Eur J Pediatr. 2025 Nov 14;184(12):755. doi: 10.1007/s00431-025-06549-z.
ABSTRACT
Establishing an accurate prognosis for newborns with hypoxic-ischaemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) remains a challenge. The effect of intra-axial haemorrhage (IAH) detected on early brain magnetic resonance imaging (MRI) is poorly explored. The objectives were to assess the impact of IAH and MRI results on neurodevelopment at 18-36 months of age. Observational study of newborns with HIE admitted to a tertiary paediatric intensive care unit submitted to TH. MRI results were classified using the Weeke score, and the presence of IAH was recorded. The outcomes at 18-36 months were classified as favourable (normal outcome or mild-moderate deficit) or unfavourable (severe deficit or death). Sixty-four newborns were included with a median gestational age of 39 weeks (IQR 38-40) and a mean birth weight of 3208 ± 460 g. On MRI, 10 had IAH, and the median total Weeke score was 4 (IQR 1-19). Regarding the outcome, 40 were favourable, of which 13 (20.3%) had mild-moderate deficits; 24 were unfavourable, of which 12 (18.8%) had severe deficits. Of the newborns with unfavourable outcomes, 5 (20.8%) had IAH versus 19 (79.2%) without IAH (p = 0.392). The total MRI score obtained an AUC of 0.948 (p < 0.001) to predict an unfavourable outcome but an AUC of 0.670 (p = 0.086) to distinguish a mild-moderate deficit from a normal outcome.
CONCLUSION: It appears that IAH does not influence the outcome at 18-36 months. Despite being an excellent predictor of unfavourable prognosis, MRI has an inferior performance distinguishing between mild-moderate deficit and normal outcome.
WHAT IS KNOWN: • Accurately determining the prognosis in newborns undergoing TH for HIE remains one of the most challenging tasks for neonatologists, particularly in mild to moderate cases. • The impact of IAH superimposed on HIE on the neurodevelopmental outcome is not clarified.
WHAT IS NEW: • The prognosis of HIE at 18-36 months was not influenced by IAH. • Despite its accuracy in predicting death or severe disability, brain MRI has a reduced capacity to distinguish normal outcomes from mild to moderate deficits.
PMID:41236550 | DOI:10.1007/s00431-025-06549-z
