Pontine and cerebellar injury in neonatal hypoxic-ischemic encephalopathy: MRI features and clinical outcomes

Background Perinatal hypoxic-ischemic encephalopathy (HIE) is a major cause of death and disability in infants. Magnetic resonance imaging (MRI) is valuable for predicting the outcome in high-risk neonates. The relationship of pontine and cerebellar injury to outcome has not been explored sufficiently. Purpose To characterize MRI features of pontine and cerebellar injury and to assess the clinical outcomes of these neonates. Material and Methods The retrospective study included 59 term neonates (25 girls) examined by MRI using 1.5-T scanner in the first two weeks of life between 2008 and 2017. Involvement of the pons and cerebellum was judged as a high signal intensity on diffusion-weighted image (DWI) and a restricted diffusion on an apparent diffusion coefficient (ADC) map. Results Pontine involvement was observed in the dorsal portion of pons in eight neonates and cerebellar involvement was observed in dentate nucleus (n = 8), cerebellar vermis (n = 3), and hemisphere (n = 1) in 11 neonates. Combined pontine and cerebellar involvement was observed in eight neonates and only cerebellar involvement in three. The pontine and cerebellar injuries were always associated with very severe brain injury including a basal ganglia/thalamus injury pattern and a total brain injury pattern. In terms of clinical outcome, all but four lost to follow-up, had severe cerebral palsy. Conclusion Pontine and cerebellar involvement occurred in the dorsal portion of pons and mostly dentate nucleus and was always associated with a more severe brain injury pattern as well as being predictive of major disability.

Download Full-text

Acute Perinatal Sentinel Events, Neonatal Brain Injury Pattern, and Outcome of Infants Undergoing a Trial of Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

The Journal of Pediatrics ◽

10.1016/j.jpeds.2016.09.026 ◽

2017 ◽

Vol 180 ◽

pp. 275-278.e2 ◽

Cited By ~ 14

Author(s):

Seetha Shankaran ◽

Abbot R. Laptook ◽

Scott A. McDonald ◽

Susan R. Hintz ◽

Patrick D. Barnes ◽

...

Keyword(s):

Brain Injury ◽

Injury Pattern ◽

Hypoxic Ischemic Encephalopathy ◽

Neonatal Brain ◽

Neonatal Brain Injury ◽

Sentinel Events ◽

Ischemic Encephalopathy

Download Full-text

Conventional MRI scan and DTI imaging show more severe brain injury in neonates with hypoxic-ischemic encephalopathy and seizures

Early Human Development ◽

10.1016/j.earlhumdev.2018.05.008 ◽

2018 ◽

Vol 122 ◽

pp. 8-14 ◽

Cited By ~ 7

Author(s):

Beth M. Kline-Fath ◽

Paul S. Horn ◽

Weihong Yuan ◽

Stephanie Merhar ◽

Charu Venkatesan ◽

...

Keyword(s):

Brain Injury ◽

Hypoxic Ischemic Encephalopathy ◽

Severe Brain Injury ◽

Mri Scan ◽

Conventional Mri ◽

Ischemic Encephalopathy

Download Full-text

Cardiac Dysfunction in Neonatal HIE Is Associated with Increased Mortality and Brain Injury by MRI

American Journal of Perinatology ◽

10.1055/s-0041-1735618 ◽

2021 ◽

Author(s):

Gabriel Altit ◽

Sonia L. Bonifacio ◽

Carolina V. Guimaraes ◽

Shazia Bhombal ◽

Ganesh Sivakumar ◽

...

Keyword(s):

Brain Injury ◽

Therapeutic Hypothermia ◽

Cardiac Dysfunction ◽

Systolic Function ◽

Brain Magnetic Resonance Imaging ◽

Lv Function ◽

Severe Brain Injury ◽

Key Points ◽

Magnetic Resonance Imaging Mri ◽

Ischemic Encephalopathy

Objective Describe the association between cardiac dysfunction and death or moderate-to-severe abnormalities on brain magnetic resonance imaging (MRI) in neonates undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy (HIE). Study Design Retrospective study in neonates with moderate or severe HIE undergoing therapeutic hypothermia between 2008 and 2017. Primary outcome was death or moderate-to-severe brain injury using the Barkovich score. Conventional and speckle-tracking echocardiography measures were extracted from available echocardiograms to quantify right (RV) and left (LV) ventricular functions. Results A total of 166 newborns underwent therapeutic hypothermia of which 53 (36.5%) had echocardiography performed. Ten (19%) died prior to hospital discharge, and 11 (26%) had moderate-to-severe brain injury. There was no difference in chronologic age at echocardiography between the normal and adverse outcome groups (22 [±19] vs. 28 [±21] hours, p = 0.35). Cardiac findings in newborns with abnormal outcome included lower systolic and diastolic blood pressure (BP) at echocardiography (p = 0.004) and decreased tricuspid annular plane systolic excursion (a marker of RV systolic function; p = 0.01), while the ratio of systolic pulmonary artery (PA) pressure to systolic BP indicated isosystemic pressures (>2/3 systemic) in both groups. A multilogistic regression analysis, adjusting for weight and seizure status, indicated an association between abnormal outcome and LV function by longitudinal strain, as well as by ejection fraction. Conclusion Newborns who died or had moderate–to-severe brain injury had a higher incidence of cardiac dysfunction but similar PA pressures when compared with those who survived with mild or no MRI abnormalities. Key Points

Download Full-text

Epilepsy-Related Outcomes in Children With Neonatal Cerebellar Injury

Journal of Child Neurology ◽

10.1177/0883073820981261 ◽

2020 ◽

pp. 088307382098126

Author(s):

Ronald R. Seese ◽

Dana D. Cummings

Keyword(s):

Brain Injury ◽

Brain Injuries ◽

Brain Connectivity ◽

Neurologic Complication ◽

Older Children ◽

Neonatal Brain ◽

Neonatal Brain Injury ◽

Cerebellar Injury ◽

Cerebellar Involvement ◽

Drug Resistant Epilepsy

Objective: Acute brain injury is a frequent perinatal neurologic complication that can involve the cerebellum. Although short-term outcomes of infants with neonatal cerebellar injury are well described, neurologic sequelae in older children are underreported. Here, we describe epilepsy-related outcomes in young children who suffered from neonatal cerebellar injuries. Methods: In-house automated software identified patients with neonatal brain injuries who were evaluated at our institution both as neonates (≤28 days) and as children (≥1 year). Neonatal hospital course, neuroimaging, and outcomes related to epilepsy were reviewed from the medical record. Patients were stratified into 2 groups based on neonatal brain injuries: those with cerebellar injury and those without cerebellar involvement. Results: Of the 282 neonates followed through childhood over the decade-long study period, 33 (12%) experienced neonatal brain injury. All 33 cases involved supratentorial injury, and 5 (15%) also included cerebellar injury. The development of epilepsy was significantly less likely in the group with cerebellar involvement (40%) compared to that with cerebellar sparing (82%; P = 0.043). In some cases, children with cerebellum-sparing injuries required admission for seizure control and developed drug-resistant epilepsy as well as status epilepticus. These outcomes occurred less frequently in the group with cerebellar involvement. Conclusions: Epilepsy-related sequelae may occur less frequently when the cerebellum is involved in neonatal brain injury. Larger prospective studies are needed to clarify how cerebellocortical networks impact functional brain connectivity and epilepsy longitudinally.

Download Full-text

Impact of outreach education program on outcomes of neonates with hypoxic ischemic encephalopathy

Paediatrics & Child Health ◽

10.1093/pch/pxaa075 ◽

2020 ◽

Author(s):

Khorshid Mohammad ◽

Dinesh Dharel ◽

Ayman Abou Mehrem ◽

Michael J Esser ◽

Renee Paul ◽

...

Keyword(s):

Brain Injury ◽

Tertiary Care ◽

Brain Magnetic Resonance Imaging ◽

Hypoxic Ischemic Encephalopathy ◽

Target Range ◽

Composite Outcome ◽

Severe Brain Injury ◽

Outreach Education ◽

The Impact ◽

Ischemic Encephalopathy

Abstract Aim To evaluate the impact of outreach education targeting neuroprotection on outcomes of outborn infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE). Methods A retrospective cohort study of infants admitted with moderate-to-severe HIE was conducted following the implementation of outreach education in January 2016. Key interventions were early identification and referral of infants with encephalopathy utilizing telemedicine and a centralized communication system, hands-on simulation, and interactive case discussion and dissemination of clinical management guidelines and educational resources. The association between the intervention and a composite outcome of death and/or severe brain injury on brain magnetic resonance imaging (MRI) was tested controlling for the confounding factors. Results Of 165 neonates, 37 (22.4%) died and/or had a severe brain injury. This outcome decreased from 35% (27/77) to 11% (10/88) following the implementation of outreach education (P<0.001). Eligible infants not undergoing therapeutic hypothermia within 6 hours from birth decreased from 19.5% (15/77) to 4.5% (4/88). The use of inotropes decreased from 49.3% (38/77) to 19.6% (13/88). Any core temperature below 33°C was recorded for 20/53 (38%) before and 16/78 (21%) after, while those within the target range of 33°C to 34°C at admission to a tertiary care facility increased from (15/53) 28% to (51/88) 58%. Outreach education was independently associated with decreased composite outcome of death and/or severe brain injury on MRI (adjusted odds ratio 0.2; 95% confidence interval 0.07 to 0.52). Conclusion Outreach education targeting neuroprotection for infants with moderate-to-severe HIE was associated with a reduction in death and/or severe brain injury.

Download Full-text

Decoding accelerometry for classification and prediction of critically ill patients with severe brain injury

10.1101/2021.05.19.21257319 ◽

2021 ◽

Author(s):

Shubhayu Bhattacharyay ◽

John Rattray ◽

Matthew Wang ◽

Peter Dziedzic ◽

Eusebia Calvillo ◽

...

Keyword(s):

Brain Injury ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Prediction Models ◽

Severe Brain Injury ◽

Short Term ◽

Time Frequency ◽

Motion Features ◽

Analysis Of Time Series

The goal of this research is to explore quantitative motor features in critically ill patients with severe brain injury (SBI). We hypothesized that computational decoding of these features would yield important information on underlying neurological states and clinical outcomes. Using wearable microsensors placed on all extremities, we recorded 1,701 hours of continuous, high-frequency accelerometry data from a prospective cohort of patients (n = 69) admitted to the ICU with SBI. Models were trained using time-, frequency-, and wavelet-domain motion features and levels of responsiveness and outcome as labels. The two primary tasks were detection of levels of responsiveness, assessed by motor sub-score of the Glasgow Coma Scale (GCSm), and prediction of functional outcome at hospital discharge, measured with the Glasgow Outcome Scale—Extended (GOSE). Detection models achieved significant (AUC: 0.70 [95% CI: 0.53—0.85]) and consistent (observation windows: 12 min — 9 hours) discrimination of SBI patients capable of purposeful movement (GCSm > 4). Prediction models accurately discriminated SBI patients of upper moderate disability or better (GOSE > 5) with 2—6 hours of observation (AUC: 0.82 [95% CI: 0.75—0.90]). Results suggest that computational analysis of time series motor activity in patients with SBI yields clinically important insights on underlying neurologic states and short-term clinical outcomes.

Download Full-text

DOES THE TIMING OF INITIATION OF THERAPEUTIC HYPOTHERMIA INFLUENCE MRI FINDINGS AND OUTCOMES IN ENCEPHALOPATHIC BABIES?

Paediatrics & Child Health ◽

10.1093/pch/pxy054.058 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e23-e23

Author(s):

Mireille Guillot ◽

Marissa Philippe ◽

Elka Miller ◽

Jorge Davila ◽

Nick Borrowman ◽

...

Keyword(s):

Brain Injury ◽

Therapeutic Hypothermia ◽

Neonatal Intensive Care ◽

Standard Treatment ◽

Severe Brain Injury ◽

Mri Findings ◽

Neurodevelopmental Outcomes ◽

Timing Of Initiation ◽

Ischemic Encephalopathy ◽

Median Birth Weight

Abstract BACKGROUND Therapeutic hypothermia (TH), initiated < 6h of life, is the standard treatment for infants with moderate to severe hypoxic ischemic encephalopathy (HIE). While preclinical studies show that TH is more effective when started early, little clinical data exists. OBJECTIVES The objectives of our study are to examine the effect of early vs. late TH on the severity and pattern of brain injury on MRI and on the neurodevelopmental outcomes. DESIGN/METHODS This retrospective cohort included infants with HIE treated with TH at a level three neonatal intensive care unit between 2009 and 2016. Babies were grouped into: early cooling (TH started ≤ 180 minutes of life) or late cooling (TH started > 180 minutes of life). Two radiologists evaluated the severity and pattern of brain injury on MRI using both NICHD and Barkovich scoring system. Neurodevelopmental outcomes were evaluated at 4, 10, 18 and 48 months. RESULTS Ninety-four patients (median gestational age 39 weeks; median birth weight 3.3 kg) were included in the study, 55 in the early cooling and 39 in the late cooling group. The early cooling group included more patients with severe HIE (32.7% vs 10.3%, p=0.01). No difference was observed between the 2 groups in regard to the pattern and severity of brain injury. In the late cooling group, there was a trend toward more severe watershed (WS) injury (WS score ≥3) (30.6% vs 17%, p=0.19) and more moderate to severe brain injury (33.3% vs 23.4%, p=0.33). There was no difference in the neurodevelopmental outcomes between the 2 groups. CONCLUSION TH initiated early (before 180 minutes of life) was neither associated with a difference in brain injury on MRI nor better neurodevelopmental outcomes. Despite having more infants with severe HIE in the early cooling group, there was a trend toward less significant brain injury in this group.

Download Full-text

Confronting the grey zone after severe brain injury

Emerging Topics in Life Sciences ◽

10.1042/etls20190115 ◽

2019 ◽

Vol 3 (6) ◽

pp. 707-711 ◽

Cited By ~ 1

Author(s):

Andrew Peterson ◽

Adrian M. Owen

Keyword(s):

Brain Injury ◽

Ethical Issues ◽

Vegetative State ◽

Clinical Care ◽

Grey Zone ◽

Severe Brain Injury ◽

New Methods ◽

Legal Decision Making ◽

Technological Developments ◽

The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

Download Full-text