White matter and cortical injury in hypoxic-ischemic encephalopathy: antecedent factors and 2-year outcome.
OBJECTIVE
To examine the spectrum of isolated white matter (WM)/cortical injury and its relation to outcomes in infants with hypoxic-ischemic encephalopathy (HIE) and normal appearing basal ganglia and thalami.


METHODS
From 1992-2007, 84 term infants with HIE and normal basal ganglia and thalami on neonatal magnetic resonance imaging were studied; WM/cortical lesions were classified by site and severity. Neurodevelopmental outcomes and head growth were documented at a median age of 2 years.


RESULTS
The WM was normal or mildly abnormal in 33.5%, moderate in 40.5%, and severely abnormal in 26% of infants. Cortical involvement was not seen or was only mild in 75.5%, moderate in 13%, and severe in 12% of infants. WM and cortical injury severity were highly correlated (Spearman ρ = 0.74; P < .001). Infants with severe WM injury had more severe neonatal courses and a higher incidence of hypoglycemia. No infant died. Five infants (6%) developed cerebral palsy but all could walk independently. Cognitive, visual, language, behavioral, and seizure problems were highly prevalent and correlated significantly with the severity of WM injury and poor postnatal head growth.


CONCLUSIONS
Infants with HIE and selective WM/cortical injury have a low prevalence of cerebral palsy but have a wide range of other problems, which occur more often with severe WM/cortical lesions.
Department of Pediatrics and Imaging Sciences, Imperial College, Hammersmith Hospital Campus, London, United Kingdom.
Miriam
M
Martinez-Biarge
Tina
T
Bregant
Courtney J
CJ
Wusthoff
Andrew T M
AT
Chew
Jesus
J
Diez-Sebastian
Mary A
MA
Rutherford
Frances M
FM
Cowan
D000293:Adolescent; D000328:Adult; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000175:diagnosis; D002508:Cephalometry; D002547:Cerebral Palsy / Q000175:diagnosis; D002675:Child, Preschool; D005865:Gestational Age; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D007223:Infant; D007231:Infant, Newborn; D007361:Intelligence Tests; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D013788:Thalamus / Q000473:pathology; D016896:Treatment Outcome