title: MRI Patterns of brain injury and neurodevelopmental outcomes in neonates with severe anaemia at birth.
abstract: To define patterns of brain injury and associated neurodevelopmental outcomes in infants with severe neonatal anaemia.
  
  
  
  We studied 20 infants with severe anaemia at birth (haemoglobin<7g/dL). Clinical details were analysed for causes of anaemia and co-morbidities. All had early brain magnetic resonance imaging (MRI) scans, which were reviewed for injury pattern. Neurodevelopmental outcomes were assessed at a median age of 24months.
  
  
  
  The aetiology of the anaemia was feto-maternal haemorrhage in 17 and antepartum haemorrhage in 3 infants. The predominant site of injury was the white matter, which was affected in all infants, with differing grades of severity and with cystic evolution in 45%. Only one infant showed an injury pattern typical of an acute severe hypoxic-ischaemic insult. Outcomes correlated closely to the severity of MRI findings. Cerebral palsy was seen only with the most severe neuroimaging patterns (n=6). Global developmental delay, learning or behavioural problems and seizures were common with moderate injury. Visual impairment occurred, particularly with posterior injury. Microcephaly developed in 45%.
  
  
  
  Severe neonatal anaemia at birth was associated with a white matter predominant pattern of injury, the severity of which was related to neurodevelopmental outcomes. Early MRI and long-term follow-up are advisable following severe neonatal anaemia.
authors.affiliation: Departamento de Pediatría, Hospital Universitario Cruces, Barakaldo, Spain. Electronic address: bego_loureiro@yahoo.es.
authors.forename: Begoña
authors.initials: B
authors.lastname: Loureiro
authors.affiliation: Department of Paediatrics, Hammersmith Hospital, Imperial College, London, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Martinez-Biarge
authors.affiliation: Department of Mental Health, Azienda Unita Sanitaria Locale di Reggio Emilia, Emilia-Romagna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Foti
authors.affiliation: Own private paediatrician practice, Cholargos Attica, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Papadaki
authors.affiliation: Department of Paediatrics, Hammersmith Hospital, Imperial College, London, UK.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.affiliation: Division of Child Neurology, Stanford University, CA, USA.
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Wusthoff
mesh_terms: D000751:Anemia, Neonatal / Q000150:complications / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D049188:Prenatal Injuries / Q000000981:diagnostic imaging*; D066127:White Matter / Q000000981:diagnostic imaging
keywords: Developmental outcomes; Feto-maternal haemorrhage; Magnetic resonance imaging; Neonatal anaemia; Neonatal encephalopathy; White matter injury