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Updated: Jun 22, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Neonatal brain imaging and the identification of metabolic acidemia and hypoxic-ischemic encephalopathy
Kristy A Ruis1, Kristy A Ruis, Christoph U Lehmann
1Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-1228, USA. kristyruis@yahoo.com
Insights
Neonatal brain imaging shows signs of basal ganglia injury in infants with metabolic acidemia and hypoxic-ischemic encephalopathy (HIE). However, these radiological findings are not precise enough to be a definitive diagnostic standard for these conditions.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Perinatal Medicine
Background:
- Intrapartum metabolic acidemia and hypoxic-ischemic encephalopathy (HIE) are critical conditions in newborns.
- Accurate and timely identification of these conditions is crucial for appropriate management and improved outcomes.
- Neonatal brain imaging is increasingly used to assess brain injury in newborns.
Purpose of the Study:
- To evaluate the precision of neonatal brain imaging in identifying intrapartum metabolic acidemia and HIE in term and near-term infants.
- To determine the diagnostic accuracy of specific radiological findings, such as basal ganglia injury, in these conditions.
Main Methods:
- A case-control study including 54 neonates (≥34 weeks gestation) with cord gas analysis and brain imaging (CT or MR).
- Exclusion of neonates with chromosomal or major congenital malformations.
- Retrospective review of brain imaging by a blinded neuroradiologist, comparing findings in neonates with and without metabolic acidemia and HIE.
Main Results:
- Metabolic acidemia was present in 27 of 54 neonates; 16 were diagnosed with HIE.
- Radiological signs of basal ganglia injury were significantly more frequent in neonates with metabolic acidemia (29.6% vs 3.7%) and HIE (37.5% vs 7.9%).
- Logistic regression indicated that basal ganglia injury signs identified HIE with an AUC of 0.71, sensitivity 37.5%, and specificity 92.1%.
Conclusions:
- Early neonatal brain imaging showing basal ganglia injury is associated with metabolic acidemia and HIE.
- However, these radiological signs lack the precision to serve as a gold standard for diagnosing metabolic acidemia or HIE.
- Further research may be needed to refine imaging biomarkers for these perinatal conditions.
Objective:
To determine the precision with which intrapartum metabolic acidemia and hypoxic-ischemic encephalopathy (HIE) in term and near-term infants can be identified by neonatal brain imaging.
Study Design:
This is a case-control study whose inclusion criteria were neonates born at > or =34 weeks gestation with a cord gas at delivery, suspected neurological abnormalities, and computed tomography (CT) or magnetic resonance (MR) imaging of the brain. Neonates with chromosomal and major congenital malformations were excluded. Brain imaging for neonates with and without metabolic acidemia (pH < 7.0 and base deficit > 12 mM) at birth and HIE were retrospectively reviewed by a neuroradiologist blinded to their clinical course and compared.
Results:
There were 54 neonates admitted to the NICU at a single university hospital between 1992 and 2006 that met these inclusion criteria of which 27 had metabolic acidemia at birth. There were 16 diagnosed clinically as having HIE at the time of neonatal discharge, 13 from the acidemic group and 3 from the nonacidemic group. Radiological signs of basal ganglia injury were significantly more common in neonates with metabolic acidemia (29.6%, 3.7%, p = 0.02) and HIE (37.5%, 7.9%, p = 0.01). Logistic regression corrected for gestational age showed that radiological signs of basal ganglia injury could identify the presence of HIE with area under the ROC curve of 0.71, sensitivity 37.5%, specificity 92.1%, positive predictive value 66.7%, and negative predictive value of 77.8%.
Conclusion:
Radiological signs of basal ganglia injury on early neonatal imaging are associated with metabolic acidemia and HIE, but is not precise enough to serve as a gold standard in the identification of these conditions.
