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Neonatal Magnetic Resonance Imaging Pattern of Brain Injury as a Biomarker of Childhood Outcomes following a Trial of Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy.

CPQCC Publication
TitleNeonatal Magnetic Resonance Imaging Pattern of Brain Injury as a Biomarker of Childhood Outcomes following a Trial of Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy.
Publication TypeJournal Article
Year of Publication2015
AuthorsShankaran S, McDonald SA, Laptook AR, Hintz SR, Barnes PD, Das A, Pappas A, Higgins RD
Corporate AuthorsEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
JournalJ Pediatr
Volume167
Issue5
Pagination987-93.e3
Date Published2015 Nov
ISSN1097-6833
KeywordsBrain Injuries, Child, Cognition Disorders, Cohort Studies, Female, Follow-Up Studies, Humans, Hyperthermia, Induced, Hypoxia-Ischemia, Brain, Infant, Infant, Newborn, Intelligence Tests, Magnetic Resonance Imaging, Male, Maternal Age, Motor Skills, Predictive Value of Tests, Treatment Outcome
Abstract

OBJECTIVE: To examine the ability of magnetic resonance imaging (MRI) patterns of neonatal brain injury defined by the National Institute of Child Health and Human Development Neonatal Research Network to predict death or IQ at 6-7 years of age following hypothermia for neonatal encephalopathy.

STUDY DESIGN: Out of 208 participants, 124 had MRI and primary outcome (death or IQ <70) data. The relationship between injury pattern and outcome was assessed.

RESULTS: Death or IQ <70 occurred in 4 of 50 (8%) of children with pattern 0 (normal MRI), 1 of 6 (17%) with 1A (minimal cerebral lesions), 1 of 4 (25%) with 1B (extensive cerebral lesions), 3 of 8 (38%) with 2A (basal ganglia thalamic, anterior or posterior limb of internal capsule, or watershed infarction), 32 of 49 (65%) with 2B (2A with cerebral lesions), and 7 of 7 (100%) with pattern 3 (hemispheric devastation), P < .001; this association was also seen within hypothermia and control subgroups. IQ was 90 ± 13 among the 46 children with a normal MRI and 69 ± 25 among the 50 children with an abnormal MRI. In childhood, for a normal outcome, a normal neonatal MRI had a sensitivity of 61%, specificity of 92%, a positive predictive value of 92%, and a negative predictive value of 59%; for death or IQ <70, the 2B and 3 pattern combined had a sensitivity of 81%, specificity of 78%, positive predictive value of 70%, and a negative predictive value of 87%.

CONCLUSIONS: The Neonatal Research Network MRI pattern of neonatal brain injury is a biomarker of neurodevelopmental outcome at 6-7 years of age.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT00005772.

DOI10.1016/j.jpeds.2015.08.013
Alternate JournalJ Pediatr
PubMed ID26387012
PubMed Central IDPMC4700815
Grant ListU10 HD027856 / HD / NICHD NIH HHS / United States
U10 HD021373 / HD / NICHD NIH HHS / United States
UL1 RR024139 / RR / NCRR NIH HHS / United States
U10 HD021385 / HD / NICHD NIH HHS / United States
U10 HD021364 / HD / NICHD NIH HHS / United States
U10 HD027880 / HD / NICHD NIH HHS / United States
U10 HD040521 / HD / NICHD NIH HHS / United States
M01 RR008084 / RR / NCRR NIH HHS / United States
U10 HD040461 / HD / NICHD NIH HHS / United States
M01 RR016587 / RR / NCRR NIH HHS / United States
U10 HD040689 / HD / NICHD NIH HHS / United States
U10 HD040492 / HD / NICHD NIH HHS / United States
U10 HD027853 / HD / NICHD NIH HHS / United States
U10 HD027904 / HD / NICHD NIH HHS / United States
U10 HD021397 / HD / NICHD NIH HHS / United States
U10 HD027871 / HD / NICHD NIH HHS / United States
U10 HD027851 / HD / NICHD NIH HHS / United States
UG1 HD021385 / HD / NICHD NIH HHS / United States
UG1 HD021364 / HD / NICHD NIH HHS / United States
U10 HD034216 / HD / NICHD NIH HHS / United States
U10 HD036790 / HD / NICHD NIH HHS / United States