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Am J Perinatol 2024; 41(S 01): e1740-e1746
DOI: 10.1055/a-2071-3057
Original Article

Diffusion Tensor Imaging to Predict Neurodevelopmental Impairment in Infants after Hypoxic–Ischemic Injury

Christa Tabacaru 
1   Department of Neonatal-Perinatal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2   Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Adebayo Braimah
3   Department of Radiology, Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
,
Beth Kline-Fath
4   Department of Radiology, Fetal and Neonatal Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
5   Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
,
Nehal Parikh
1   Department of Neonatal-Perinatal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
6   Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio
,
Stephanie Merhar
1   Department of Neonatal-Perinatal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2   Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Abstract

Objective Magnetic resonance imaging (MRI) is the standard of care for evaluation of brain injury after hypoxic–ischemic encephalopathy (HIE) in term newborns. This study utilizes diffusion tensor imaging (DTI) to (1) identify infants at highest risk of development of cerebral palsy (CP) following HIE and to (2) identify regions of the brain critical to normal fidgety general movements (GMs) at 3 to 4 months of postterm. Absence of these normal, physiological movements is highly predictive of CP.

Study Design Term infants treated with hypothermia for HIE from January 2017 to December 2021 were consented for participation and had brain MRI with DTI after rewarming. The Prechtl's General Movements Assessment was performed at 12 to 16 weeks of age. Structural MRIs were reviewed for abnormalities, and DTI data were processed with the FMRIB Software Library. Infants underwent the Bayley Scales of Infant and Toddler Development III test at 24 months.

Results Forty-five infant families were consented; three infants died prior to MRI and were excluded, and a fourth infant was excluded due to diagnosis of a neuromuscular disorder. Twenty-one infants were excluded due to major movement artifact on diffusion images. Ultimately, 17 infants with normal fidgety GMs were compared with 3 infants with absent fidgety GMs with similar maternal and infant characteristics. Infants with absent fidgety GMs had decreased fractional anisotropy of several important white matter tracts, including the posterior limb of the internal capsule, optic radiations, and corpus callosum (p < 0.05). All three infants with absent fidgety GMs and two with normal GMs went on to be diagnosed with CP.

Conclusion This study identifies white matter tracts of the brain critical to development of normal fidgety GMs in infants at 3 to 4 months of postterm using advanced MRI techniques. These findings identify those at highest risk for CP among infants with moderate/severe HIE prior to hospital discharge.

Key Points

  • HIE has devastating impacts on families and infants.

  • Diffusion MRI identifies infants at highest risk for developing neurodevelopmental impairment.

  • Normal general movements of infancy are generated by key white matter tracts.

Keywords

cerebral palsy - neurodevelopmental impairment - General Movements Assessment - diffusion tensor imaging - hypoxic–ischemic encephalopathy - fractional anisotropy - magnetic resonance imaging - fidgety movements


Publikationsverlauf

Eingereicht: 26. August 2022

Angenommen: 04. April 2023

Accepted Manuscript online:
11. April 2023

Artikel online veröffentlicht:
11. Mai 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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