593 - Neonatal MRI and Long-term Neurodevelopmental Outcome in Neonatal Encephalopathy treated with Therapeutic Hypothermia

Publication Number: 3574.593

Corline E.J.. Parmentier, University Medical Center Utrecht,, Utrecht, Utrecht, Netherlands; Floris Groenendaal, Univerisity Medical Center Utrecht, Utrecht, Utrecht, Netherlands; Elisabeth Magdalena de. Bruijne, Utrecht University Medical Centre, Utrecht, Utrecht, Netherlands; Kim Annink, University Medical Centre Utrecht, Utrecht, Utrecht, Netherlands; Niek E. van der Aa, University Medical Center Utrecht, Utrecht, Utrecht, Netherlands; Virginia Maria Ginocchio, Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Emilia-Romagna, Italy; Corine Koopman-Esseboom, UMCU, Utrecht, Utrecht, Netherlands; Rian Eijsermans, Child development and exercise center, Wilhelmina Childrens Hospital, Utrecht, Utrecht, Netherlands; Rick M. van der sluis, Wilhelmina Children’s Hospital, Utrecht, Utrecht, Netherlands; Monique van schooneveld, Wilhelmina kinderziekenhuis Utrecht, Utrecht, Utrecht, Netherlands; Linda S. de Vries, LUMC, Leiden, Zuid-Holland, Netherlands; Thomas Alderliesten, University Medical Center Utrecht, Utrecht, Utrecht, Netherlands; Manon Benders, University Medical Center Utrecht, Zeist, Utrecht, Netherlands

Background: Neonatal brain magnetic resonance imaging (MRI) is an important biomarker for future neurodevelopment in neonatal encephalopathy (NE) following therapeutic hypothermia (TH). The Weeke MRI score correlates well with 2-year neurodevelopmental outcome. However, it does not assess the mammillary bodies (MB), and data on its prognostic value for outcome beyond 2 years are scarce.

Objective: To study the association of neonatal brain MRI and neurodevelopment ≥5 years in NE treated with TH.

Design/Methods: Retrospective single center cohort study on infants treated with TH for NE with brain MRI < 2 weeks after birth and developmental assessments at 5 and/or 8-10 years’ age. MRI was assessed with the Weeke score (with a white matter (WM), deep gray matter (DGM), cerebellum, and additional injury subscore) and was also analyzed for MB injury. Motor development was assessed at 5 and 8-10 years with the Movement Assessment Battery for Children 2nd Edition, Dutch version (MABC-2-NL). An adverse motor outcome was defined as cerebral palsy or motor delay (MABC-2-NL total score ≤5th percentile). Cognition was assessed with the Dutch version of the Wechsler Preschool and Primary Scale of Intelligence 3rd or 4th Edition at 5 years, and the Wechsler Intelligence Scale for Children 3rd or 5th Edition at 8-10 years. Multivariable analysis was used to study the association between neurodevelopment and MRI with adjustments for gestational age (GA) and socioeconomic status.

Results: Of 273 infants treated with TH for NE, 77 died and 24 had a congenital/genetic anomaly. Of the remaining 172, 143 (83%) had MRI < 2 weeks and outcome data ≥5 years available. At 5 years, multivariable analysis showed that higher DGM injury scores (odds ratio 1.3, 95% CI 1.1 to 1.4) and lower GA were independently associated with adverse motor outcome. WM scores were independently associated with lower total IQ at 5 years (regression coefficient -1.6, 95% CI: -2.4 to -0.7). In the subset of children aged 8-10 years (motor outcome available for n=58, cognition for n=48), MRI findings were not independently associated with adverse motor outcome at 8-10 years. Only MB injury was independently associated with lower total IQ at 8-10 years (difference -14 points, 95% CI -24 to -5).

Conclusion(s): Early brain MRI is associated with long-term neurodevelopment in NE treated with TH. While DGM and WM injury scores are associated with respectively motor and cognitive outcome at 5 years, MB injury appears as a predictor of cognition at 8–10 years. Incorporating MB assessment may improve the prognostic value of the Weeke score for long-term neurodevelopment.