Encephalopathy as a predictor of magnetic resonance imaging abnormalities in asphyxiated newborns

• Published in: Pediatric neurology 2003-05, Vol.28 (5), p.342-346
• Main Authors: Kaufman, Seth A, Miller, Steven P, Ferriero, Donna M, Glidden, David H, Barkovich, A.James, Partridge, J.Colin
• Format: Article
• Language: English
• Subjects: asphyxia; Asphyxia Neonatorum - complications; Asphyxia Neonatorum - diagnosis; Basal Ganglia - pathology; Biological and medical sciences; Delivery. Postpartum. Lactation; Disorders; encephalopathy; Female; Gynecology. Andrology. Obstetrics; Humans; Hypoxia, Brain - complications; Hypoxia, Brain - diagnosis; Infant, Newborn; Magnetic Resonance Imaging - methods; Male; Medical sciences; MRI; neonate; Predictive Value of Tests; Prospective Studies; Statistics, Nonparametric
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/S0887-8994(03)00015-8

Basal ganglia abnormalities on magnetic resonance imaging predict neurodevelopmental impairment in newborns with perinatal depression. We determined the value of a clinical encephalopathy score as a predictor of abnormal magnetic resonance imaging results in newborns with perinatal depression. We assigned a neonatal encephalopathy score to 101 newborns. The encephalopathy score, based on alertness, feeding, tone, respiratory status, reflexes, and seizure activity, was assigned once daily. The maximum score from the first 3 days of life was compared with abnormal magnetic resonance imaging results present globally or solely in the basal ganglia. Eighty-one percent of patients manifested abnormalities on any magnetic resonance imaging sequence, and 37% manifested abnormalities in the basal ganglia alone. The encephalopathy score correlated well with magnetic resonance imaging abnormalities in the basal ganglia (Spearman Rho = 0.335, P < 0.0001). Newborns with mild and severe encephalopathy had likelihood ratios of 0.41 and 7.4, respectively, for abnormal basal ganglia magnetic resonance imaging results. Newborns with moderate encephalopathy (composing 47% of the cohort) manifested basal ganglia abnormalities with a likelihood ratio of 0.785. Severe clinical encephalopathy correlates with abnormal basal ganglia magnetic resonance imaging results, and mild encephalopathy correlates with a normal magnetic resonance imaging result. However, standard clinical criteria do not alter the prior risk of abnormal basal ganglia magnetic resonance imaging results for newborns with moderate encephalopathy.