Brain injury following trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy.
OBJECTIVE
The objective of our study was to examine the relationship between brain injury and outcome following neonatal hypoxic-ischaemic encephalopathy treated with hypothermia.


METHODS
Neonatal MRI scans were evaluated in the National Institute of Child Health and Human Development (NICHD) randomised controlled trial of whole-body hypothermia and each infant was categorised based upon the pattern of brain injury on the MRI findings. Brain injury patterns were assessed as a marker of death or disability at 18-22 months of age.


RESULTS
Scans were obtained on 136 of 208 trial participants (65%); 73 in the hypothermia and 63 in the control group. Normal scans were noted in 38 of 73 infants (52%) in the hypothermia group and 22 of 63 infants (35%) in the control group. Infants in the hypothermia group had fewer areas of infarction (12%) compared to infants in the control group (22%). Fifty-one of the 136 infants died or had moderate or severe disability at 18 months. The brain injury pattern correlated with outcome of death or disability and with disability among survivors. Each point increase in the severity of the pattern of brain injury was independently associated with a twofold increase in the odds of death or disability.


CONCLUSIONS
Fewer areas of infarction and a trend towards more normal scans were noted in brain MRI following whole-body hypothermia. Presence of the NICHD pattern of brain injury is a marker of death or moderate or severe disability at 18-22 months following hypothermia for neonatal encephalopathy.
Department of Pediatrics/Neonatology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA. sshankar@med.wayne.edu
Seetha
S
Shankaran
Patrick D
PD
Barnes
Susan R
SR
Hintz
Abbott R
AR
Laptook
Kristin M
KM
Zaterka-Baxter
Scott A
SA
McDonald
Richard A
RA
Ehrenkranz
Michele C
MC
Walsh
Jon E
JE
Tyson
Edward F
EF
Donovan
Ronald N
RN
Goldberg
Rebecca
R
Bara
Abhik
A
Das
Neil N
NN
Finer
Pablo J
PJ
Sanchez
Brenda B
BB
Poindexter
Krisa P
KP
Van Meurs
Waldemar A
WA
Carlo
Barbara J
BJ
Stoll
Shahnaz
S
Duara
Ronnie
R
Guillet
Rosemary D
RD
Higgins
D001930:Brain Injuries / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000401:mortality / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome