Brain MRI T2 hyperintensity and neurodevelopmental outcomes in neonatal encephalopathy

The objective of this study was to examine the association between early brain MRI T2 hyperintensity and neurodevelopmental outcomes in term infants with neonatal encephalopathy.

A prospective cohort of neonates born ≥ 36 weeks postmenstrual age with neonatal encephalopathy underwent brain MRI in the early postnatal period. Scans were graded for T2 hyperintensity using Kidokoro scoring, and diffusion restriction using Barkovich scoring. The association between T2 hyperintensity (diffuse, mamillary body, pons) and Bayley-III cognitive, language, and motor composite scores at 3 years was examined using multivariable linear regression modeling.

The cohort included 102 term infants (63% males), with brain MRI at a median of 4 days of age (IQR: 1). T2 hyperintensity was present in 76% diffusely, 28% in the mamillary bodies, and 17% in the pons. Diffuse T2 hyperintensity score and mamillary body T2 hyperintensity were not associated with cognitive, language, and motor outcomes at 3 years of age when controlling for diffusion restriction.

T2 hyperintensity is a common neuroimaging finding on early brain MRI in neonatal encephalopathy. Diffuse, mamillary body, and pontine T2 hyperintensity were not associated with early neurodevelopmental outcomes and can help guide neuroprognostication in this population.

T2 hyperintensity on early brain MRI is a common finding in neonatal encephalopathy, however, it is not associated with neurodevelopmental outcomes at 3 years. These results can help with neuroprognostication in the neonatal intensive care unit. T2 hyperintensity in neonatal encephalopathy on early brain MRI is unlikely to influence future cognitive, language, and motor outcomes.