Resident Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, Pennsylvania, United States
Background: Hypoxic ischemic encephalopathy (HIE) is a common diagnosis in neonates. Therapeutic hypothermia (TH) is the current treatment in order to mitigate inflammation. Even after TH however, 30-50% of infants with moderate to severe HIE have moderate to severe neurodevelopmental impairments at 2 years of age. It remains crucial to identify these infants early in their course to ensure they receive necessary interventions. One method of prediction which has shown promise is magnetic resonance imaging (MRI) findings. Objective: The goal of this study is to examine the predictive value of a severity scoring system of brain MRI after therapeutic hypothermia for the neurodevelopmental outcomes of neonates with moderate to severe HIE. Design/Methods: This is a retrospective chart review that has been approved by the institution’s IRB. We will be reviewing the charts of neonates (gestational age >35 weeks) born from December 2006-December 2022 who were diagnosed with HIE, received therapeutic cooling and had an MRI completed. The severity of the MRI will be categorized into normal (score of 0), moderately abnormal (score of 1-2), severely abnormal (score of 3-4) and assigned by a blinded neuroradiologist using the basal ganglia/watershed (BG/W) scoring system. We defined a composite primary outcome as death or severe disability, which is defined as having a composite Bayley Scales of Infant and Toddler Development or BSID score < 70 in any of the three domains: cognitive, language, and motor between the ages of 12-24 months. Moderate neurodevelopmental disability was defined as a composite BSID score < 85 in any of the three domains. Categorical outcomes will be analyzed with chi-squared analysis and continuous variables will be assessed using ANOVA (with Dunn’s post-hoc analysis). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal MRI for predicting outcomes will be calculated. Chart review has almost been completed, approximately 110 infants met the inclusion criteria and data analysis is planned to be completed in early 2024.
