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Sequential neurological examinations in infants with neonatal encephalopathy and low apgar scores: relationship with
1Department of Paediatrics, Faculty of Medicine, Imperial College, Hammersmith Campus, London, United Kingdom.
Insights
Neurological impairments in infants with neonatal encephalopathy vary based on brain lesion patterns. Understanding these patterns helps predict long-term neurological development and outcomes in affected children.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Neonatal Care
Background:
- Neonatal encephalopathy (NE) is a serious condition affecting newborns.
- Abnormal neurological signs and outcomes are common in NE survivors.
- Brain MRI is crucial for diagnosing NE-related brain damage.
Purpose of the Study:
- To track neurological sign evolution in infants with NE and poor outcomes.
- To correlate neurological sign changes with brain MRI lesion patterns.
Main Methods:
- Longitudinal study of 15 infants with NE, low Apgar scores, and abnormal outcomes.
- Neurological examinations at 1-2 weeks, 5-7 weeks, and 6 months.
- Neonatal brain MRI scans were analyzed for lesion patterns.
Main Results:
- All infants showed persistent abnormalities, with severity linked to lesion patterns.
- Severe basal ganglia/white matter lesions correlated with severe, unremitting impairments.
- Moderate lesions showed some functional improvements by 6 months, with better motor milestones.
Conclusions:
- The pattern of brain lesions in NE significantly influences the long-term neurological recovery.
- MRI-based lesion patterns can help predict the trajectory of neurological development in infants with NE.
Objective:
The aims of this study were to (a) describe the evolution of neurological signs after the neonatal period in infants with neonatal encephalopathy and abnormal outcome and (b) to establish the relationship between the evolution of neurological signs and patterns of lesions on brain MRI.
Patients:
Fifteen children with low Apgar scores, abnormal neurological signs at the end of the neonatal period, and abnormal outcome were examined at 1 - 2 weeks, 5 - 7 weeks, and 6 months. All the infants had at least one MRI scan performed in the neonatal period.
Results:
All infants had persistent abnormalities on all examinations performed but the severity of neurological impairment was variable and was related to the pattern of brain lesions. Infants with severe basal ganglia and white matter lesions showed abnormal axial and limb tone, movements, and visual function on all the examinations and none achieved independent sitting. In infants with moderate basal ganglia lesions and/or severe white matter changes, visual function and feeding improved by 5 - 7 weeks and were still normal at 6 months while limb tone, which was reduced in the first weeks, appeared to be normal at 5 - 6 weeks but was found to be increased at 6 months; all were able to sit unsupported at 2 years and most of them achieved the ability to walk with support.
Conclusions:
Our results suggest that the evolution of the neurological patterns after the neonatal period in infants with persisting neonatal abnormalities depends on their pattern of brain lesions.
