MRI Findings of Martinez-Biarge et al That Are Predictive of Outcomes in a Term Infant with Hypoxic-Ischemic Encephalopathy (HIE)

Description

Martinez-Biarge et al identified changes in an MRI of the brain that correlate with outcome in a term infant with hypoxic-ischemic encephalopathy (HIE). An infants at greater risk for more severe cerebral palsy (CP) may benefit from early and aggressive management. The authors are from Imperial Colleg London, Hammersmith Hospital Campus and La Paz University Hospital in Madrid.

Patient selection:

(1) >= 35 weeks gestational age

(2) signs of fetal compromise

(3) poor condition at birth, with Apgar score at 5 minutes less than 5, pH of cord arterial blood < 7.1, need for major resuscitation

(4) neonatal encephalopathy with altered consciousness, problems with respirations, abnormal muscle tone, abnormal reflexes, variable seizures

(5) basal ganglia-thalamic (BGT) lesions on MRI taken before 6 weeks after birth

Cerebral MRI was performed up to 6 weeks after birth

Findings:

(1) basal ganglia-thalamus (BGT) lesions

(2) posterior limb of the internal capsule (PLIC)

(3) brainstem

(4) cerebellum

MRI Finding	Significance
BGT, mild	7% moderate CP, 0% severe CP, 0% death
BGT, moderate	27% moderate CP, 27% severe CP, 5% death
BGT, severe	96% with severe CP, 43% death
normal PLIC	100% survival and 100% walking at 2 years
equivocal PLIC	100% survival and 67% walking at 2 years
abnormal PLIC	37% death, 12% walking at 2 years
cerebellar damage	100% severe CP, 63% death
brainstem damage, normal	0% death
brainstem damage, mesencephalic and pontine, moderate	25% death
brainstem damage, mesencephalic and pontine, severe	50-60% death

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Description

Specialty

ICD-10