Feeding and communication impairments in infants with central grey matter lesions following perinatal hypoxic-ischaemic injury.
BACKGROUND
Basal ganglia and thalamic (BGT) injury is common after acute perinatal hypoxia-ischaemia. Cerebral palsy is the most obvious consequence of BGT injury affecting 70-75% of survivors and is predictable from neonatal magnetic resonance imaging (MRI). However there is no equivalent predictive data for other specific outcomes. Feeding and communication impairments are also common in children following hypoxic-ischaemic encephalopathy (HIE) and BGT injury.


OBJECTIVE
To describe, in infants with HIE and BGT injury, the prevalence of feeding and communication impairments; and to evaluate the accuracy of early MRI for predicting these outcomes.


METHODS
175 term infants with HIE and BGT injury were studied. Brain lesions were classified by site and severity from the MRI scans. Motor, feeding and communication impairments were documented at 2 years.


RESULTS
Feeding and communication impairments occurred in 65% and 82% of 126 survivors respectively and related strongly to the severity of motor impairment. Forty-one children had a gastrostomy or long-term nasogastric tube. Injury severity in all brain regions was significantly associated with feeding and communication impairment on univariate analysis. On logistic regression analysis BGT (OR 10.9) and mesencephalic lesions (OR 3.7) were independently associated with feeding impairment; BGT (OR 10.5) and pontine lesions (OR 3.8) were associated with gastrostomy; the severity of BGT lesions (OR 20.1) was related to the severity of communication impairment.


CONCLUSIONS
Feeding and communication impairment are very common in children with BGT and brainstem injury of neonatal origin and can be well predicted from early MRI scans.
Department of Paediatrics and Imaging Sciences, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom.
Miriam
M
Martinez-Biarge
Jesus
J
Diez-Sebastian
Courtney J
CJ
Wusthoff
Stacey
S
Lawrence
Annie
A
Aloysius
Mary A
MA
Rutherford
Frances M
FM
Cowan
D001480:Basal Ganglia Diseases / Q000473:pathology / Q000523:psychology; D001921:Brain / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology; D002675:Child, Preschool; D003147:Communication Disorders / Q000209:etiology* / Q000523:psychology; D003680:Deglutition Disorders / Q000209:etiology; D004750:Enteral Nutrition; D019959:Feeding and Eating Disorders of Childhood / Q000209:etiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000473:pathology* / Q000523:psychology*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009068:Movement / Q000502:physiology; D011237:Predictive Value of Tests; D013788:Thalamus / Q000473:pathology; D016896:Treatment Outcome