Early Imaging and Adverse Neurodevelopmental Outcome in Asphyxiated Newborns Treated With Hypothermia - 26/07/17
Abstract |
Background |
Brain injury can be identified as early as day two of life in asphyxiated newborns treated with hypothermia, when using diffusion magnetic resonance imaging (MRI). However, it remains unclear whether these diffusion changes can predict future neurodevelopment. This study aimed to determine whether abnormal early diffusion changes in newborns treated with hypothermia are associated with adverse neurodevelopmental outcome at age two years.
Methods |
Asphyxiated newborns treated with hypothermia were enrolled prospectively. They underwent magnetic resonance imaging (MRI) at specific time points over the first month of life, including diffusion-weighted imaging and diffusion-tensor imaging. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in different regions of interest. Adverse neurodevelopmental outcome was defined as cerebral palsy, global developmental delay, and/or seizure disorder around age two years. ADC and FA values were compared between the newborns developing or not developing adverse outcome.
Results |
Twenty-nine asphyxiated newborns treated with hypothermia were included. Among the newborns developing adverse outcome, ADC values were significantly decreased on days two to three of life and increased around day ten of life in the thalamus, posterior limb of the internal capsule, and the lentiform nucleus. FA values decreased in the same regions around day 30 of life. These newborns also had increased ADC around day ten of life and around day 30 of life, and decreased FA around day 30 of life in the anterior and posterior white matter.
Conclusions |
Diffusion changes that were evident as early as day two of life, when the asphyxiated newborns were still treated with hypothermia, were associated with later abnormal neurodevelopmental outcome.
Le texte complet de cet article est disponible en PDF.Keywords : birth asphyxia, cerebral palsy, epilepsy, global developmental delay, hypothermia, magnetic resonance imaging, neonatal encephalopathy, neurodevelopment
Plan
| Conflicts of interest: The authors have no conflicts of interest. This manuscript has been contributed to, seen, and approved by all the authors. Guillaume Gilbert is an employee of Philips Healthcare. All the authors fulfill the authorship credit requirements. Fatema Al Amrani is a pediatric neurology resident in training and wrote the first draft of this manuscript. No honorarium grant or other form of payment was received for the preparation of this manuscript. |
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| Financial disclosure: Pia Wintermark receives research grant funding from the FRSQ Clinical Research Scholar Career Award Junior 2, as well as the New Investigator Research Grant from the SickKids Foundation and the CIHR Institute of Human Development, Child and Youth Health (IHDCYH). The study sponsors had no involvement in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the article for publication. |
Vol 73
P. 20-27 - août 2017 Retour au numéro
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