Prediction of outcome from MRI and general movements assessment after hypoxic-ischaemic encephalopathy in low-income and middle-income countries: data from a randomised controlled trial.
neonatology
neurology
neuropathology
Journal
Archives of disease in childhood. Fetal and neonatal edition
ISSN: 1468-2052
Titre abrégé: Arch Dis Child Fetal Neonatal Ed
Pays: England
ID NLM: 9501297
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
01
12
2020
revised:
26
03
2021
accepted:
20
04
2021
pubmed:
12
6
2021
medline:
4
1
2022
entrez:
11
6
2021
Statut:
ppublish
Résumé
To evaluate the accuracy of neonatal MRI and general movements assessment (GMA) in predicting neurodevelopmental outcomes in infants with hypoxic-ischaemic encephalopathy (HIE). Secondary analyses of a randomised controlled trial (RCT). Tertiary neonatal intensive care unit in India. Fifty infants with HIE were included in an RCT of therapeutic hypothermia (25 cooled and 25 non-cooled). All infants underwent brain MRI at day 5, GMA at 10-15 weeks and outcome assessments including Bayley Scales of Infant and Toddler Development, third edition, at 18 months. Associations between patterns of brain injury, presence/absence of fidgety movements (FMs) and outcomes were assessed. Seventeen of 47 (36%) had adverse outcome (5 (21%) cooled vs 12 (52%) non-cooled, p=0.025). Eight infants died (four before an MRI, another three before GMA). Two developed severe cerebral palsy and seven had Bayley-III motor/cognitive composite score <85. Twelve (26%) had moderately/severely abnormal MRI and nine (23%) had absent FMs. The positive predictive value (95% CI) of an adverse outcome was 89% (53% to 98%) for moderate/severe basal ganglia and thalami (BGT) injury, 83% (56% to 95%) for absent/equivocal signal in the posterior limb of the internal capsule (PLIC) and 67% (38% to 87%) for absent FMs. Negative predictive values (95% CI) were 85% (74% to 92%) for normal/mild BGT injury, 90% (78% to 96%) for normal PLIC and 86% (74% to 93%) for present FMs. Neonatal MRI and GMA predicted outcomes with high accuracy in infants with HIE. The GMA is a feasible low-cost method which can be used alone or complementary to MRI in low-resource settings to prognosticate and direct follow-up. CTRI/2013/05/003693.
Identifiants
pubmed: 34112719
pii: archdischild-2020-321309
doi: 10.1136/archdischild-2020-321309
pmc: PMC8685634
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
32-38Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: NT has a patent 1796/DEL/2013 Life cradle device for inducing neonatal hypothermia issued.
Références
Arch Dis Child Fetal Neonatal Ed. 2011 Jan;96(1):F75-8
pubmed: 21068075
Int J Dev Neurosci. 2013 Nov;31(7):543-9
pubmed: 23831075
Arch Dis Child Fetal Neonatal Ed. 2012 Nov;97(6):F398-404
pubmed: 23080477
J Pediatr. 2012 Nov;161(5):799-807
pubmed: 22682614
J Clin Med. 2019 Oct 25;8(11):
pubmed: 31717717
Arch Pediatr Adolesc Med. 2012 Jul 1;166(7):634-40
pubmed: 22751877
Dev Med Child Neurol. 1997 Apr;39(4):214-23
pubmed: 9183258
Semin Fetal Neonatal Med. 2015 Apr;20(2):72-9
pubmed: 25457083
Pediatrics. 2008 May;121(5):906-14
pubmed: 18450893
Dev Med Child Neurol. 2013 Nov;55(11):1053-9
pubmed: 23927586
J Paediatr Child Health. 2020 Sep;56(9):1414-1418
pubmed: 32767642
Cochrane Database Syst Rev. 2013 Jan 31;(1):CD003311
pubmed: 23440789
PLoS One. 2014 Feb 05;9(2):e87874
pubmed: 24505327
Arch Pediatr Adolesc Med. 2010 Apr;164(4):352-6
pubmed: 20368488
Lancet Neurol. 2010 Jan;9(1):39-45
pubmed: 19896902
Am J Obstet Gynecol. 1999 Apr;180(4):1024-9
pubmed: 10203673
Dev Med Child Neurol. 2000 Dec;42(12):816-24
pubmed: 11132255
Bull World Health Organ. 2005 Jun;83(6):409-17
pubmed: 15976891
Early Hum Dev. 2010 Nov;86(11):675-82
pubmed: 20864278
Dev Med Child Neurol. 2018 May;60(5):480-489
pubmed: 29468662
J Pediatr. 2011 Jun;158(6):904-11
pubmed: 21232764
Clin Neuropsychol. 2017 Feb;31(2):371-381
pubmed: 27687612
Semin Perinatol. 2003 Aug;27(4):320-32
pubmed: 14510323
Early Hum Dev. 2013 Oct;89(10):787-93
pubmed: 23850484
J Pediatr (Rio J). 2016 May-Jun;92(3 Suppl 1):S64-70
pubmed: 26997356
J Pediatr. 2005 Apr;146(4):453-60
pubmed: 15812446
Arch Dis Child Fetal Neonatal Ed. 2020 Jul;105(4):405-411
pubmed: 31662328
EClinicalMedicine. 2018 Dec;6:26-35
pubmed: 30740596
JAMA Pediatr. 2017 Sep 1;171(9):897-907
pubmed: 28715518
Pediatr Res. 2014 May;75(5):670-4
pubmed: 24492622
Pediatr Res. 2014 Jul;76(1):93-9
pubmed: 24713817
Pediatr Crit Care Med. 2013 Oct;14(8):786-95
pubmed: 23897243
Indian J Pediatr. 2021 Jan;88(1):28-33
pubmed: 32488806