Marianne Alison (France)
Hôpital Robert Debré Pediatric radiology unitAuthor Of 1 Presentation
CEREBRAL INJURIES IN INFANTS WITH NEONATAL ENCEPHALOPATHY TREATED WITH HYPOTHERMIA: FRENCH LYTONEPAL COHORT
Abstract
Background and Aims
To assess brain injury MRI patterns and neonatal’ profiles in a large cohort of newborns > 36 weeks’ gestation in the context of neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH).
Methods
French prospective observational population-based cohort including newborns with moderate and severe NE treated with TH. Images from brain MRI performed between birth and 12 days of life in surviving and deceased patients were analyzed in 7 brain regions according to Rutherford’s classification.
Results
575 newborns were eligible, 479 had an available MRI; 80 (16.7%) infants had died. MRI findings were normal for 231 (48.2%) infants; 155 (62.5%) infants had injuries in more than one region. Basal ganglia thalamus (BGT) and white matter injuries were predominant, reported for 33.7% and 32.4% infants, respectively. Infra-tentorial injuries were observed for 8.5% (brainstem) and 5.1% (cerebellum) of infants, respectively. Posterior-limb internal capsule and brainstem injuries were systematically associated with BGT injuries. Infants with severe injuries (BGT) more frequently had a warning event before birth, the poorest neonatal adaptation and severe acidemia, but almost 1 in 2 infants had the same associated factors as those with normal MRI findings.
Conclusions
This study updates the panorama of brain lesions in NE in the era of TH, with a large proportion of normal MRI findings in half of the infants and peculiar brain injuries associations. NE is mainly a diffuse brain pathology. MRI may assist to diagnose the hypoxic-ischemic nature of the encephalopathy. Prognostic markers for identifying brain-injured patients require further analysis.