title: [The contribution of the clinical examination, electroencephalogram, and brain MRI in assessing the prognosis in term newborns with neonatal encephalopathy. A cohort of 30 newborns before the introduction of treatment with hypothermia].
abstract: OBJECTIVE
  Perinatal asphyxia complicated by hypoxic ischemic brain injury remains a source of neurological lesions. A major aim of neonatologists is to evaluate the severity of neonatal encephalopathy (NE) and to evaluate prognosis. The purpose of this study was to determine the contribution of brain MRI compared to electroencephalogram (EEG) and clinical data in assessing patients' prognosis.
  
  
  METHODS
  Thirty newborns from the pediatric resuscitation unit at Rouen university hospital were enrolled in a retrospective study between January 2006 and December 2008, prior to introduction of hypothermia treatment. All 30 newborns had at least two anamnestic criteria of perinatal asphyxia, one brain MRI in the first 5 days of life and another after 7 days of life as well as an early EEG in the first 2 days of life. Then, the infants were seen in consultation to assess neurodevelopment.
  
  
  RESULTS
  This study showed a relation between NE stage and prognosis. During stage 1, prognosis was good, whereas stage 3 was associated with poor neurodevelopment outcome. Normal clinical examination before the 8th day of life was a good prognostic factor in this study. There was a relationship between severity of EEG after the 5th day of life and poor outcome. During stage 2, EEG patterns varied in severity, and brain MRI provided a better prognosis. Lesions of the basal ganglia and a decreased or absent signal of the posterior limb of the internal capsule were poor prognostic factors during brain MRI. These lesions were underestimated during standard MRI in the first days of life but were visible with diffusion sequences. Cognitive impairment affected 40% of surviving children, justifying extended pediatric follow-up.
  
  
  CONCLUSIONS
  This study confirms the usefulness of brain MRI as a diagnostic tool in hypoxic ischemic encephalopathy in association with clinical data and EEG tracings.
authors.affiliation: Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle de l'enfant, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe région-Inserm EA 4309 Neovasc handicap neurologique périnatal, IRIB, faculté de médecine et pharmacie, université de Rouen, 76000 Rouen, France. Electronic address: vincentjadas@yahoo.fr.
authors.forename: V
authors.initials: V
authors.lastname: Jadas
authors.affiliation: Service de radiologie pédiatrique, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Brasseur-Daudruy
authors.affiliation: Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle de l'enfant, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe région-Inserm EA 4309 Neovasc handicap neurologique périnatal, IRIB, faculté de médecine et pharmacie, université de Rouen, 76000 Rouen, France.
authors.forename: C
authors.initials: C
authors.lastname: Chollat
authors.affiliation: Service de pédiatrie générale, CHU de Caen, 14200 Caen, France.
authors.forename: L
authors.initials: L
authors.lastname: Pellerin
authors.affiliation: Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle de l'enfant, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe région-Inserm EA 4309 Neovasc handicap neurologique périnatal, IRIB, faculté de médecine et pharmacie, université de Rouen, 76000 Rouen, France.
authors.forename: A M
authors.initials: AM
authors.lastname: Devaux
authors.affiliation: Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle de l'enfant, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe région-Inserm EA 4309 Neovasc handicap neurologique périnatal, IRIB, faculté de médecine et pharmacie, université de Rouen, 76000 Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Marret
mesh_terms: D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D001921:Brain / Q000473:pathology*; D001925:Brain Damage, Chronic / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D002675:Child, Preschool; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D004569:Electroencephalography; D005260:Female; D005316:Fetal Distress / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D011379:Prognosis