Encephalopathy as a predictor of magnetic resonance imaging abnormalities in asphyxiated newborns.
Basal ganglia abnormalities on magnetic resonance imaging predict neurodevelopmental impairment in newborns with perinatal depression. We determined the value of a clinical encephalopathy score as a predictor of abnormal magnetic resonance imaging results in newborns with perinatal depression. We assigned a neonatal encephalopathy score to 101 newborns. The encephalopathy score, based on alertness, feeding, tone, respiratory status, reflexes, and seizure activity, was assigned once daily. The maximum score from the first 3 days of life was compared with abnormal magnetic resonance imaging results present globally or solely in the basal ganglia.Eighty-one percent of patients manifested abnormalities on any magnetic resonance imaging sequence, and 37% manifested abnormalities in the basal ganglia alone. The encephalopathy score correlated well with magnetic resonance imaging abnormalities in the basal ganglia (Spearman Rho = 0.335, P < 0.0001). Newborns with mild and severe encephalopathy had likelihood ratios of 0.41 and 7.4, respectively, for abnormal basal ganglia magnetic resonance imaging results. Newborns with moderate encephalopathy (composing 47% of the cohort) manifested basal ganglia abnormalities with a likelihood ratio of 0.785. Severe clinical encephalopathy correlates with abnormal basal ganglia magnetic resonance imaging results, and mild encephalopathy correlates with a normal magnetic resonance imaging result. However, standard clinical criteria do not alter the prior risk of abnormal basal ganglia magnetic resonance imaging results for newborns with moderate encephalopathy.
Kaufman
Seth A
SA
School of Medicine, University of California at San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143-0114, USA.
Miller
Steven P
SP
Ferriero
Donna M
DM
Glidden
David H
DH
Barkovich
A James
AJ
Partridge
J Colin
JC
D001238:Asphyxia Neonatorum / Q000150:complications / Q000175:diagnosis*; D001479:Basal Ganglia / Q000473:pathology; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications / Q000175:diagnosis*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018709:Statistics, Nonparametric