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Updated: Apr 11, 2026
Early Pathological and Magnetic Resonance Detection of Cerebral Injury Using a Rat Model of Neonatal Hypoxic Ischemic Encephalopathy
Published on: October 28, 2022
Early Anatomical Injury Patterns Predict Epilepsy in Head Cooled Neonates With Hypoxic-Ischemic Encephalopathy
Da Eun Jung1, David G Ritacco1, Douglas R Nordli1
1Department of Pediatrics, Division of Neurology & Epilepsy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; The Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Early MRI scans showing brainstem injury in infants treated for hypoxic-ischemic encephalopathy predict infantile spasms. Cortical injury alone indicates a low risk for postneonatal epilepsy, aiding prognostic decisions.
Area of Science:
- Neonatal neurology
- Neuroimaging
- Pediatric epilepsy
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Selective head cooling is a standard treatment for HIE.
- Predicting long-term neurological outcomes after HIE remains challenging.
Purpose of the Study:
- To investigate the correlation between early magnetic resonance imaging (MRI) anatomical injury patterns and the development of postneonatal epilepsy.
- To identify early predictors of neurological sequelae in infants treated with selective head cooling for HIE.
Main Methods:
- Retrospective analysis of infants (≥35 weeks gestation) treated with selective head cooling for HIE.
- Brain MRI scans obtained at days 4-5 post-birth.
- Electroencephalograms (EEGs) recorded during rewarming and at 3-6 months of age.
- Follow-up for at least one year to assess for postneonatal epilepsy and other outcomes.
Main Results:
- Of 73 infants, 18% developed postneonatal epilepsy, including 8 with infantile spasms. 16% died.
- Diffuse brain injury (cortical and subcortical gray matter) was most common (35%).
- Brainstem involvement alongside cortical/subcortical gray matter injury was associated with a high risk of infantile spasms (4/4 survivors) and mortality (9/13).
- Cortical and subcortical white matter injury (25%) predicted survival with no postneonatal epilepsy.
- Subcortical region injury (basal ganglia, thalamus ± brainstem) significantly increased the risk of postneonatal epilepsy (P < 0.003).
Conclusions:
- Early MRI findings, particularly brainstem injury, are highly predictive of infantile spasms.
- Cortical injury alone on early MRI suggests a low risk for short-term postneonatal epilepsy.
- MRI-based anatomical injury patterns can inform prognostic decisions for newborns with HIE treated with cooling.
Background:
Our aim was to determine whether early anatomical injury patterns on magnetic resonance imaging-correlate with the development of postneonatal epilepsy in infants treated with selective head cooling for hypoxic-ischemic encephalopathy.
Methods:
We retrospectively analyzed infants ≥35 weeks' gestation born between 2008 and 2013 and followed for at least one year at Northwestern University. All had brain magnetic resonance imaging scans at days 4-5 and electroencephalographs during rewarming and at 3 to 6 months of age.
Results:
Outcome was favorable for our cohort of 73 individuals with a mean follow-up of 41 (±7) months. The majority (66%) survived with no seizure recurrence, whereas 13 (18%) developed postneonatal epilepsy, including eight who had infantile spasms. Twelve infants (16%) died. The most common magnetic resonance imaging pattern was diffuse brain injury involving both cortical and subcortical gray matter (26/73, 35%), followed by cortical and subcortical white matter injury (18/73, 25%) and normal magnetic resonance imaging (16/73, 22%). In 13 infants (18%), the brainstem was involved in addition to cortical and subcortical gray matter; nine died and all four surviving infants developed infantile spasms. All 18 infants with cortical and subcortical white matter injury survived and none developed postneonatal epilepsy. The risk of postneonatal epilepsy was associated with injury involving subcortical regions (basal ganglia, thalamus ± brainstem) (12/39 versus 1/34, P < 0.003).
Conclusions:
Brainstem injury was highly predictive of infantile spasms, whereas cortical injury alone predicted low risk for short-term postneonatal epilepsy. Location of anatomical injury on magnetic resonance imaging can be an early predictive factor for development of infantile spasms and inform prognostic decisions in newborns treated with selective head cooling for hypoxic-ischemic encephalopathy.
