Patterns of brain injury in term neonatal encephalopathy.
OBJECTIVE
To determine whether the pattern of brain injury in term neonatal encephalopathy is associated with distinct prenatal and perinatal factors and to determine whether the pattern of injury is associated with 30-month neurodevelopmental outcome.


METHODS
A total of 173 term newborns with neonatal encephalopathy from 2 centers underwent magnetic resonance imaging (MRI) at a median of 6 days of age (range, 1-24 days). Patterns of injury on MRI were defined on the basis of the predominant site of injury: watershed predominant, basal ganglia/thalamus predominant, and normal.


RESULTS
The watershed pattern of injury was seen in 78 newborns (45%), the basal ganglia/thalamus pattern was seen in 44 newborns (25%), and normal MRI studies were seen in 51 newborns (30%). Antenatal conditions such as maternal substance use, gestational diabetes, premature rupture of membranes, pre-eclampsia, and intra-uterine growth restriction did not differ across patterns. The basal ganglia/thalamus pattern was associated with more severe neonatal signs, including more intensive resuscitation at birth ( P = .001), more severe encephalopathy ( P = .0001), and more severe seizures ( P = .0001). The basal ganglia/thalamus pattern was associated with the most impaired motor and cognitive outcome at 30 months.


CONCLUSIONS
The patterns of brain injury in term neonatal encephalopathy are associated with different clinical presentations and neurodevelopmental outcomes. Measured prenatal risk factors did not predict the pattern of brain injury.
Miller
Steven P
SP
Department of Neurology, University of California at San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA.
Ramaswamy
Vijay
V
Michelson
David
D
Barkovich
A James
AJ
Holshouser
Barbara
B
Wycliffe
Nathaniel
N
Glidden
David V
DV
Deming
Douglas
D
Partridge
J Colin
JC
Wu
Yvonne W
YW
Ashwal
Stephen
S
Ferriero
Donna M
DM
D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis*; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male