Brain injury patterns predict outcomes in oxygen-starved infants

By Helen Albert, Senior MedWire Reporter

Patterns of brain injury in babies with neonatal hypoxic-ischemic encephalopathy (HIE) predict survival and disability in late infancy, show study findings.

The researchers also found that children treated by inducing hypothermia shortly after birth are more likely to have a normal brain scan and have significantly fewer areas of brain infarction following treatment than those undergoing usual care.

Seetha Shankaran (Wayne State University, Detroit, Michigan, USA) and colleagues assessed links between initial brain injury, as measured by magnetic resonance imaging (MRI), and outcomes at 18-22 months in 136 children with HIE enrolled in a randomized study testing the efficacy of hypothermia treatment.

Overall, 73 children treated with hypothermia and 63 children in the control group (usual care) had MRI scans of adequate quality taken by 44 weeks postmenstrual age (mean age of 15 days).

Normal scans were significantly more common in children in the hypothermia group than the control group, at 52% versus 35%.

Similarly, infants who underwent induced hypothermia had significantly fewer areas of infarction than those in the control group, at 12% versus 22%.

All brain scans were classified using the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN) defined patterns of brain injury (0, 1A, 1B, 2A, 2B, 3).

The team found that each point increase in severity of the NICHD NRN pattern of injury (across all children in the study) increased the risk for death or disability at 18-22 months by a significant 2.35-fold.

"Our study demonstrating an excellent correlation between the NICHD NRN MRI evidence of neonatal brain injury and outcome of death or disability at 18-22 months of age may be useful when counselling parents of infants with HIE," say Shankaran and team in the Archives of Disease in Childhood.

"Conventional MRI is currently available in the majority of neonatal centres. With further study and validation, the NICHD pattern of injury following hypoxia-ischaemia may serve as a biomarker of brain injury as well as a response to neuroprotective strategies," they conclude.

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