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  • Clinical Research Article
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Insights from serial magnetic resonance imaging in neonatal encephalopathy in term infants

Pediatric Research (2024)Cite this article

Abstract

Background

Limited serial neuroimaging studies use magnetic resonance imaging (MRI) to define the evolution of hypoxic-ischemic insults to the brain of term infants and encompass both the primary injury and its secondary impact on cerebral development. The optimal timing of MRI to fully evaluate the impact of hypoxic-ischemic encephalopathy on brain development and associated neurodevelopmental sequelae remains unknown.

Methods

Goals: (a) review literature related to serial neuroimaging in term infants with HIE; (b) describe pilot data in two infants with HIE treated with therapeutic hypothermia who had a brain injury at day 3–5 and underwent four additional MRIs over the next 12 weeks of life and developmental evaluation at 24 months of age.

Results

Early MRI defines primary injury on diffusion-weighted imaging, yet the full impact may not be fully apparent until after 1 month of life.

Conclusion

The full impact of an ischemic injury on the neonatal brain may not be fully visible until several weeks after the initial insult. This suggests the benefit of obtaining later time points for MRI to fully define the extent of injury and its neurodevelopmental impact.

Impact

  • Few studies inform the nature of the evolution of brain injury with hypothermia in HIE, limiting understanding of potential neuroprotection.

  • MRI is the standard of care for prognosis in infants with HIE, however timing for optimal prognostic prediction remains unclear.

  • Insights from MRI after the first week of life may assist in defining the full extent of brain injury and prognostic significance.

  • A pilot study using five MRI timepoints up to 3 months of age, is presented.

  • More data is required with a systematic evaluation of the impact of early brain injury on brain development in term infants with HIE following TH.

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Fig. 1: An overview.
Fig. 2: Case Study 1 Serial MRI Scans.
Fig. 3: Case Study 2 Serial MRI Scans.

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Data availability

Deidentified imaging data can be shared upon request to the principal investigator. It is not publicly available due to protected health information.

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Acknowledgements

We thank all the families who provided consent for their infants to participate in our research MRI studies. We also thank all our research nurses, Tina Steele, Deborah Cuddyer, and Yvonne Sheldon, and the staff who helped obtain the research scans as well as Dr. Gomez and Dr. Markowitz who administered the BSID-IV assessments. Lastly, we would like to thank the Charles Hood Foundation for funding this research.

Funding

This research study was funded by a grant from the Charles Hood Foundation.

Author information

Author notes

  1. These authors contributed equally: Emily Sotelo, Danielle Sharon.

Authors and Affiliations

  1. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Emily Sotelo, Danielle Sharon & Elizabeth Singh

  2. Department of Radiology, Boston Children’s Hospital, Boston, MA, USA

    Borjan Gagoski & P. Ellen Grant

  3. Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA

    P. Ellen Grant

  4. Harvard Medical School, Boston, MA, USA

    P. Ellen Grant

  5. Division of Neonatology, Children’s Hospital of Orange County and University of California, Irvine, CA, USA

    Terrie E. Inder

Authors
  1. Emily Sotelo
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  4. P. Ellen Grant
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Contributions

E.A.S. participated in research data acquisition. E.S., E.A.S., and D.S. reviewed the literature, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. B.G. assisted in the MRI sequence information, and reviewed and revised the manuscript. PEG performed MRI reads for research studies, reviewed and revised the manuscript, and T.E.I. conceptualized and designed the studies with the acquisition of funding, helped draft the initial manuscript, and reviewed and revised the manuscript.

Corresponding author

Correspondence to Terrie E. Inder.

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Competing interests

Dr. Inder and Dr. Grant are both scientific advisors for Aspect Imaging.

Consent statement

IRB approved the study, and patients consented.

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Sotelo, E., Sharon, D., Gagoski, B. et al. Insights from serial magnetic resonance imaging in neonatal encephalopathy in term infants. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03258-5

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