Seetha Shankaran1, Scott A McDonald2, Abbot R Laptook3, Susan R Hintz4, Patrick D Barnes5, Abhik Das2, Athina Pappas6, Rosemary D Higgins5. 1. Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI. Electronic address: sshankar@med.wayne.edu. 2. Biostatistics and Epidemiology Division, Research Triangle Institute, International, Research Triangle Park, NC. 3. Department of Pediatrics, Women and Infant's Hospital, Brown University, Providence, RI. 4. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 5. Department of Radiology, Stanford University School of Medicine, Palo Alto, CA. 6. Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
Abstract
OBJECTIVE: To examine the ability of magnetic resonance imaging (MRI) patterns of neonatal brain injury defined by the National Institute of Child Health and Human Development Neonatal Research Network to predict death or IQ at 6-7 years of age following hypothermia for neonatal encephalopathy. STUDY DESIGN: Out of 208 participants, 124 had MRI and primary outcome (death or IQ <70) data. The relationship between injury pattern and outcome was assessed. RESULTS:Death or IQ <70 occurred in 4 of 50 (8%) of children with pattern 0 (normal MRI), 1 of 6 (17%) with 1A (minimal cerebral lesions), 1 of 4 (25%) with 1B (extensive cerebral lesions), 3 of 8 (38%) with 2A (basal ganglia thalamic, anterior or posterior limb of internal capsule, or watershed infarction), 32 of 49 (65%) with 2B (2A with cerebral lesions), and 7 of 7 (100%) with pattern 3 (hemispheric devastation), P < .001; this association was also seen within hypothermia and control subgroups. IQ was 90 ± 13 among the 46 children with a normal MRI and 69 ± 25 among the 50 children with an abnormal MRI. In childhood, for a normal outcome, a normal neonatal MRI had a sensitivity of 61%, specificity of 92%, a positive predictive value of 92%, and a negative predictive value of 59%; for death or IQ <70, the 2B and 3 pattern combined had a sensitivity of 81%, specificity of 78%, positive predictive value of 70%, and a negative predictive value of 87%. CONCLUSIONS: The Neonatal Research Network MRI pattern of neonatal brain injury is a biomarker of neurodevelopmental outcome at 6-7 years of age. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00005772.
RCT Entities:
OBJECTIVE: To examine the ability of magnetic resonance imaging (MRI) patterns of neonatal brain injury defined by the National Institute of Child Health and Human Development Neonatal Research Network to predict death or IQ at 6-7 years of age following hypothermia for neonatal encephalopathy. STUDY DESIGN: Out of 208 participants, 124 had MRI and primary outcome (death or IQ <70) data. The relationship between injury pattern and outcome was assessed. RESULTS:Death or IQ <70 occurred in 4 of 50 (8%) of children with pattern 0 (normal MRI), 1 of 6 (17%) with 1A (minimal cerebral lesions), 1 of 4 (25%) with 1B (extensive cerebral lesions), 3 of 8 (38%) with 2A (basal ganglia thalamic, anterior or posterior limb of internal capsule, or watershed infarction), 32 of 49 (65%) with 2B (2A with cerebral lesions), and 7 of 7 (100%) with pattern 3 (hemispheric devastation), P < .001; this association was also seen within hypothermia and control subgroups. IQ was 90 ± 13 among the 46 children with a normal MRI and 69 ± 25 among the 50 children with an abnormal MRI. In childhood, for a normal outcome, a normal neonatal MRI had a sensitivity of 61%, specificity of 92%, a positive predictive value of 92%, and a negative predictive value of 59%; for death or IQ <70, the 2B and 3 pattern combined had a sensitivity of 81%, specificity of 78%, positive predictive value of 70%, and a negative predictive value of 87%. CONCLUSIONS: The Neonatal Research Network MRI pattern of neonatal brain injury is a biomarker of neurodevelopmental outcome at 6-7 years of age. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00005772.
Authors: Seetha Shankaran; Athina Pappas; Scott A McDonald; Betty R Vohr; Susan R Hintz; Kimberly Yolton; Kathryn E Gustafson; Theresa M Leach; Charles Green; Rebecca Bara; Carolyn M Petrie Huitema; Richard A Ehrenkranz; Jon E Tyson; Abhik Das; Jane Hammond; Myriam Peralta-Carcelen; Patricia W Evans; Roy J Heyne; Deanne E Wilson-Costello; Yvonne E Vaucher; Charles R Bauer; Anna M Dusick; Ira Adams-Chapman; Ricki F Goldstein; Ronnie Guillet; Lu-Ann Papile; Rosemary D Higgins Journal: N Engl J Med Date: 2012-05-31 Impact factor: 91.245
Authors: Susan E Jacobs; Colin J Morley; Terrie E Inder; Michael J Stewart; Katherine R Smith; Patrick J McNamara; Ian M R Wright; Haresh M Kirpalani; Brian A Darlow; Lex W Doyle Journal: Arch Pediatr Adolesc Med Date: 2011-04-04
Authors: Jeanie L Y Cheong; Lee Coleman; Rod W Hunt; Katherine J Lee; Lex W Doyle; Terrie E Inder; Susan E Jacobs Journal: Arch Pediatr Adolesc Med Date: 2012-07-01
Authors: Seetha Shankaran; Patrick D Barnes; Susan R Hintz; Abbott R Laptook; Kristin M Zaterka-Baxter; Scott A McDonald; Richard A Ehrenkranz; Michele C Walsh; Jon E Tyson; Edward F Donovan; Ronald N Goldberg; Rebecca Bara; Abhik Das; Neil N Finer; Pablo J Sanchez; Brenda B Poindexter; Krisa P Van Meurs; Waldemar A Carlo; Barbara J Stoll; Shahnaz Duara; Ronnie Guillet; Rosemary D Higgins Journal: Arch Dis Child Fetal Neonatal Ed Date: 2012-11 Impact factor: 5.747
Authors: Miriam Martinez-Biarge; Tina Bregant; Courtney J Wusthoff; Andrew T M Chew; Jesus Diez-Sebastian; Mary A Rutherford; Frances M Cowan Journal: J Pediatr Date: 2012-06-07 Impact factor: 4.406
Authors: Denis Azzopardi; Brenda Strohm; Neil Marlow; Peter Brocklehurst; Aniko Deierl; Oya Eddama; Julia Goodwin; Henry L Halliday; Edmund Juszczak; Olga Kapellou; Malcolm Levene; Louise Linsell; Omar Omar; Marianne Thoresen; Nora Tusor; Andrew Whitelaw; A David Edwards Journal: N Engl J Med Date: 2014-07-10 Impact factor: 91.245
Authors: C Prempunpong; L F Chalak; J Garfinkle; B Shah; V Kalra; N Rollins; R Boyle; K-A Nguyen; I Mir; A Pappas; P Montaldo; S Thayyil; P J Sánchez; S Shankaran; A R Laptook; G Sant'Anna Journal: J Perinatol Date: 2017-11-02 Impact factor: 2.521
Authors: Eric M Chin; Srishti Jayakumar; Ezequiel Ramos; Gwendolyn Gerner; Bruno P Soares; Elizabeth Cristofalo; Mary Leppert; Marilee Allen; Charla Parkinson; Michael Johnston; Frances Northington; Vera Joanna Burton Journal: Dev Neurosci Date: 2019-06-05 Impact factor: 2.984
Authors: Seetha Shankaran; Abbot R Laptook; Scott A McDonald; Susan R Hintz; Patrick D Barnes; Abhik Das; Rosemary D Higgins Journal: J Pediatr Date: 2016-10-21 Impact factor: 4.406
Authors: Stephanie L Merhar; Elveda Gozdas; Jean A Tkach; Nehal A Parikh; Beth M Kline-Fath; Lili He; Weihong Yuan; Mekibib Altaye; James L Leach; Scott K Holland Journal: Am J Perinatol Date: 2019-03-27 Impact factor: 1.862