Resting-State Functional Magnetic Resonance Imaging Network Association With Mortality, Epilepsy, Cognition, and Motor Two-Year Outcomes in Suspected Severe Neonatal Acute Brain Injury - 16/02/24
, Iliana Manjón, MS b, Bethany L. Sussman, PhD c, Alyssa McGary, MS d, Lucia Mirea, PhD d, Kirsten Gillette, BS a, Jordan Broman-Fulks, MD a, Emilio G. Cediel, MD a, Martin Arhin, MS a, Senyene E. Hunter, MD, PhD a, Sarah N. Wyckoff, PhD c, Kimberlee Allred, NNP-BC e, Deborah Tom, MD eAbstract |
Background and Objectives |
In acute brain injury of neonates, resting-state functional magnetic resonance imaging (MRI) (RS) showed incremental association with consciousness, mortality, cognitive and motor development, and epilepsy, with correction for multiple comparisons, at six months postgestation in neonates with suspected acute brain injury (ABI). However, there are relatively few developmental milestones at six months to benchmark against, thus, we extended this cohort study to evaluate two-year outcomes.
Methods |
In 40 consecutive neonates with ABI and RS, ordinal scores of resting-state networks; MRI, magnetic resonance spectroscopy, and electroencephalography; and up to 42-month outcomes of mortality, general and motor development, Pediatric Cerebral Performance Category Scale (PCPC), and epilepsy informed associations between tests and outcomes.
Results |
Mean gestational age was 37.8 weeks, 68% were male, and 60% had hypoxic-ischemic encephalopathy. Three died in-hospital, four at six to 42 months, and five were lost to follow-up. Associations included basal ganglia network with PCPC (P = 0.0003), all-mortality (P = 0.005), and motor (P = 0.0004); language/frontoparietal network with developmental delay (P = 0.009), PCPC (P = 0.006), and all-mortality (P = 0.01); default mode network with developmental delay (P = 0.003), PCPC (P = 0.004), neonatal intensive care unit mortality (P = 0.01), and motor (P = 0.009); RS seizure onset zone with epilepsy (P = 0.01); and anatomic MRI with epilepsy (P = 0.01).
Conclusion |
For the first time, at any age, resting state functional MRI in ABI is associated with long-term epilepsy and RSNs predicted mortality in neonates. Severity of RSN abnormality was associated with incrementally worsened neurodevelopment including cognition, language, and motor function over two years.
Le texte complet de cet article est disponible en PDF.Keywords : Functional connectivity, Coma, Prognosis, Resting-state fMRI, Neonatal, Acute brain injury, Disorders of consciousness
Plan
| Data availability statement: Data not provided in the article because of space limitations and approved by the IRB may be shared (anonymized) at the request of any qualified investigator for purposes of replicating procedures and results. |
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| Ethics statement: This retrospective study involving human participants was reviewed and approved by the Institutional Review Board (IRB # 20-331) at Phoenix Children's Hospital. Written informed waived consent for this cohort study was waived by the IRB. |
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| Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. |
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| Contribution to the field statement: Recently, we published the first work of resting state functional connectivity after acute severe brain insult in neonates detailing developmental and epileptogenic six-month outcomes. That study's weakness is that the major developmental milestones at six months were yet to come by that age, including language and walking. Also, the ambiguity between normal baby movements may have reduced the identification of the seizure network-epilepsy relationship. Studying the most important period of development, two years, would clarify if neonatal networks after brain injury inform these life-impacting outcomes of cognition, language, motor development, mortality, and epilepsy. The primary novel finding of this study was for the first time, at any age, rs-fMRI acquired during the acute phase of acute brain injury is associated with long-term epilepsy. Resting-state networks were also shown to predict mortality for the first time in neonates. Last, the degree of resting-state network abnormality was associated with incrementally worsened neurodevelopment in terms of cognition, language, and motor function over a longer-range follow-up of two years, to a higher degree than found previously. |
Vol 152
P. 41-55 - mars 2024 Retour au numéro
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