title: Neonatal encephalopathic cerebral injury in South India assessed by perinatal magnetic resonance biomarkers and early childhood neurodevelopmental outcome.
abstract: Although brain injury after neonatal encephalopathy has been characterised well in high-income countries, little is known about such injury in low- and middle-income countries. Such injury accounts for an estimated 1 million neonatal deaths per year. We used magnetic resonance (MR) biomarkers to characterise perinatal brain injury, and examined early childhood outcomes in South India.
  
  
  METHODS
  We recruited consecutive term or near term infants with evidence of perinatal asphyxia and a Thompson encephalopathy score ≥6 within 6 h of birth, over 6 months. We performed conventional MR imaging, diffusion tensor MR imaging and thalamic proton MR spectroscopy within 3 weeks of birth. We computed group-wise differences in white matter fractional anisotropy (FA) using tract based spatial statistics. We allocated Sarnat encephalopathy stage aged 3 days, and evaluated neurodevelopmental outcomes aged 3½ years using Bayley III.
  
  
  RESULTS
  Of the 54 neonates recruited, Sarnat staging was mild in 30 (56%); moderate in 15 (28%) and severe in 6 (11%), with no encephalopathy in 3 (6%). Six infants died. Of the 48 survivors, 44 had images available for analysis. In these infants, imaging indicated perinatal rather than established antenatal origins to injury. Abnormalities were frequently observed in white matter (n = 40, 91%) and cortex (n = 31, 70%) while only 12 (27%) had abnormal basal ganglia/thalami. Reduced white matter FA was associated with Sarnat stage, deep grey nuclear injury, and MR spectroscopy N-acetylaspartate/choline, but not early Thompson scores. Outcome data were obtained in 44 infants (81%) with 38 (79%) survivors examined aged 3½ years; of these, 16 (42%) had adverse neurodevelopmental outcomes.
  
  
  CONCLUSIONS
  No infants had evidence for established brain lesions, suggesting potentially treatable perinatal origins. White matter injury was more common than deep brain nuclei injury. Our results support the need for rigorous evaluation of the efficacy of rescue hypothermic neuroprotection in low- and middle-income countries.
authors: Perinatal Neurology and Neonatology, Imperial College London, London, United Kingdom.
authors: Peter J
authors: PJ
authors: Lally
authors: Medical Physics and Bioengineering, University College London Hospitals, London, United Kingdom.
authors: David L
authors: DL
authors: Price
authors: Perinatal Neurology and Neonatology, Imperial College London, London, United Kingdom.
authors: Shreela S
authors: SS
authors: Pauliah
authors: Medical Physics and Bioengineering, University College London Hospitals, London, United Kingdom.
authors: Alan
authors: A
authors: Bainbridge
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Justin
authors: J
authors: Kurien
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Neeraja
authors: N
authors: Sivasamy
authors: Imperial College London, London, United Kingdom.
authors: Frances M
authors: FM
authors: Cowan
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Guhan
authors: G
authors: Balraj
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Manjula
authors: M
authors: Ayer
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Kariyapilly
authors: K
authors: Satheesan
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Sreejith
authors: S
authors: Ceebi
authors: Perinatal Neurology and Neonatology, Imperial College London, London, United Kingdom.
authors: Angie
authors: A
authors: Wade
authors: Neonatal Medicine, Manipal Hospital, Bangalore, Karnataka, India.
authors: Ravi
authors: R
authors: Swamy
authors: Imaging, Dr Shaj's MRI and Research Centre, Kozhikode, Kerala, India.
authors: Shaji
authors: S
authors: Padinjattel
authors: Perinatal Neurology and Neonatology, Imperial College London, London, United Kingdom.
authors: Betty
authors: B
authors: Hutchon
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Madhava
authors: M
authors: Vijayakumar
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Mohandas
authors: M
authors: Nair
authors: Neonatal Medicine, Government Medical College, Kozhikode, Kerala, India.
authors: Krishnakumar
authors: K
authors: Padinharath
authors: Centre for Medical Image Computing, University College London, London, United Kingdom.
authors: Hui
authors: H
authors: Zhang
authors: Medical Physics and Bioengineering, University College London Hospitals, London, United Kingdom.
authors: Ernest B
authors: EB
authors: Cady
authors: Neonatal-Perinatal Division, Wayne State University, Detroit, Massachusetts, United States of America.
authors: Seetha
authors: S
authors: Shankaran
authors: Perinatal Neurology and Neonatology, Imperial College London, London, United Kingdom.
authors: Sudhin
authors: S
authors: Thayyil
mesh_terms: D001238:Asphyxia Neonatorum / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality; D015415:Biomarkers / Q000378:metabolism; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D018572:Disease-Free Survival; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies; D011859:Radiography; D015996:Survival Rate
chemical_list: D015415:Biomarkers