66 - Prognostic Utility of a Brain MRI Scoring System with Two-Year Follow-Up in Neonatal Hypoxic-Ischemic Encephalopathy after Therapeutic Hypothermia

Publication Number: 1059.66

Vanessa Rodriguez, University of Central Florida College of Medicine, Orlando, FL, United States; Caroline Chua, Nemours Children's Hospital, Belle Isle, FL, United States; Tushar Chandra, Nemours Childrens Hospital, Orlando, FL, United States; Gleidson Silva, Nemours Children's Hospital, Orlando, FL, United States; Timothy M. Maul, Nemours Children's Hospital, Orlando, FL, United States; Rochelle Sequeira Gomes, Nemours Children's Hospital, Orlando, FL, United States

Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a common cause of neurodevelopmental impairment (NDI) in children. While therapeutic hypothermia (TH) improves neurological outcomes, accurately predicting long-term NDI in the neonatal period remains difficult. Brain MRI with diffusion-weighted imaging (DWI) post-TH can provide both qualitative and quantitative assessment of ischemic injury, but the association between early MRI scores and NDI at two years needs further study.

Objective: To evaluate the correlation of a validated Brain MRI scoring system in the first week of life post TH with neurodevelopmental outcomes assessed at 2 years in neonatal HIE.

Design/Methods: This retrospective chart review included 58 neonates with moderate to severe HIE treated with TH at a single Level IV NICU between 2017-2023. Baseline demographic and clinical characteristics were collected and analyzed. MRI with DWI scans were reviewed and signal abnormalities were scored by blinded neuroradiologists as follows - on T1-weighted, T2-weighted, and DWI sequences using a validated scoring system across five anatomical regions: subcortical structures (caudate nucleus, globus pallidus/putamen, thalamus, posterior limb of the internal capsule), white matter, cortex, cerebellum, and brainstem. Injury severity was graded as none, mild, moderate, or severe. Surviving infants underwent neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development, Fourth Edition (BSID-IV), at 18 to 24 months of age. Non-surviving infants were scored as zero on the BSID-IV. Statistical analysis included non-parametric comparisons (Kruskal-Wallis with Bonferroni correction) between MRI scores and BSID-IV assessments.

Results: A total of 58 neonates were included in the study with their baseline characteristics shown in Table 1. Brain MRI was performed on 50 neonates (86%) at postnatal age 4.1 + 3.6 days. Among the study cohort, 42 individuals survived to discharge (72%), while 18 (28%) died. Of the survivors, 21 (50%) completed follow-up assessment at 18-24 months. Our results showed that higher MRI injury grades were significantly associated with lower motor, cognitive and language standard scores on the BSID IV test at 2 years of age (P < 0.05), as shown in Figure 1, suggesting more severe NDI with higher MRI scores.

Conclusion(s): A qualitative Brain MRI scoring system can be used to predict the neurodevelopmental outcomes at two years of age in neonates with HIE, offering valuable prognostic insight in the neonatal period.

Table 1. Baseline Demographic and Clinical Characteristics
Data expressed as number (percentage), mean + SD and mean range

Figure 1. Correlation of MRI Injury Score and Severity of Developmental Delay by Domain