Correlation between early magnetic resonance imaging brain abnormalities in term infants with perinatal asphyxia and neuro developmental outcome at one year
Keywords:Perinatal asphyxia, MRI, Brain, Abnormality, Neurodevelopmental outcome
Background: Hypoxic ischemic encephalopathy is an important cause of permanent brain damage in neonates with perinatal asphyxia. Magnetic resonance imaging (MRI) is valuable in predicting prognosis following HIE.
Methods: Prospective observational cohort study was conducted in tertiary level referral hospital in term infants born with perinatal asphyxia. MRI brain was done between 5 to 14 days of age. Anthropometry and neurological examinations were recorded at birth, discharge and follow-up. Denver developmental screening test II was performed at follow up.
Results: Out of 174 neonates born with PA, enrolled 64 underwent MRI brain. Out of these 14% had stage I, 70% stage II and 16 % stage III HIE as per Sarnat staging. At follow up, abnormalities in tone were noted in 36% infants, which included spastic quadriplegia in 34% and atonic cerebral palsy in 2%. DDST II was normal in 32 and suspect in 18 (36%) infants; with global developmental delay in 14 (28%) and predominantly motor development delay in 4 (8%). Abnormal lesions were seen in the corpus callosum in 34 (68%), posterior limb of internal capsule in 14 (28%), basal ganglia in 11 (22%), watershed region in 6 (12%), thalamus in 4 (8%) and corticospinal tract in 1 (2%) infants were associated with statistical significant poor neurodevelopment outcome p<0.05. Diffusion weighted MRI showed abnormalities in the posterior limb of internal capsule (PLIC) in 27 (54%), BG in 8 (16%) and thalamus in 2 (4%) infants was associated with statistically significant poor neurodevelopmental outcome (NDO) (p<0.05).
Conclusions: Lesion in BG, thalamic region and PLIC in conventional MRI and abnormality in DW imaging in PLIC and BG were found to correlate with poor NDO at one year of life.
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