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Published on: March 14, 2013
Head growth in infants with hypoxic-ischemic encephalopathy: correlation with neonatal magnetic resonance imaging
E Mercuri1, D Ricci, F M Cowan
1Department of, Imperial College of Science, Technology and Medicine, Hammersmith Campus, London, United Kingdom.
Insights
Suboptimal head growth in the first year is common in infants with hypoxic-ischemic encephalopathy (HIE). This growth pattern predicts neurodevelopmental outcomes better than microcephaly alone.
Area of Science:
- Neonatal neurology
- Pediatric neurodevelopment
- Medical imaging
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a serious birth complication.
- Neonatal brain magnetic resonance imaging (MRI) is crucial for assessing HIE-related brain injury.
- Head growth patterns in infancy can reflect underlying neurological development.
Purpose of the Study:
- To investigate the relationship between head growth in the first year of life and brain injury patterns on neonatal MRI in infants with HIE.
- To determine if head growth patterns correlate with neurodevelopmental outcomes at one year of age.
Main Methods:
- Retrospective analysis of 52 term infants with HIE and neonatal MRI.
- Evaluation of head circumference charts to track head growth over the first year.
- Classification of suboptimal head growth (drop >2 SDs) and microcephaly (<3rd percentile).
Main Results:
- 53% of HIE infants showed suboptimal head growth versus 3% of controls.
- Suboptimal head growth correlated significantly with severe white matter and basal ganglia/thalamic lesions.
- Suboptimal head growth predicted abnormal neurodevelopmental outcome with 79% sensitivity and 78% specificity.
Conclusions:
- Suboptimal head growth is a significant indicator of brain injury severity and predicts neurodevelopmental outcomes in HIE infants.
- Head growth monitoring in the first year offers valuable prognostic information for infants with HIE.
- Head growth patterns provide a more sensitive predictive measure of neurodevelopmental outcomes than microcephaly alone in HIE survivors.
Objectives:
The aims of the study were to establish the relationship between head growth in the first year of life with the pattern on injury on neonatal magnetic resonance imaging (MRI) in infants with hypoxic-ischemic encephalopathy (HIE) and to relate these to the neurodevelopmental outcome.
Methods:
Fifty-two term infants who presented at birth with a neonatal encephalopathy consistent with HIE and who had neonatal brain MRI were entered into the study. Head circumference charts were evaluated retrospectively and the head growth over the first year of life compared with the pattern of brain lesions on MRI and with the neurodevelopmental outcome at 1 year of age. Suboptimal head growth was classified as a drop of >2 standard deviations across the percentiles with or without the development of microcephaly, which was classified as a head circumference below the third percentile.
Results:
There was no statistical difference between the neonatal head circumferences of the infants presenting with HIE and control infants. At 12 months, microcephaly was present in 48% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was documented in 53% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was significantly associated with the pattern of brain lesions, in particular to involvement of severe white matter and to severe basal ganglia and thalamic lesions. Suboptimal head growth predicted abnormal neurodevelopmental outcome with a sensitivity of 79% and a specificity of 78%, compared with the presence of microcephaly at 1 year of age, which had a sensitivity of only 65% and a specificity of 73%. The exceptions were explained by infants with only moderate white matter abnormalities who had suboptimal head growth but normal outcome at 1 year of age and by infants with moderate basal ganglia and thalamic lesions only who had normal head growth but significant motor abnormality.
