Early Imaging And Adverse Neurodevelopmental Outcome in Asphyxiated Newborns Treated with Hypothermia
Publication date: Available online 19 May 2017 Source:Pediatric Neurology Author(s): Fatema Al Amrani, Saskia Kwan, Guillaume Gilbert, Christine Saint-Martin, Michael Shevell, Pia Wintermark BackgroundBrain injury can be identified as early as day 2 of life in asphyxiated newborns treated with hypothermia, when using diffusion magnetic resonance imaging (MRI). However, it remains unclear if these diffusion changes can predict future neurodevelopment. This study aimed to determine whether abnormal early diffusion changes in newborns treated with hypothermia are associated with adverse neurodevelopmental outcome at 2 years of age.MethodsAsphyxiated newborns treated with hypothermia were enrolled prospectively. They had magnetic resonance imaging (MRI) at specific time-points over the first month of life, including diffusion-weighted imaging and diffusion-tensor imaging. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in different regions of interest. Adverse neurodevelopmental outcome was defined as cerebral palsy, global developmental delay, and/or seizure disorder around 2 years of age. ADC and FA values were compared between the newborns developing or not adverse outcome.ResultsTwenty-nine asphyxiated newborns treated with hypothermia were included. Among the newborns developing adverse outcome, ADC values were significantly decreased on days 2–3 of life and increased around day 10 of life in the thalamus, posterior limb of the internal capsule, and the lentiform nucleus. FA values decreased in the same regions around day 30 of life. These newborns also had increased ADC around day 10 of life and around day 30 of life, and decreased FA around day 30 of life in the anterior and posterior white matter.ConclusionDiffusion changes that were evident as early as day 2 of life when the asphyxiated newborns were still treated with hypothermia were associated with later abnormal neurodevelopmental outcome.