Authors
Abbot R. Laptook, Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI
Seetha Shankaran, Department of Pediatrics, Wayne State University, Detroit, MI
Patrick Barnes, Department of Radiology and Pediatrics, Stanford University School of Medicine, Palo Alto, CA
Nancy Rollins, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
Barbara T. Do, Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC
Nehal A. Parikh, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Shannon Hamrick, Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
Susan R. Hintz, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
Jon E. Tyson, Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
Edward F. Bell, Department of Pediatrics, University of Iowa, Iowa City, IA
Namasivayam Ambalavanan, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
Ronald N. Goldberg, Department of Pediatrics, Duke University, Durham, NC
Athina Pappas, Department of Pediatrics, Wayne State University, Detroit, MI
Carolyn Huitema, Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
Claudia Pedroza, Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
Aasma S. Chaudhary, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
Angelita M. Hensman, Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI
Abhik Das, Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
Myra Wyckoff, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
Amir Khan, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
Michelle C. Walsh, Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH
Kristi L. Watterberg, University of New Mexico Health Sciences Center, Albuquerque, NM
Roger Faix, Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
William Truog, Department of Pediatrics, Children's Mercy Hospital and University of Missouri Kansas City School of Medicine, Kansas City, MO
Ronnie Guillet, University of Rochester School of Medicine and Dentistry, Rochester, NY
Gregory M. Sokol, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
Brenda B. Poindexter, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
Rosemary D. Higgins, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Pregnancy and Perinatology Branch, Bethesda, MD; George Mason University, Fairfax, VA
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Publication Date
3-1-2021
Abstract
OBJECTIVE: To investigate if magnetic resonance imaging (MRI) is an accurate predictor for death or moderate-severe disability at 18-22 months of age among infants with neonatal encephalopathy in a trial of cooling initiated at 6-24 hours.
STUDY DESIGN: Subgroup analysis of infants ≥36 weeks of gestation with moderate-severe neonatal encephalopathy randomized at 6-24 postnatal hours to hypothermia or usual care in a multicenter trial of late hypothermia. MRI scans were performed per each center's practice and interpreted by 2 central readers using the Eunice Kennedy Shriver National Institute of Child Health and Human Development injury score (6 levels, normal to hemispheric devastation). Neurodevelopmental outcomes were assessed at 18-22 months of age.
RESULTS: Of 168 enrollees, 128 had an interpretable MRI and were seen in follow-up (n = 119) or died (n = 9). MRI findings were predominantly acute injury and did not differ by cooling treatment. At 18-22 months, death or severe disability occurred in 20.3%. No infant had moderate disability. Agreement between central readers was moderate (weighted kappa 0.56, 95% CI 0.45-0.67). The adjusted odds of death or severe disability increased 3.7-fold (95% CI 1.8-7.9) for each increment of injury score. The area under the curve for severe MRI patterns to predict death or severe disability was 0.77 and the positive and negative predictive values were 36% and 100%, respectively.
CONCLUSIONS: MRI injury scores were associated with neurodevelopmental outcome at 18-22 months among infants in the Late Hypothermia Trial. However, the results suggest caution when using qualitative interpretations of MRI images to provide prognostic information to families following perinatal hypoxia-ischemia.
TRIAL REGISTRATION: Clinicaltrials.gov: NCT00614744.
Publication Title
The Journal of pediatrics
DOI
10.1016/j.jpeds.2020.11.015
Recommended Citation
Laptook AR, Shankaran S, Barnes P, Rollins N, Do BT, Parikh NA, Hamrick S, Hintz SR, Tyson JE, Bell EF, Ambalavanan N, Goldberg RN, Pappas A, Huitema C, Pedroza C, Chaudhary AS, Hensman AM, Das A, Wyckoff M, Khan A, Walsh MC, Watterberg KL, Faix R, Truog W, Guillet R, Sokol GM, Poindexter BB, Higgins RD; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Limitations of Conventional Magnetic Resonance Imaging as a Predictor of Death or Disability Following Neonatal Hypoxic-Ischemic Encephalopathy in the Late Hypothermia Trial. J Pediatr. 2021 Mar;230:106-111.e6. doi: 10.1016/j.jpeds.2020.11.015. Epub 2020 Nov 13. PMID: 33189747; PMCID: PMC7914162.
