A Novel Magnetic Resonance Imaging Score Predicts Neurodevelopmental Outcome After Perinatal Asphyxia and Therapeutic Hypothermia

To assess the predictive value of a novel magnetic resonance imaging (MRI) score, which includes diffusion-weighted imaging as well as assessment of the deep grey matter, white matter, and cerebellum, for neurodevelopmental outcome at 2 years and school age among term infants with hypoxic-ischemic e...

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Veröffentlicht in:	The Journal of pediatrics Jg. 192; S. 33 - 40.e2
Hauptverfasser:	Weeke, Lauren C., Groenendaal, Floris, Mudigonda, Kalyani, Blennow, Mats, Lequin, Maarten H., Meiners, Linda C., van Haastert, Ingrid C., Benders, Manon J., Hallberg, Boubou, de Vries, Linda S.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Elsevier Inc 01.01.2018 Mosby
Schlagworte:	Asphyxia Neonatorum - complications Asphyxia Neonatorum - diagnostic imaging Asphyxia Neonatorum - mortality Asphyxia Neonatorum - therapy Brain - diagnostic imaging Cerebral Palsy - diagnosis Cerebral Palsy - etiology Child Child, Preschool Decision Support Techniques Developmental Disabilities - diagnosis Developmental Disabilities - etiology Diffusion Magnetic Resonance Imaging Female Follow-Up Studies Humans hypothermia Hypothermia, Induced Hypoxia-Ischemia, Brain - complications Hypoxia-Ischemia, Brain - diagnostic imaging Hypoxia-Ischemia, Brain - mortality Hypoxia-Ischemia, Brain - therapy hypoxic-ischemic encephalopathy Infant, Newborn Logistic Models Male MRI outcome Predictive Value of Tests Retrospective Studies score Severity of Illness Index Treatment Outcome ADC WPPSI-III-NL MRI HIE WISC-IV-SV CP NAA score 1H-MRS BSITD-III hypoxic-ischemic encephalopathy hypothermia DWI GMFCS outcome
ISSN:	0022-3476, 1097-6833, 1097-6833
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Abstract	To assess the predictive value of a novel magnetic resonance imaging (MRI) score, which includes diffusion-weighted imaging as well as assessment of the deep grey matter, white matter, and cerebellum, for neurodevelopmental outcome at 2 years and school age among term infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia. This retrospective cohort study (cohort 1, The Netherlands 2008-2014; cohort 2, Sweden 2007-2012) including infants born at >36 weeks of gestational age treated with therapeutic hypothermia who had an MRI in the first weeks of life. The MRI score consisted of 3 subscores: deep grey matter, white matter/cortex, and cerebellum. Primary adverse outcome was defined as death, cerebral palsy, Bayley Scales of Infant and Toddler Development, third edition, motor or cognitive composite scores at 2 years of <85, or IQ at school age of <85. In cohort 1 (n = 97) and cohort 2 (n = 76) the grey matter subscore was an independent predictor of adverse outcome at 2 years (cohort 1, OR, 1.6; 95% CI, 1.3-1.9; cohort 2, OR, 1.4; 95% CI, 1.2-1.6), and school age (cohort 1, OR, 1.3; 95% CI, 1.2-1.5; cohort 2, OR, 1.3; 95% CI, 1.1-1.6). The white matter and cerebellum subscore did not add to the predictive value. The positive predictive value, negative predictive value, and area under the curve for the grey matter subscore were all >0.83 in both cohorts, whereas the specificity was >0.91 with variable sensitivity. A novel MRI score, which includes diffusion-weighted imaging and assesses all brain areas of importance in infants with therapeutic hypothermia after perinatal asphyxia, has predictive value for outcome at 2 years of age and at school age, for which the grey matter subscore can be used independently.
AbstractList	To assess the predictive value of a novel magnetic resonance imaging (MRI) score, which includes diffusion-weighted imaging as well as assessment of the deep grey matter, white matter, and cerebellum, for neurodevelopmental outcome at 2 years and school age among term infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia. This retrospective cohort study (cohort 1, The Netherlands 2008-2014; cohort 2, Sweden 2007-2012) including infants born at >36 weeks of gestational age treated with therapeutic hypothermia who had an MRI in the first weeks of life. The MRI score consisted of 3 subscores: deep grey matter, white matter/cortex, and cerebellum. Primary adverse outcome was defined as death, cerebral palsy, Bayley Scales of Infant and Toddler Development, third edition, motor or cognitive composite scores at 2 years of <85, or IQ at school age of <85. In cohort 1 (n = 97) and cohort 2 (n = 76) the grey matter subscore was an independent predictor of adverse outcome at 2 years (cohort 1, OR, 1.6; 95% CI, 1.3-1.9; cohort 2, OR, 1.4; 95% CI, 1.2-1.6), and school age (cohort 1, OR, 1.3; 95% CI, 1.2-1.5; cohort 2, OR, 1.3; 95% CI, 1.1-1.6). The white matter and cerebellum subscore did not add to the predictive value. The positive predictive value, negative predictive value, and area under the curve for the grey matter subscore were all >0.83 in both cohorts, whereas the specificity was >0.91 with variable sensitivity. A novel MRI score, which includes diffusion-weighted imaging and assesses all brain areas of importance in infants with therapeutic hypothermia after perinatal asphyxia, has predictive value for outcome at 2 years of age and at school age, for which the grey matter subscore can be used independently. To assess the predictive value of a novel magnetic resonance imaging (MRI) score, which includes diffusion-weighted imaging as well as assessment of the deep grey matter, white matter, and cerebellum, for neurodevelopmental outcome at 2 years and school age among term infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.OBJECTIVETo assess the predictive value of a novel magnetic resonance imaging (MRI) score, which includes diffusion-weighted imaging as well as assessment of the deep grey matter, white matter, and cerebellum, for neurodevelopmental outcome at 2 years and school age among term infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.This retrospective cohort study (cohort 1, The Netherlands 2008-2014; cohort 2, Sweden 2007-2012) including infants born at >36 weeks of gestational age treated with therapeutic hypothermia who had an MRI in the first weeks of life. The MRI score consisted of 3 subscores: deep grey matter, white matter/cortex, and cerebellum. Primary adverse outcome was defined as death, cerebral palsy, Bayley Scales of Infant and Toddler Development, third edition, motor or cognitive composite scores at 2 years of <85, or IQ at school age of <85.STUDY DESIGNThis retrospective cohort study (cohort 1, The Netherlands 2008-2014; cohort 2, Sweden 2007-2012) including infants born at >36 weeks of gestational age treated with therapeutic hypothermia who had an MRI in the first weeks of life. The MRI score consisted of 3 subscores: deep grey matter, white matter/cortex, and cerebellum. Primary adverse outcome was defined as death, cerebral palsy, Bayley Scales of Infant and Toddler Development, third edition, motor or cognitive composite scores at 2 years of <85, or IQ at school age of <85.In cohort 1 (n = 97) and cohort 2 (n = 76) the grey matter subscore was an independent predictor of adverse outcome at 2 years (cohort 1, OR, 1.6; 95% CI, 1.3-1.9; cohort 2, OR, 1.4; 95% CI, 1.2-1.6), and school age (cohort 1, OR, 1.3; 95% CI, 1.2-1.5; cohort 2, OR, 1.3; 95% CI, 1.1-1.6). The white matter and cerebellum subscore did not add to the predictive value. The positive predictive value, negative predictive value, and area under the curve for the grey matter subscore were all >0.83 in both cohorts, whereas the specificity was >0.91 with variable sensitivity.RESULTSIn cohort 1 (n = 97) and cohort 2 (n = 76) the grey matter subscore was an independent predictor of adverse outcome at 2 years (cohort 1, OR, 1.6; 95% CI, 1.3-1.9; cohort 2, OR, 1.4; 95% CI, 1.2-1.6), and school age (cohort 1, OR, 1.3; 95% CI, 1.2-1.5; cohort 2, OR, 1.3; 95% CI, 1.1-1.6). The white matter and cerebellum subscore did not add to the predictive value. The positive predictive value, negative predictive value, and area under the curve for the grey matter subscore were all >0.83 in both cohorts, whereas the specificity was >0.91 with variable sensitivity.A novel MRI score, which includes diffusion-weighted imaging and assesses all brain areas of importance in infants with therapeutic hypothermia after perinatal asphyxia, has predictive value for outcome at 2 years of age and at school age, for which the grey matter subscore can be used independently.CONCLUSIONA novel MRI score, which includes diffusion-weighted imaging and assesses all brain areas of importance in infants with therapeutic hypothermia after perinatal asphyxia, has predictive value for outcome at 2 years of age and at school age, for which the grey matter subscore can be used independently.
Author	Groenendaal, Floris de Vries, Linda S. Blennow, Mats Lequin, Maarten H. van Haastert, Ingrid C. Meiners, Linda C. Weeke, Lauren C. Mudigonda, Kalyani Hallberg, Boubou Benders, Manon J.
AuthorAffiliation	3 Department of Radiology, Wilhelmina Children's Hospital, University Medical Centerer Utrecht, Utrecht University, the Netherlands 2 Department of Neonatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden 4 Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands 1 Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands
AuthorAffiliation_xml	– name: 1 Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands – name: 2 Department of Neonatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden – name: 3 Department of Radiology, Wilhelmina Children's Hospital, University Medical Centerer Utrecht, Utrecht University, the Netherlands – name: 4 Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands
Author_xml	– sequence: 1 givenname: Lauren C. surname: Weeke fullname: Weeke, Lauren C. organization: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands – sequence: 2 givenname: Floris surname: Groenendaal fullname: Groenendaal, Floris organization: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands – sequence: 3 givenname: Kalyani surname: Mudigonda fullname: Mudigonda, Kalyani organization: Department of Neonatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden – sequence: 4 givenname: Mats surname: Blennow fullname: Blennow, Mats organization: Department of Neonatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden – sequence: 5 givenname: Maarten H. surname: Lequin fullname: Lequin, Maarten H. organization: Department of Radiology, Wilhelmina Children's Hospital, University Medical Centerer Utrecht, Utrecht University, the Netherlands – sequence: 6 givenname: Linda C. surname: Meiners fullname: Meiners, Linda C. organization: Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands – sequence: 7 givenname: Ingrid C. surname: van Haastert fullname: van Haastert, Ingrid C. organization: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands – sequence: 8 givenname: Manon J. surname: Benders fullname: Benders, Manon J. organization: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands – sequence: 9 givenname: Boubou surname: Hallberg fullname: Hallberg, Boubou organization: Department of Neonatology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden – sequence: 10 givenname: Linda S. surname: de Vries fullname: de Vries, Linda S. email: l.s.devries@umcutrecht.nl organization: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, The Netherlands
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/29246356$$D View this record in MEDLINE/PubMed http://kipublications.ki.se/Default.aspx?queryparsed=id:137533417$$DView record from Swedish Publication Index (Karolinska Institutet)
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ContentType	Journal Article
Copyright	2017 The Author(s) Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved. 2017 The Author(s) 2017
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ISSN	0022-3476 1097-6833
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Keywords	ADC WPPSI-III-NL MRI HIE WISC-IV-SV CP NAA score 1H-MRS BSITD-III hypoxic-ischemic encephalopathy hypothermia DWI GMFCS outcome
Language	English
License	This is an open access article under the CC BY license. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Contributed equally.
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Snippet	To assess the predictive value of a novel magnetic resonance imaging (MRI) score, which includes diffusion-weighted imaging as well as assessment of the deep...
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SubjectTerms	Asphyxia Neonatorum - complications Asphyxia Neonatorum - diagnostic imaging Asphyxia Neonatorum - mortality Asphyxia Neonatorum - therapy Brain - diagnostic imaging Cerebral Palsy - diagnosis Cerebral Palsy - etiology Child Child, Preschool Decision Support Techniques Developmental Disabilities - diagnosis Developmental Disabilities - etiology Diffusion Magnetic Resonance Imaging Female Follow-Up Studies Humans hypothermia Hypothermia, Induced Hypoxia-Ischemia, Brain - complications Hypoxia-Ischemia, Brain - diagnostic imaging Hypoxia-Ischemia, Brain - mortality Hypoxia-Ischemia, Brain - therapy hypoxic-ischemic encephalopathy Infant, Newborn Logistic Models Male MRI outcome Predictive Value of Tests Retrospective Studies score Severity of Illness Index Treatment Outcome
Title	A Novel Magnetic Resonance Imaging Score Predicts Neurodevelopmental Outcome After Perinatal Asphyxia and Therapeutic Hypothermia
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