MRI-Based Assessment of Brain Injury in Neonates With Hypoxic–Ischemic Encephalopathy Treated With Therapeutic Hypothermia: An Observational Study

Arjun Kumar Morishetty, Rabindran Chandran, Umamaheswari Balakrishnan, Prakash Amboiram, Prabha Sudalaimani, Rajeswaran Rangasami

Abstract

Background: Hypoxic–ischemic encephalopathy (HIE) is a leading cause of neonatal morbidity and mortality. Neuroimaging plays a critical role in assessing brain injury and predicting outcomes. However, data from low- and middle-income countries remain limited.

Aims: Our primary objective was to describe the spectrum and severity of MRI abnormalities in neonates with moderate-to-severe HIE treated with therapeutic hypothermia (TH). The secondary objective was to correlate MRI findings with clinical parameters and long-term neurodevelopmental outcomes.

Materials and Methods: This retrospective study included neonates born at ≥ 36 weeks’ gestation and with a birth weight ≥ 1.8 kg, treated with TH for HIE at a tertiary care center. MRI was performed between days 5 and 7 of life and was analyzed using the Trivedi MRI Scoring System. Neurodevelopmental outcomes were assessed at 18 to 22 months using the Developmental Assessment Scale for Indian Infants-II or the Bayley Scale of Infant and Toddler Development-III.

Results: Of the 65 neonates, 71% had abnormal MRI findings on diffusion-weighted imaging (DWI). Cortical involvement was the most common (44%), followed by white matter and basal ganglia–thalamus (24% each), and posterior limb of internal capsule (15%). MRI abnormalities were significantly associated with clinical seizures (P = .021). Among 23 infants who came for neurodevelopmental follow-up, 60% of those with abnormal MRIs showed developmental delays.

Conclusion: DWI-enhanced MRI detected brain injuries in 70% of asphyxiated neonates undergoing cooling, with cortical regions being the most affected. Clinical seizures were significantly associated with MRI-detected injuries. Regular follow-up is advised for all neonates, as delay occurs even in those with normal MRI findings.