Warming up to the need for MRI after hypothermia

Abstract

A number of clinical trials around the globe, including the Total Body Hypothermia for Neonatal Encephalopathy (TOBY), CoolCap, Infant Cooling Evaluation (ICE), and National Institute of Childhood Health and Human Development (NICHD) Neonatal Research Network (NRN) studies, have demonstrated that therapeutic hypothermia reduces the incidence of neonatal death and long-term neurodevelopmental disability among infants born with acute, moderate-to-severe neonatal encephalopathy, characterized by acidosis and low Apgar scores. Hypothermia has become a standard, though not panacea, for these at-risk newborns. As the implementation of hypothermia within 6 hours of birth has become widespread for perinatal asphyxia, what other practices should become standard? In this issue of The Journal, the NICHD NRN investigators report on the importance of neonatal brain magnetic resonance imaging (MRI) following rewarming to predict future outcome. MRIs were obtained in their trial at approximately 44 weeks postmenstrual age. A normal brain MRI had a sensitivity of 61% and positive predictive value (PPV) of 92% for normal outcome and intelligence quotient (IQ) ≥ 70 at age 6 to 7 years. However, MRI involvement of either basal ganglia, thalamus, anterior or posterior limb of the internal capsule, or an area of infarction, plus any additional cerebral lesions (or cerebral hemispheric devastation) had an 81% sensitivity and 70% PPV for death or IQ <70 at aged 6 to 7 years. These MRI patterns can be highly helpful to counsel the families of affected newborns. MRI following therapeutic hypothermia should now be a standard procedure. Article page 987▶ Neonatal Magnetic Resonance Imaging Pattern of Brain Injury as a Biomarker of Childhood Outcomes following a Trial of Hypothermia for Neonatal Hypoxic-Ischemic EncephalopathyThe Journal of PediatricsVol. 167Issue 5PreviewTo examine the ability of magnetic resonance imaging (MRI) patterns of neonatal brain injury defined by the National Institute of Child Health and Human Development Neonatal Research Network to predict death or IQ at 6-7 years of age following hypothermia for neonatal encephalopathy. Full-Text PDF