Neuroimaging Findings of the High-risk Neonates and Infants Referred to Mofid Children's Hospital

Sasan Saket; Parvaneh Karimzadeh; Mohammad Mehdi Nasehi; Mohammad Mehdi Taghdiri; Minoo Falahi; Ahmadreza Shamshiri; Elham Rahimian

doi:10.22037/ijcn.v16i4.35943

Neuroimaging Findings of the High-risk Neonates and Infants Referred to Mofid Children's Hospital

Iran J Child Neurol. 2022 Fall;16(4):33-44. doi: 10.22037/ijcn.v16i4.35943. Epub 2022 Oct 23.

Authors

Sasan Saket^{1

2}, Parvaneh Karimzadeh^{1

2}, Mohammad Mehdi Nasehi^{1

2}, Mohammad Mehdi Taghdiri^{1

2}, Minoo Falahi³, Ahmadreza Shamshiri⁴, Elham Rahimian⁵

Affiliations

¹ Iranian Child Neurology Center of Excellence (ICNCE), Pediatric Neurology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Pediatric Neurology Department, Mofid Children's Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Pediatric Neonatology, Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Department of Community Oral Health, School of Dentistry, Research Center for Caries Prevention, Dental Research Institute, Tehran University of Medical SciencesTehran, Iran.
⁵ Neuroradiologist, Haghighat MRI Center, Tehran, Iran.

Abstract

Objectives: Neuroimaging in high-risk neonates and infants is done to help child neurologists predict the future neurodevelopmental outcome of these children. In this study, we assessed high-risk neonates and infants admitted to the NICU or neonatal wards of Mofid children's Hospital, especially regarding clinical development and brain imaging.

Materials & methods: This cross-sectional study was conducted on 170 patients admitted to the neonatal and NICU ward of Mofid children's Hospital. Considering the inclusion criteria, 112 patients were included in this project. Brain ultrasonography was performed on almost all of these babies by a single radiologist. Some patients underwent a brain CT scan, and brain MRI without contrast was done on the others. These images were interpreted and compared by a single pediatric neuro-radiologist blinded to clinical data. All of these babies were followed up until 18 months of age.

Results: In this study, 57.1% of the patients were male and 42.9% were female. Of 44 patients who obtained Electroencephalogram (EEG) during the hospitalization period with probable seizure, 25 (56.8%) had normal EEGs. Of 89 babies who were examined by ultrasound, 19 (21.3%) had abnormal findings; ventriculomegaly and then germinal matrix hemorrhage (GMH) were the most common abnormalities. Also, 27 cases (71.1%) of 38 patients undergoing a CT scan had abnormal findings. The most common findings were a hypodense area in the white matter and ventriculomegaly. Of 41 patients who underwent MRI between 1 and 27 months, 34 cases (82.9%) had an abnormal MRI. The most common findings were periventricular hyperintensities in 17 cases (41.5%), mildly delayed myelination in 15 cases (36.6%), and severe brain atrophy or thinning of corpus callosum or white matter volume loss in seven cases (17.1%). During the follow-up period, which was 18.55 ± 6.56 months, 79 (70.5%) of the children had normal development and 33 (29.5%) were suffering from a global neurodevelopmental delay. More precisely, 49 (43.7%) and 35 (31.2%) patients had motor development delay and delayed verbal development, respectively. The abnormal findings of brain imaging in the ultrasound, CT scan, and MRI were all significantly associated with an adverse neurodevelopmental outcome (P <0.001, P = 0.02, and P <0.001, respectively).

Conclusion: In this study, we showed that at any time before six months or after one year of age, the result of brain MRI was a strong predictor of the patient's outcome.

Keywords: High-risk neonates; Neurodevelopmental outcome; Neuroimaging findings; infants.