21 - Associations of punctate white matter injury with clinical risk factors and neurologic outcomes in term neonates with hypoxic ischemic encephalopathy

Publication Number: 1018.21

Kia Anarna, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Phoenix Au-Yeung, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Elke H. Roland, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Julia K. Charlton, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Makabongwe Tshuma, BC Children's Hospital, Vancouver, BC, Canada; Thiviya Selvanathan, University of British Columbia, Vancouver, BC, Canada

Background: Punctate white matter injury (PWMI) is associated with neurodevelopmental concerns in preterm infants, dependent on injury severity and location. Term infants with hypoxic ischemic encephalopathy (HIE) may have PWMI although risk factors and associations with neurologic outcomes are not well established in this population.

Objective: To determine the clinical characteristics of term neonates with HIE with predominant PWMI pattern of injury and to assess the relationships between lesion location and severity with neurologic outcomes.

Design/Methods: In a single-centre retrospective cohort spanning 10 years from 2015-2024 of term/near-term infants with HIE admitted to a tertiary Neonatal Intensive Care Unit (NICU), infants with predominant PWMI were identified. Brain MRIs were reviewed and lesion location (anterior vs posterior-only to midventricular line) and severity (mild vs moderate-severe) of punctate white matter lesions were scored using established scoring systems for PWMI in very preterm infants. Data of clinical risk factors and neurologic and neurodevelopmental outcomes were collected through chart review and analyzed with descriptive statistics.

Results: 56 of 345 infants with neonatal HIE had predominant PWMI, 39 had neurologic outcomes data available (69.6%) at 2 years of age. Median gestational age was 39 weeks (IQR 38-40) (Table 1). Majority were outborn (66.1%), delivered via cesarean section (64.3%) and underwent cooling (83.9%). The initial brain MRI was performed at median age of 4 days (IQR 4-5). Anterior (71.4%) and moderate-severe (62.5%) PWMI were more commonly observed (Figure 1). Infants with repeat MRI (n=16) had less PWMI on repeat imaging except for one.

A greater proportion of infants with anterior PWMI had motor, cognitive, language and behavioral delays and epilepsy (Table 2). Similarly, a greater proportion of infants with moderate-severe PWMI had motor, cognitive, language, and behavioral delays and epilepsy (Table 2).

Conclusion(s): PWMI was the predominant pattern of brain injury seen in 16% of term/near-term infants with HIE admitted in a tertiary NICU over a ten-year period. Moderate-severe and anteriorly located PWMI may be associated with poorer neurodevelopmental outcomes in infants with HIE, similar to those born very preterm.

Table 1. Clinical variables of infants with punctate white matter injury.
Data presented as No. (%) or median (IQR)

Figure 1. Axial T1-weighted images showing moderate-severe and anterior PWMI (left) versus mild and posterior-only PWMI (right).


Table 2. Outcomes of infants with punctate white matter injury based on lesion location and severity.
Data presented as No. (%)