26 - Predictive value of consensus classification of brain injury on MRI on long term neurodevelopmental outcomes in infants with Hypoxic Ischemic encephalopathy post therapeutic hypothermia.

Poster Number: 26
Publication Number: 26.559

Background: Hypoxic Ischemic Encephalopathy (HIE) is a significant cause of perinatal
encephalopathy, affecting a substantial number of neonates. Therapeutic hypothermia
(TH) has become a standard treatment, significantly reducing mortality leaving a portion
of survivors with varying degrees of neurodevelopmental impairment. Neuroimaging,
specifically magnetic resonance imaging (MRI), plays a crucial role in prognostication. A
standardized MRI scoring system to assess brain injury severity and extent is crucial for
predicting long term neurodevelopmental outcome.

Objective: This study aimed to investigate the predictive value of the Canadian Standardized
consensus classification of brain injury diagnosed with MRI on long – term
neurodevelopmental outcomes at 18 – 24 months of corrected age in infants with HIE
post therapeutic hypothermia.

Design/Methods: A Retrospective observational cohort study conducted between April 2014 and March
2020 included term and near – term neonates with moderate to severe HIE who
underwent TH and had MRI imaging to evaluate brain injury who were admitted to a
tertiary care center in Calgary, Alberta. Institutional criteria for TH eligibility were
defines. A Canadian consensus scoring system, categorizing various patterns of brain
injury, was applied to the MRI scans. Follow up at 18 – 24 months adjusted age assessed
neurodevelopmental outcomes. The data was compiled and underwent statistical analysis
using SAS software, Version 9.4. Tests used were two sided and significance define as a
p-value < 0.05.

Results: Of the 171 infants included, 5% died and 81% were assessed for neurodevelopmental
outcomes. Among surviving infants, a substantial proportion exhibited various degrees of
neurodevelopmental impairment, including severe NDI (28.8%), any NDI (56.1%),
severe cerebral palsy (3%) and uncontrolled seizure disorder (3%). Lower composite
Bayley scores were observed in 46.7% of infants. MRI scores were associated with these
outcomes, underscoring the utility of the MRI scoring system for predicting adverse
neurodevelopmental outcomes.

Conclusion(s): This study demonstrates the significant long – term consequences of moderate to severe
HIE, even after therapeutic hypothermia. The standardized Canadian consensus MRI
classification offers a valuable tool for predicting these outcomes and can guide treatment
decisions and support families. Further research and validation of these findings are
necessary to enhance care and management for infants with neonatal encephalopathy,
providing improved prognostication and potentially better ling term outcomes.