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MRI Can Predict Outcome of Infants Deficient of Oxygen at Birth

NEW YORK -- November 5, 2009 -- Children whose brains are starved of oxygen at birth suffer less brain injury if they undergo therapeutic cooling, according to a study published online first and appearing in the January 2010 edition of The Lancet Neurology.

The study also shows that magnetic resonance imaging (MRI) can predict with 80% accuracy the likelihood of death or disability by age 18 months.

Babies who are starved of oxygen at birth can develop hypoxic-ischaemic encephalopathy. This is an important cause of mortality and morbidity in newborns that accounts for about 20% of occurrences of cerebral palsy in childhood.

In the already published Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial, infants who were allocated to prolonged moderate hypothermia showed no significant difference in the combined rate of death or disability at 18 months but had a reduced rate of cerebral palsy and improved mental and psychomotor outcomes compared with those allocated to standard care.

In this new study, Denis Azzopardi, Clinical Sciences Centre, Imperial College London, United Kigndom, and colleagues hypothesised that whole-body cooling would be associated with a reduction in cerebral lesions seen on MRI that are characteristic of hypoxic-ischaemic encephalopathy, including those predicting neurodevelopmental impairments. They also proposed that cooling would not alter the accuracy of neonatal MRI for predicting neurological outcome at age 18 months.

To test this hypothesis, they reviewed the MRI scans for 131 of the 325 infants enrolled in the TOBY trial.

The team found that therapeutic hypothermia was associated with a 30% to 40% reduction in lesions in various areas of the brain associated with neurological development.

Compared with non-cooled infants, cooled infants had fewer scans that were predictive of later neuromotor abnormalities, and were nearly 3 times more likely to have normal scans. The accuracy of prediction by MRI of death or disability to 18 months of age was similar in both groups (84% cooled vs 81% non-cooled).

"The accuracy of MRI done during the neonatal period for the prediction of neurological outcomes up to 18 months of age was unaltered by therapeutic hypothermia," the authors wrote. "In this large cohort of infants who had an MRI after hypoxic-ischaemic encephalopathy, we found no unusual patterns of lesions and no increase in haemorrhagic or thrombotic lesions associated with therapeutic hypothermia."

"Our finding that MRI at a median of 8 days accurately predicted outcome at 18 months of age in cooled and non-cooled infants is likely to be generally applicable," they concluded. "These data show that MRI in the neonatal period is qualified as a biomarker of disease and treatment response and might be of use in other neuroprotective studies."

SOURCE: The Lancet Neurology

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