MRI is the gold standard test to define brain injury in infants with neonatal encephalopathy(NE). As imaging findings evolve considerably over the first week, early imaging may not fully reflect the final nature of the injury. This study aimed to compare day 4 versus second week MRI in infants with NE.
Retrospective cohort study including infants who received therapeutic hypothermia(TH) for NE and had two MRIs: early (≤7days) and late (>7days). MRIs were clinically reported and also reviewed by study investigators.
94infants with NE were included (40mild,49moderate,5severe). Twenty-four infants(26%) had a normal early scan of which 3/24(13%) had injury noted on repeat MRI. Seventy infants(74%) had abnormal findings noted on early MRI, of which 4/70(6%) had further evolution of injury while 11/70(16%) had complete resolution of findings. Applying a grading system resulted in a change of grade in 7 infants.
In infants who received TH for NE, 19% had changes noted between their early and late MRIs. While the impact on predicting neurodevelopmental outcome was not studied, relying solely on early MRI may overestimate injury in a proportion of infants and miss injury in others. Combining early and late MRI allows for better characterization of injury.
MRI is the gold standard tool to define brain injury in infants with NE, however, imaging findings evolve considerably over the first week of life.
Most centers perform a single MRI on day 4 after rewarming.
In our cohort, 19% of infants had a notable change in their MRI findings between early (within the first week) and late (beyond the first week) scans.
Relying solely on early MRI may overestimate injury in a proportion of infants and miss injury in others.
Combining early and late MRI following hypothermia allows for better characterization of brain injury.
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The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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All of the infants and families included in this study. Staff of the Brigham and Women’s Hospital.
The authors declare no competing interests.
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Garvey, A.A., El-Shibiny, H., Yang, E. et al. Differences between early and late MRI in infants with neonatal encephalopathy following therapeutic hypothermia. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02580-8
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