Neonatal Magnetic Resonance Imaging Pattern of Brain Injury as a Biomarker of Childhood Outcomes following a Trial of Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

Abstract

Objective: To examine the ability of magnetic resonance imaging (MRI) patterns of neonatal brain injury defined by the National Institute of Child Health and Human Development Neonatal Research Network to predict death or IQ at 6-7 years of age following hypothermia for neonatal encephalopathy.

Study design: Out of 208 participants, 124 had MRI and primary outcome (death or IQ <70) data. The relationship between injury pattern and outcome was assessed.

Results: Death or IQ <70 occurred in 4 of 50 (8%) of children with pattern 0 (normal MRI), 1 of 6 (17%) with 1A (minimal cerebral lesions), 1 of 4 (25%) with 1B (extensive cerebral lesions), 3 of 8 (38%) with 2A (basal ganglia thalamic, anterior or posterior limb of internal capsule, or watershed infarction), 32 of 49 (65%) with 2B (2A with cerebral lesions), and 7 of 7 (100%) with pattern 3 (hemispheric devastation), P < .001; this association was also seen within hypothermia and control subgroups. IQ was 90 ± 13 among the 46 children with a normal MRI and 69 ± 25 among the 50 children with an abnormal MRI. In childhood, for a normal outcome, a normal neonatal MRI had a sensitivity of 61%, specificity of 92%, a positive predictive value of 92%, and a negative predictive value of 59%; for death or IQ <70, the 2B and 3 pattern combined had a sensitivity of 81%, specificity of 78%, positive predictive value of 70%, and a negative predictive value of 87%.

Conclusions: The Neonatal Research Network MRI pattern of neonatal brain injury is a biomarker of neurodevelopmental outcome at 6-7 years of age.

Trial registration: ClinicalTrials.gov: NCT00005772.

Figure

A, NICHD NRN score = 0 (Term infants; normal T2(3T and 1.5T)). B, NICHD NRN score 1A with minimal cerebral lesions only (arrow) without any involvement of the basal ganglia, thalamus, ALIC, PLIC, or WS infarction. C, NICHD NRN score 1B with more extensive cerebral lesion without any BGT, ALIC, PLIC, or infarction. D, NICHD NRN score 2A: any BGT, ALIC, PLIC, or WS infarction without any other cerebral lesions. E, NICHD NRN score 2B: BGT, ALIC, PLIC, or WS infarction and cerebral lesions. F, NICHD NRN score 3: cerebral hemispheric devastation.