Document Detail


Predicting motor outcome and death in term hypoxic-ischemic encephalopathy.
MedLine Citation:
PMID:  21670434     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Central gray matter damage, the hallmark of term acute perinatal hypoxia-ischemia, frequently leads to severe cerebral palsy and sometimes death. The precision with which these outcomes can be determined from neonatal imaging has not been fully explored. We evaluated the accuracy of early brain MRI for predicting death, the presence and severity of motor impairment, and ability to walk at 2 years in term infants with hypoxic-ischemic encephalopathy (HIE) and basal ganglia-thalamic (BGT) lesions.
METHODS: From 1993 to 2007, 175 term infants with evidence of perinatal asphyxia, HIE, and BGT injury seen on early MRI scans were studied. BGT, white matter, posterior limb of the internal capsule (PLIC), and cortex and brainstem abnormality were classified by severity. Motor impairment was staged using the Gross Motor Function Classification System.
RESULTS: The severity of BGT lesions was strongly associated with the severity of motor impairment (Spearman rank correlation 0.77; p < 0.001). The association between white matter, cortical, and brainstem injury and motor impairment was less strong and only BGT injury correlated significantly in a logistic regression model. The predictive accuracy of severe BGT lesions for severe motor impairment was 0.89 (95% confidence interval 0.83-0.96). Abnormal PLIC signal intensity predicted the inability to walk independently by 2 years (sensitivity 0.92, specificity 0.77, positive predictive value 0.88, negative predictive value 0.85). Brainstem injury was the only factor with an independent association with death.
CONCLUSION: We have shown that in term newborns with HIE and BGT injury, early MRI can be used to predict death and specific motor outcomes.
Authors:
M Martinez-Biarge; J Diez-Sebastian; O Kapellou; D Gindner; J M Allsop; M A Rutherford; F M Cowan
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurology     Volume:  76     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-14     Completed Date:  2011-08-26     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2055-61     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Hammersmith Hospital, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Basal Ganglia / pathology
Developmental Disabilities / etiology,  pathology,  physiopathology
Humans
Hypoxia-Ischemia, Brain / complications*,  mortality*,  pathology*,  physiopathology
Infant
Infant, Newborn
Internal Capsule / pathology
Magnetic Resonance Imaging / methods
Movement Disorders / etiology*,  pathology*,  physiopathology*
Predictive Value of Tests
Retrospective Studies
Thalamus / pathology
Walking*
Grant Support
ID/Acronym/Agency:
//Medical Research Council
Comments/Corrections
Comment In:
Neurology. 2011 Jun 14;76(24):2048-9   [PMID:  21670432 ]

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