Abstract:
Background and aims: Perinatal asphyxia and neonatal encephalopathy remain leading causes for mortality and morbidity, urging markers of neurodevelopmental outcome in hypothermia-treated (HT) newborns. This study evaluated whether established clinical parameters and neuroimaging within two weeks after birth predict the neurodevelopmental outcome in HT newborns.
Methods: Observational retrospective study of HT newborns from three neonatal centers in 2012-2017 in Munich, highest level of care. The relationship between Apgar-score, umbilical cord blood pH, cranial ultrasound (cUS) or magnetic resonance imaging (cMRI) with the outcome was assessed using Fisher's exact test. Subgroups were compared using Mann-Whitney U-Test.
Results: Outcome data from 3 to 24 months were available in 40/56 HT newborns (mean gestational age: 39,4 weeks; in n= 21 clinical assessments, in n= 15 Münchener Funktionelle Entwicklungsdiagnostik, in n= 4 Bayley tests). Neither the 10 min Apgar-score ≤ 5 (n = 26/52) nor the umbilical cord pH < 7,0 (n = 21/56) correlated with asphyxia-related abnormalities in the neuroimaging or clinical outcome. The 1 min Apgar-Score tended to be lower in HT newborns with unfavorable outcome (p = 0.08; mean 1.3 ± 2.8 versus 2.0 ± 2.3). In HT newborns with unfavorable outcome, the rates of severe pathological findings in cUS (p = 0.04, n = 3 vs. 0 patients) and cMRI (p = 0.007, n = 3 vs. 0 patients) were significantly higher. Brainstem, cerebellum, basal ganglia, and thalamus were affected more often in HT newborns with unfavorable outcome (p = 0,03).
Conclusion: cUS and cMRI can predict unfavorable outcome in HT newborns instead of APGAR score or umbilical cord pH. Prospectives studies with standardized long-term follow-up are required to improve the prognostic value of specific lesions in neuroimaging.
