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The predictive value of cerebral MR imaging for later neurodevelopment in newborns who have undergone therapeutic hypothermia for hypoxic-ischaemic encephalopathy in clinical practice

Presented at the Neonatal Society 2018 Summer Meeting.

Tharmapoopathy P, Barlas A, Chisholm P, Varsami M, Gupta N, Ekitzidou G, Ponnusamy V, Kappelou O, Evanson J, Shah DK

Barts and The London School of Medicine and Dentistry
Royal London Hospital
Southampton University Hospital
Homerton University Hospital
Ashford and St Peters Hospitals

Background: Cerebral MRI findings have been shown to be predictive of later neurodevelopmental outcomes in newborns with hypoxic-ischaemic encephalopathy (HIE) in the pre-therapeutic hypothermia (TH) era. Studies have shown that babies who have undergone TH have fewer lesions on cerebral MRI, and if lesions are present, they are predictive of outcome (1). Hypothesis: Cerebral MRI findings are predictive of later neurodevelopmental outcomes in newborns with HIE after TH in clinical practice.

Methods: A prospective cohort of term newborns recruited from four centres between 2014 – 2015 who were cooled for HIE and had cerebral MRI performed were studied after informed consent from the families. Cooled newborns had cerebral MR images independently rated by two experts (OK, JE). MR images for each baby were rated for: basal ganglia and thalamus (BGT), posterior limb of the internal capsule (PLIC) and white matter (WM). The children were followed up with later neurodevelopmental outcome. An unfavourable neurodevelopmental outcome was defined as Bayley score of <85 for either cognition or motor composite scores, cerebral palsy or death. This study had local research and ethics approval (REC 13/LO/17380, Bromley NRES).

Results: Of 83 babies recruited, 75 had cerebral MRI and were eligible for study. Twenty-two (27%) babies had cerebral MRI predictive of unfavourable outcome. Neurodevelopment outcomes were available for 61/75 (81%) babies. On multiple regression, the BGT abnormalities were most predictive for motor (p=0.002), cognition (p=0.013) and language (p=0.039) outcomes. In our cohort, this method of rating cerebral MRI was highly predictive of neurodevelopmental outcome (sensitivity= 94%, specificity=95%, PPV=89% and NPV=98%). See table for details.

The predictive value of cerebral MR imaging for later neurodevelopment in newborns who have undergone therapeutic hypothermia for hypoxic-ischaemic encephalopathy in clinical practice

Conclusion: In this clinical cohort outside of the hypothermia trials, cerebral MRI appears to be a good predictor of outcomes in term infants with HIE after TH. BGT abnormality remains important in predicting outcomes. Our data suggests that cerebral MRI is a good surrogate of later outcome for research and for counselling families.

Corresponding author: d.shah@qmul.ac.uk

References
1. Rutherford et al. Lancet Neurology 2010

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