Neonatal encephalopathic cerebral injury in South India assessed by perinatal magnetic resonance biomarkers and early childhood neurodevelopmental outcome

Autor: Shaji Padinjattel, G Balraj, Manjula Ayer, Frances M. Cowan, Seetha Shankaran, Sudhin Thayyil, Sreejith Ceebi, Ernest B. Cady, Kariyapilly Satheesan, Peter J Lally, Mohandas Nair, SS Pauliah, Justin Kurien, Alan Bainbridge, Madhava Vijayakumar, Hui Zhang, Angie Wade, Ravi Swamy, Neeraja Sivasamy, Krishnakumar Padinharath, D Price, Betty Hutchon
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Pediatrics
Medical Physics
Epidemiology
CHILDREN
Disease
Developmental and Pediatric Neurology
Hypoxic Ischemic Encephalopathy
DISEASE
Diagnostic Radiology
Early childhood
Prospective Studies
Prospective cohort study
Asphyxia Neonatorum
Multidisciplinary
medicine.diagnostic_test
Cognitive Neurology
Physics
ASPHYXIAL ENCEPHALOPATHY
Magnetic Resonance Imaging
Multidisciplinary Sciences
Survival Rate
Neurology
REGISTRATION
Science & Technology - Other Topics
Medicine
medicine.symptom
Radiology
Research Article
medicine.medical_specialty
General Science & Technology
Science
WHOLE-BODY HYPOTHERMIA
India
Neuroimaging
Brain damage
Disease-Free Survival
Cerebral palsy
MD Multidisciplinary
medicine
Humans
HYPOXIC-ISCHEMIC ENCEPHALOPATHY
NEWBORN PIGLET
Science & Technology
Neonatal encephalopathy
business.industry
Cerebral Palsy
ENERGY FAILURE
Infant
Newborn
Infant
Magnetic resonance imaging
SPATIAL STATISTICS
medicine.disease
RANDOMIZED-TRIAL
Radiography
Biomarker Epidemiology
Brain Injuries
Neonatology
business
Biomarkers
Zdroj: PLoS ONE, Vol 9, Iss 2, p e87874 (2014)
PLoS ONE
ISSN: 1932-6203
Popis: UnlabelledAlthough brain injury after neonatal encephalopathy has been characterised well in high-income countries, little is known about such injury in low- and middle-income countries. Such injury accounts for an estimated 1 million neonatal deaths per year. We used magnetic resonance (MR) biomarkers to characterise perinatal brain injury, and examined early childhood outcomes in South India.MethodsWe recruited consecutive term or near term infants with evidence of perinatal asphyxia and a Thompson encephalopathy score ≥6 within 6 h of birth, over 6 months. We performed conventional MR imaging, diffusion tensor MR imaging and thalamic proton MR spectroscopy within 3 weeks of birth. We computed group-wise differences in white matter fractional anisotropy (FA) using tract based spatial statistics. We allocated Sarnat encephalopathy stage aged 3 days, and evaluated neurodevelopmental outcomes aged 3½ years using Bayley III.ResultsOf the 54 neonates recruited, Sarnat staging was mild in 30 (56%); moderate in 15 (28%) and severe in 6 (11%), with no encephalopathy in 3 (6%). Six infants died. Of the 48 survivors, 44 had images available for analysis. In these infants, imaging indicated perinatal rather than established antenatal origins to injury. Abnormalities were frequently observed in white matter (n = 40, 91%) and cortex (n = 31, 70%) while only 12 (27%) had abnormal basal ganglia/thalami. Reduced white matter FA was associated with Sarnat stage, deep grey nuclear injury, and MR spectroscopy N-acetylaspartate/choline, but not early Thompson scores. Outcome data were obtained in 44 infants (81%) with 38 (79%) survivors examined aged 3½ years; of these, 16 (42%) had adverse neurodevelopmental outcomes.ConclusionsNo infants had evidence for established brain lesions, suggesting potentially treatable perinatal origins. White matter injury was more common than deep brain nuclei injury. Our results support the need for rigorous evaluation of the efficacy of rescue hypothermic neuroprotection in low- and middle-income countries.
Databáze: OpenAIRE
Externí odkaz: