Mild hypoxic-ischemic encephalopathy (HIE): timing and pattern of MRI brain injury

Yi Li; Jessica L Wisnowski; Lina Chalak; Amit M Mathur; Robert C McKinstry; Genesis Licona; Dennis E Mayock; Taeun Chang; Krisa P Van Meurs; Tai-Wei Wu; Kaashif A Ahmad; Marie-Coralie Cornet; Rakesh Rao; Aaron Scheffler; Yvonne W Wu

doi:10.1038/s41390-022-02026-7

Mild hypoxic-ischemic encephalopathy (HIE): timing and pattern of MRI brain injury

Pediatr Res. 2022 Dec;92(6):1731-1736. doi: 10.1038/s41390-022-02026-7. Epub 2022 Mar 30.

Authors

Yi Li¹, Jessica L Wisnowski², Lina Chalak³, Amit M Mathur⁴, Robert C McKinstry⁵, Genesis Licona⁶, Dennis E Mayock⁷, Taeun Chang⁸, Krisa P Van Meurs⁹, Tai-Wei Wu¹⁰, Kaashif A Ahmad¹¹, Marie-Coralie Cornet¹², Rakesh Rao¹³, Aaron Scheffler¹⁴, Yvonne W Wu^{12

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Affiliations

¹ Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. yi.li@ucsf.edu.
² Department of Radiology and Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA.
³ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁴ Division of Neonatal Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA.
⁵ Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
⁶ Division of Neonatology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
⁷ Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
⁸ Department of Neurology, Children's National Hospital, George Washington School of Medicine & Health Sciences, Washington, DC, USA.
⁹ Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
¹⁰ Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹¹ Pediatrix Medical Group of San Antonio, San Antonio, TX, USA.
¹² Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
¹³ Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
¹⁴ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
¹⁵ Department of Neurology, University of California San Francisco, San Francisco, CA, USA.

Abstract

Background: Mild hypoxic-ischemic encephalopathy (HIE) is increasingly recognized as a risk factor for neonatal brain injury. We examined the timing and pattern of brain injury in mild HIE.

Methods: This retrospective cohort study includes infants with mild HIE treated at 9 hospitals. Neonatal brain MRIs were scored by 2 reviewers using a validated classification system, with discrepancies resolved by consensus. Severity and timing of MRI brain injury (i.e., acute, subacute, chronic) was scored on the subset of MRIs that were performed at or before 8 days of age.

Results: Of 142 infants with mild HIE, 87 (61%) had injury on MRI at median age 5 (IQR 4-6) days. Watershed (23%), deep gray (20%) and punctate white matter (18%) injury were most common. Among the 125 (88%) infants who received a brain MRI at ≤8 days, mild (44%) injury was more common than moderate (11%) or severe (4%) injury. Subacute (37%) lesions were more commonly observed than acute (32%) or chronic lesions (1%).

Conclusion: Subacute brain injury is common in newborn infants with mild HIE. Novel neuroprotective treatments for mild HIE will ideally target both subacute and acute injury mechanisms.

Impact: Almost two-thirds of infants with mild HIE have evidence of brain injury on MRI obtained in the early neonatal period. Subacute brain injury was seen in 37% of infants with mild HIE. Neuroprotective treatments for mild HIE will ideally target both acute and subacute injury mechanisms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain / diagnostic imaging
Brain / pathology
Brain Injuries* / therapy
Humans
Hypothermia, Induced*
Hypoxia-Ischemia, Brain* / therapy
Infant
Infant, Newborn
Magnetic Resonance Imaging
Retrospective Studies

Grants and funding

K23 HD099309/HD/NICHD NIH HHS/United States