures

Figure 1
Figure 1
(A) National Institute of Child Health and Human Development Neonatal Research Network score=0; (B) score 1A: lesions in frontal and parietal subcortical areas; (C) score 1B: more extensive cerebral lesions in frontal, parietal and occipital subcortical areas; (D) score 2A: lesions in the basal ganglia and thalamic area (BGT) and internal capsule (IC); (E) score 2B: lesions in the BGT, IC and cerebral areas; (F) score 3: cerebral hemispheric devastation.
See this image and copyright information in PMC

References

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