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



(1) basal ganglia-thalamus (BGT) lesions

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

(3) brainstem

(4) cerebellum

MRI Finding


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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