In clinical practice, cerebral MRI in newborns is highly predictive of neurodevelopmental outcome after therapeutic hypothermia.

Autor: Tharmapoopathy P; The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK; Centre for Neuroscience & Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK., Chisholm P; Homerton University Hospitals NHS Foundation Trust, London, E9 6SR, UK., Barlas A; The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK., Varsami M; The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK., Gupta N; University Hospital Southampton, Southampton, UK., Ekitzidou G; Homerton University Hospitals NHS Foundation Trust, London, E9 6SR, UK., Ponnusamy V; Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK; Centre for Genomics & Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK., Kappelou O; Homerton University Hospitals NHS Foundation Trust, London, E9 6SR, UK., Evanson J; The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK., Rosser G; Centre for Genomics & Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK., Shah DK; The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK; Centre for Neuroscience & Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK. Electronic address: d.shah@qmul.ac.uk.
Jazyk: angličtina
Zdroj: European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society [Eur J Paediatr Neurol] 2020 Mar; Vol. 25, pp. 127-133. Date of Electronic Publication: 2019 Dec 17.
DOI: 10.1016/j.ejpn.2019.12.018
Abstrakt: Objective: In the trials, a substantial proportion of newborns who underwent therapeutic hypothermia (TH) had an adverse outcome after hypoxic-ischaemic encephalopathy (HIE). Cooled babies were noted to have fewer cerebral lesions on MRI but when present lesions were predictive of adverse outcome. We investigate the predictive value of cerebral MRI in babies who undergo cooling in the clinical setting outside of the clinical trials in a prospective UK cohort.
Results: Of 75 babies recruited from four centres, neurodevelopment was available for 69 (92%) with 29% (20/69) being abnormal. The unfavourable MRI group (n = 22) had significantly lower motor (p < 0.001), language (p < 0.001) and cognition (p < 0.001) scores on Bayley-III assessment, compared to the favourable MRI group (n = 47). On multiple regression there was a significant relationship between basal ganglia and thalami abnormality and motor (p = 0.002), cognition (p = 0.011) and language (p = 0.013) outcomes. Half of the babies who had an MRI predictive of adverse outcome (11/22) had highest grade cerebral palsy. Cerebral MRI had 95% sensitivity, 94% specificity, 91% PPV and 98% NPV in predicting neurodevelopment.
Conclusions: In this clinical cohort, fewer children had adverse neurodevelopment after TH compared to the TH trials. However, half the children who had an MRI predictive of adverse ND outcome had the most severe form of cerebral palsy. In this cohort, cerebral MRI was found to be highly predictive of neurodevelopmental outcome.
Competing Interests: Declaration of competing interest All authors report no conflict of interests in the writing of this publication.
(Copyright © 2019 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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