title: Neonatal neurobehavior after therapeutic hypothermia for hypoxic ischemic encephalopathy.
abstract: BACKGROUND
  Perinatal hypoxic ischemic encephalopathy (HIE) is a major cause of neurodevelopmental impairment including cerebral palsy and intellectual disability. Brain magnetic resonance imaging is the gold standard for acute assessment of cerebral injury in HIE. Limited data are available regarding the significance of clinically manifested neurobehavioral impairments in the neonatal period.
  
  
  OBJECTIVE
  To evaluate brain structure-function relationships in newborns with HIE using diffusion tensor imaging (DTI) and the NICU Network Neurobehavioral Scale (NNNS).
  
  
  METHODS
  Prospective observational study with secondary longitudinal component.
  
  
  METHODS
  Forty-five newborns (62% male) with HIE referred for therapeutic hypothermia who underwent MRI and neurobehavioral assessment prior to discharge.
  
  
  METHODS
  DTI was performed at median age of 8 days (range 5-16) and NNNS at median 12 days of life (range 5-20, postmenstrual age 40±2 weeks). Developmental assessment with the Bayley Scales of Infant Development-II was performed at median age of 21.6 months (range 20.8-30.6).
  
  
  RESULTS
  Significant associations were observed between DTI corticospinal tract integrity and NNNS neuromotor performance in HIE newborns. Neonatal neuromotor performance was also related to later early childhood motor outcomes.
  
  
  CONCLUSIONS
  NNNS performed after therapeutic hypothermia in newborns with HIE can identify neuromotor abnormalities that are related to microstructural brain injury in the corticospinal tract and later motor outcomes in early childhood. These data support the NNNS as a valid early functional assessment of perinatal brain injury.
authors.affiliation: Department of Neonatology, Children's National Health Systems, Washington, DC, United States; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States. Electronic address: anguyenm@cnmc.org.
authors.forename: An N
authors.initials: AN
authors.lastname: Massaro
authors.affiliation: Department of Diagnostic Imaging and Radiology, Children's National Health Systems, Washington, DC, United States; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States; Department of Radiology, George Washington University School of Medicine, Washington, DC, United States.
authors.forename: Iordanis
authors.initials: I
authors.lastname: Evangelou
authors.affiliation: Department of Psychology & Behavioral Health, Children's National Health Systems, Washington, DC, United States.
authors.forename: Judy
authors.initials: J
authors.lastname: Brown
authors.affiliation: Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States.
authors.forename: Ali
authors.initials: A
authors.lastname: Fatemi
authors.affiliation: Department of Diagnostic Imaging and Radiology, Children's National Health Systems, Washington, DC, United States; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States; Department of Radiology, George Washington University School of Medicine, Washington, DC, United States.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Vezina
authors.affiliation: Department of Biostatistics & Informatics, Children's National Health Systems, Washington, DC, United States; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States; Department of Epidemiology & Biostatistics, George Washington University School of Medicine, Washington, DC, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.affiliation: Department of Psychology & Behavioral Health, Children's National Health Systems, Washington, DC, United States; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States.
authors.forename: Penny
authors.initials: P
authors.lastname: Glass
authors.affiliation: Department of Diagnostic Imaging and Radiology, Children's National Health Systems, Washington, DC, United States; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States.
authors.forename: Catherine
authors.initials: C
authors.lastname: Limperopoulos
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D002657:Child Development; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications*; D018730:Infant Behavior; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination
keywords: Diffusion tensor imaging; Hypoxic ischemic encephalopathy; Magnetic resonance imaging; Neurobehavior; Newborn