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Published on: November 20, 2015
Risk Factors and Outcomes for Cerebral Palsy With Hypoxic-Ischemic Brain Injury Patterns Without Documented Neonatal
Olivier Fortin1, Nafisa Husein1, Maryam Oskoui1
1From the Prenatal Pediatric Institute (O.F.), Children's National Hospital, Washington, DC; Departments of Pediatrics and Neurology/Neurosurgery (O.F., M.O., M.I.S.), McGill University; Research Institute-McGill University Health Centre (N.H., M.O., M.I.S.), Montreal, Quebec; Departments of Pediatrics and Clinical Neurosciences (A.K.); Alberta Children's Hospital Research Institute (A.K., M.D.); and Departments of Pediatrics and Community Health Sciences (M.D.), University of Calgary, Alberta.
Approximately 17% of term-born infants with cerebral palsy and MRI evidence of hypoxic-ischemic injury (HII) lack neonatal encephalopathy (NE). This suggests antenatal HII may occur without obvious signs of NE, emphasizing the importance of MRI for diagnosis.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Perinatal hypoxic-ischemic brain injury (HII) is a primary cause of term-born cerebral palsy (CP).
- Diagnosis typically relies on neonatal encephalopathy (NE) and neuroimaging, but some children present later without NE.
- This study investigates the prevalence of CP with HII but without NE in term-born infants.
Purpose of the Study:
- To determine the prevalence of term-born children with CP and MRI-confirmed HII but without documented NE.
- To identify clinical and fetal characteristics associated with HII in the absence of NE.
- To compare outcomes between children with and without NE.
Main Methods:
- Retrospective analysis of 170 children from the Canadian Cerebral Palsy Registry with HII on MRI (>36 weeks gestation).
- Exclusion of postnatal causes for HII; documentation of NE was noted.
- Comparison of maternal-fetal factors, neonatal course, and outcomes using statistical tests and propensity scores.
Main Results:
- 17.0% (29/170) of children with HII on MRI lacked documented NE.
- The NE-absent group showed more amniotic fluid abnormalities, fetal growth restriction, less resuscitation, higher Apgar scores, and fewer neonatal seizures.
- MRI timing differed significantly; hemiplegia was more common in the NE-absent group, but ambulatory function rates were similar.
Conclusions:
- A significant proportion of term-born children with CP and HII on MRI do not have documented NE.
- Absence of NE may be associated with antenatal factors and a less complex neonatal course.
- MRI is crucial for diagnosing HII, even without clinical signs of NE, as outcomes can be comparable.
