Journal article
Limitations of Conventional Magnetic Resonance Imaging as a Predictor of Death or Disability Following Neonatal Hypoxic-Ischemic Encephalopathy in the Late Hypothermia Trial
The Journal of pediatrics, Vol.230, pp.106-111.e6
03/2021
DOI: 10.1016/j.jpeds.2020.11.015
PMCID: PMC7914162
PMID: 33189747
Abstract
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.
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.
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.
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.
Clinicaltrials.gov: NCT00614744.
Details
- Title: Subtitle
- Limitations of Conventional Magnetic Resonance Imaging as a Predictor of Death or Disability Following Neonatal Hypoxic-Ischemic Encephalopathy in the Late Hypothermia Trial
- Creators
- Abbot R Laptook - Brown UniversitySeetha Shankaran - Wayne State UniversityPatrick Barnes - Stanford UniversityNancy Rollins - The University of Texas Southwestern Medical CenterBarbara T Do - RTI InternationalNehal A Parikh - Cincinnati Children's Hospital Medical CenterShannon Hamrick - Emory University School of MedicineSusan R Hintz - Lucile Packard Children's HospitalJon E Tyson - The University of Texas Health Science CenterEdward F Bell - University of IowaNamasivayam Ambalavanan - University of Alabama at BirminghamRonald N Goldberg - Duke UniversityAthina Pappas - Wayne State UniversityCarolyn Huitema - RTI InternationalClaudia Pedroza - The University of Texas Health Science CenterAasma S Chaudhary - University of PennsylvaniaAngelita M Hensman - Women & Infants Hospital of Rhode IslandAbhik Das - RTI InternationalMyra Wyckoff - The University of Texas Southwestern Medical CenterAmir Khan - Lucile Packard Children's HospitalMichelle C Walsh - Case Western Reserve UniversityKristi L Watterberg - University of New MexicoRoger Faix - University of UtahWilliam Truog - University of Missouri–Kansas CityRonnie Guillet - University of RochesterGregory M Sokol - Indiana UniversityBrenda B Poindexter - University of CincinnatiRosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Contributors
- John M Dagle (Contributor) - University of Iowa, Stead Family Department of Pediatrics
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.230, pp.106-111.e6
- DOI
- 10.1016/j.jpeds.2020.11.015
- PMID
- 33189747
- PMCID
- PMC7914162
- NLM abbreviation
- J Pediatr
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Grant note
- UG1 HD040689 / NICHD NIH HHS U10 HD040689 / NICHD NIH HHS UL1 TR003167 / NCATS NIH HHS KL2 TR003168 / NCATS NIH HHS UG1 HD027904 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS
- Language
- English
- Date published
- 03/2021
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Biochemistry and Molecular Biology; Neonatology
- Record Identifier
- 9984293076002771
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