Brainstem hypoxic–ischemic lesions on MRI in infants treated with therapeutic cooling: effects on the length of stay and mortality



To test the hypothesis that brainstem hypoxic–ischemic injury on magnetic resonance imaging (MRI) would be independently associated with short-term outcomes in cooled asphyxiated infants.


A total of 90 consecutively cooled asphyxiated infants who survived to have brain MRI were reviewed. A neuroradiologist who was masked to outcomes evaluated MRI images for brainstem involvement. Outcomes were mortality and length of stay.


Brainstem lesions were present on post-cooling brain MRI in 20 of the 90 infants (22%). Overall, four infants died before discharge, and all four had brainstem involvement. The infants with brainstem involvement had longer hospital stay (29 days, IQR 20–47 versus 16 days, IQR 10–26; P = 0.0001), compared to infants without brainstem lesions (n = 70); and upon multivariate analysis, brainstem involvement remained independently associated with prolonged hospital stay (β = 12.4, P = 0.001).


This study demonstrates the importance of recognizing brainstem injury for the prediction of short-term outcomes in cooled asphyxiated infants.

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Fig. 1: Brain MRI displaying brainstem involvement.


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Author information




Subrata Sarkar, MD, developed the study concept, design, and analysis. He also critically revised and approved the final paper. Siddhartha Sarkar collected the data and provided critical input into the analysis of the data. He wrote the first draft of the paper and received input from the authors below as part of the paper revision. Other co-investigators (Suneeti Gupta, MD; Jayapalli Bapuraj, MD; and Ronald E. Dechert, RRT) provided critical input into the design and analysis of the study. They also critically revised and approved the final paper.

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Correspondence to Subrata Sarkar.

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Sarkar, S.S., Gupta, S., Bapuraj, J.R. et al. Brainstem hypoxic–ischemic lesions on MRI in infants treated with therapeutic cooling: effects on the length of stay and mortality. J Perinatol (2020).

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