942 Portable neonatal magnetic resonance brain imaging for the investigation of suspected hypoxic ischaemic encephalopathy: disruptive potential for high-access low-cost technology

• Published in: Archives of disease in childhood 2023-07, Vol.108 (Suppl 2), p.A170-A171
• Main Authors: Ilie, Carmen, Padormo, Francesco, Cromb, Daniel, Almalbis, Jennifer, Fuente, Miguel De la, Marenzana, Massimo, Teixera, Rui, Consortium, UNITY, Williams, Steve, Counsell, Serena, Arichi, Tomoki, Rutherford, Mary A, Hajnal, Joseph V, Edwards, David, Cawley, Paul
• Format: Article
• Language: English
• Subjects: Asphyxia; Attrition (Research Studies); Babies; Brain; Brain injury; Brain mapping; British Association of Perinatal Medicine and Neonatal Society; Clinical trials; Encephalopathy; Hypothermia; Hypoxia; Infant mortality; Infants; Injuries; Ischemia; Magnetic resonance imaging; Medical imaging; Neonates; Nervous system; Neuroimaging; Neurological complications; Newborn babies; Pathology; Pediatrics; Severe Disabilities; Traumatic brain injury; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.272

ObjectiveHypoxic ischaemic encephalopathy (HIE) is a major cause of infant mortality and severe neurodisability globally.1–4Therapeutic hypothermia (TH) reduces mortality without increasing moderate-severe disability in high-resource settings but there are many pathologies which may mimic the perinatal asphyxia syndrome – for which TH may confer no benefit or cause harm.4,5 Brain Magnetic Resonance Imaging (MRI) is the gold-standard reference for establishing neurological aetiology and prognosis. However, maintenance of TH cannot be guaranteed on transport to MRI and, post-TH, transport of infants still requiring Intensive therapies is high risk. Additionally, the absence of accessible neuroimaging can both impair start-up of TH trials within Low- and Middle-Income Countries (LMICs), as well as denying vulnerable infants in LMICs access to timely diagnoses.6 Solution to these challenges may be provided by novel low-cost high-access portable MRI systems. 6–8 However, use of these systems for the investigation of neonatal HIE is untested. We share our preliminary findings of portable MRI in a cohort of newborn infants presenting with suspected HIE.MethodsParticipants recruited from Evelina Children’s Hospital as part an NHS UK REC approved study (19/LO/1384). Paired MR brain scans were acquired using the 64mT Hyperfine Swoop® portable MR scanner and a reference Philips Achieva 3T MR scanner. Physiological monitoring and hearing protection were used. We have iteratively optimised MRI brain sequences in a total of 118 neonatal scans. Infants within this cohort who presented with clinical suspicion of HIE were eligible for inclusion in this study. Outcome was stratified by congruence of portable MRI with reference imaging for major brain pathology.Results9 portable brain MRI were performed in 8 infants with suspicion of HIE. 6 infants underwent TH, 2 infants were not eligible for TH due to prematurity. 1 infant underwent repeat paired MRI at term-equivalent age. In all cases, congruence of major MRI findings was observed between portable and 3T reference systems. Example portable imaging is provided in figure 1.ConclusionIn this preliminary series, portable brain MRI could distinguish HIE related brain injury from HIE-mimicking pathologies, as well the absence of major brain injury. This technology has global transformative potential for equitable medicine and is ready for a wide-scale research trial in multi-resource settings.ReferencesMillar LJ, Shi L, Hoerde