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Differences between early and late MRI in infants with neonatal encephalopathy following therapeutic hypothermia

Pediatric Research (2023)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Impact

  • 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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Fig. 1: Example of MRI images of normal early scan and abnormal late scan.
Fig. 2: Example of MRI images of abnormal early scan and normal late scan.
Fig. 3: Example of MRI images of abnormal early scan and evolved abnormalities on the late scan.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

All of the infants and families included in this study. Staff of the Brigham and Women’s Hospital.

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Authors and Affiliations

  1. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Aisling A. Garvey, Hoda El-Shibiny, Terrie E. Inder & Mohamed El-Dib

  2. Harvard Medical School, Boston, MA, USA

    Aisling A. Garvey, Terrie E. Inder & Mohamed El-Dib

  3. INFANT Research Centre, Cork, Ireland

    Aisling A. Garvey

  4. Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Edward Yang

  5. Childrens Hospital of Orange County, University of California Irvine, Irvine, CA, USA

    Terrie E. Inder

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  4. Terrie E. Inder
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  5. Mohamed El-Dib
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Contributions

A.G., T.I., M.E.-D. made substantial contributions to the conception and design of the study. A.G. and H.E.-S. made substantial contributions to the acquisition of data. A.G., E.Y. and M.E.-D. made significant contributions to the analysis and interpretation of the data. All authors were involved in drafting and revising of the manuscript and approve the final version to be published.

Corresponding author

Correspondence to Mohamed El-Dib.

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The authors declare no competing interests.

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Patient consent was not required. This was a retrospective data study and institutional review board approval waived consent.

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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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