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Published on: January 7, 2021
Correlation between fetal heart rate evolution patterns and magnetic resonance imaging findings in severe cerebral
Masahiro Nakao1,2,3, Yukiko Nanba1,4, Asumi Okumura1,2
1The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.
Insights
Basal ganglia-thalamus injury is the most common brain damage in infants with severe cerebral palsy (CP), occurring even in prenatal cases. Hypoxic-ischaemic insult significantly impacts CP development antenatally.
Area of Science:
- Neuroscience
- Pediatrics
- Obstetrics
Background:
- Cerebral palsy (CP) is a significant cause of long-term disability in children.
- Understanding the timing and type of brain injury is crucial for CP prevention and management.
- Hypoxic-ischaemic insult is a known contributor to CP, but its precise relationship with injury patterns requires further investigation.
Purpose of the Study:
- To investigate the association between the timing of hypoxic-ischaemic insult and the type of brain injury in infants with severe CP.
- To analyze the predominant brain injury patterns in relation to fetal heart rate (FHR) evolution and potential antenatal factors.
Main Methods:
- A longitudinal study analyzed data from infants with severe CP born at or after 34 weeks gestation.
- Intrapartum FHR strips were categorized (e.g., bradycardia, non-reassuring, reassuring).
- Brain MRI scans were classified by predominant injury site: basal ganglia-thalamus (BGT), white matter (WM), watershed (WS), or stroke.
Main Results:
- Basal ganglia-thalamus (BGT) dominant injury was observed in 76% of infants with severe CP.
- Placental abruption increased the risk of BGT injury (aOR 8.02), while small-for-gestational age decreased it (aOR 0.38).
- BGT injury was prevalent across most FHR patterns, including those with reassuring patterns, and was common even in antenatal-onset cases.
Conclusions:
- Basal ganglia-thalamus injury is the predominant brain damage in severe CP, even in antenatal-onset cases.
- Hypoxic-ischaemic insult plays a significant role in CP development during the antenatal period.
- These findings highlight the importance of antenatal factors in the pathogenesis of CP.
Objective:
To investigate the association between hypoxic-ischaemic insult timing and brain injury type in infants with severe cerebral palsy (CP).
Design:
Longitudinal study.
Setting:
Database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy.
Sample:
Infants with severe CP born at ≥34 weeks of gestation.
Methods:
The intrapartum fetal heart rate (FHR) strips were categorised as continuous bradycardia; persistently non-reassuring (NR-NR); reassuring-prolonged deceleration (R-PD); Hon's pattern (R-Hon); persistently reassuring (R-R); and unclassified. The brain magnetic resonance imaging (MRI) scans were categorised based on the predominant site involved: basal ganglia-thalamus (BGT); white matter (WM); watershed (WS); stroke; normal; and unclassified.
Main Outcome Measures:
Manifestations of the brain MRI types and the association between FHR evolution pattern and MRI type were analysed.
Results:
Among 672 eligible infants, 76% had BGT-dominant injury, 5.4% WM, 1.2% WS, 1.6% stroke, 1.9% normal, and 14% unclassified. Placental abruption and small-for-gestational age were associated with an increased (adjusted odds ratio [aOR] 8.02) and decreased (aOR 0.38) risk of BGT injury, respectively. The majority of infants had BGT injury in most FHR groups (bradycardia, 97%; NR-NR, 75%; R-PD, 90%; R-Hon, 76%; and R-R, 45%). The risk profiles in case of BGT in the NR-NR group were similar to those in the R-PD and R-Hon groups.
Conclusion:
BGT-dominant brain damage accounted for three-fourths of the cases of CP in term or near-term infants, even in prenatal onset cases. Hypoxic-ischaemic insult has a major impact on CP development during the antenatal period.
Tweetable Abstract:
Basal ganglia-thalamus injury constitutes 76% of severe cerebral palsy cases, predominant even in antenatal-onset cases.
