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Updated: Jul 22, 2026
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
Brain MRI Injury Patterns across Gestational Age among Preterm Infants with Perinatal Asphyxia
Corline E J Parmentier1, Loubna El Bakkali2, Elise A Verhagen2
1Department of Neonatology, Wilhelmina Children's Hospital Utrecht and Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Insights
Brain injury patterns in preterm infants with perinatal asphyxia (PA) vary by gestational age. Deep gray matter abnormalities on MRI are linked to poor neurodevelopmental outcomes.
Area of Science:
- Neonatal neurology
- Pediatric neuroimaging
- Perinatal medicine
Background:
- Perinatal asphyxia (PA) poses significant risks to preterm infants.
- Brain injury patterns in this population are not well-documented.
- Understanding these patterns is crucial for predicting neurodevelopmental outcomes.
Purpose of the Study:
- To investigate brain magnetic resonance imaging (MRI) findings in preterm infants experiencing PA.
- To correlate these MRI findings with neurodevelopmental outcomes.
- To analyze injury patterns based on gestational age groups.
Main Methods:
- Retrospective multicenter study of 119 preterm infants (GA 24.0-36.0 weeks) with PA.
- Early MRI (<36 weeks postmenstrual age) and MRI at term-equivalent age (TEA) were analyzed.
- Neurodevelopmental outcomes assessed at 18-24 months corrected age.
Main Results:
- Early MRI revealed predominantly hemorrhagic injury in younger preterm infants (GA <32 weeks) and white matter/watershed injury in older preterm infants (GA ≥32 weeks).
- MRI at TEA showed higher white matter scores in infants with GA 28.0-36.0 weeks.
- Deep gray matter (DGM) injury on early MRI and DGM/white matter scores at TEA were significantly associated with adverse neurodevelopmental outcomes.
Conclusions:
- Brain injury patterns following PA in preterm infants are heterogeneous and depend on gestational age.
- Deep gray matter abnormalities are particularly predictive of adverse neurodevelopmental outcomes in this cohort.
Introduction:
Brain injury patterns of preterm infants with perinatal asphyxia (PA) are underreported. We aimed to explore brain magnetic resonance imaging (MRI) findings and associated neurodevelopmental outcomes in these newborns.
Methods:
Retrospective multicenter study included infants with gestational age (GA) 24.0-36.0 weeks and PA, defined as ≥2 of the following: (1) umbilical cord pH ≤7.0, (2) 5-min Apgar score ≤5, and (3) fetal distress or systemic effects of PA. Findings were compared between GA <28.0 (group 1), 28.0-31.9 (group 2), and 32.0-36.0 weeks (group 3). Early MRI (<36 weeks postmenstrual age or <10 postnatal days) was categorized according to predominant injury pattern, and MRI around term-equivalent age (TEA, 36.0-44.0 weeks and ≥10 postnatal days) using the Kidokoro score. Adverse outcomes included death, cerebral palsy, epilepsy, severe hearing/visual impairment, or neurodevelopment <-1 SD at 18-24 months corrected age.
Results:
One hundred nineteen infants with early MRI (n = 94) and/or MRI around TEA (n = 66) were included. Early MRI showed predominantly hemorrhagic injury in groups 1 (56%) and 2 (45%), and white matter (WM)/watershed injury in group 3 (43%). Around TEA, WM scores were highest in groups 2 and 3. Deep gray matter (DGM) (aOR 15.0, 95% CI: 3.8-58.9) and hemorrhagic injury on early MRI (aOR 2.5, 95% CI: 1.3-4.6) and Kidokoro WM (aOR 1.3, 95% CI: 1.0-1.6) and DGM sub-scores (aOR 4.8, 95% CI: 1.1-21.7) around TEA were associated with adverse neurodevelopmental outcomes.
Conclusion:
The brain injury patterns following PA in preterm infants differ across GA. Particularly DGM abnormalities are associated with adverse neurodevelopmental outcomes.
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