Table 2.
Neonatal brain MRI and MRS findings and 2-year neurodevelopmental outcomes among 451 infants who received therapeutic hypothermia for HIE.
| All | No NDI | Mild NDI | Moderate NDI | Severe NDI | Death | OR (95% CI)a | aOR (95% CI)b | |
|---|---|---|---|---|---|---|---|---|
| n = 451 | n = 231 | n = 56 | n = 64 | n = 58 | n = 42 | |||
| MRI injury score, median (IQR) | 8 (2, 22) | 4 (0, 12) | 6 (0, 14.5) | 6 (2, 14.25) | 44 (15.25, 65.25) | 81 (62, 110) | 1.1 (1.1, 1.1) | 1.1 (1.1, 1.1) |
| MRI injury severity | ||||||||
| None | 93 | 61 (66) | 15 (16) | 13 (14) | 4 (4) | 0 (0) | Ref | Ref |
| Mild | 169 | 109 (64) | 23 (14) | 32 (19) | 5 (3) | 0 (0) | 1.2 (0.7, 2.2) | 1.2 (0.7, 2.2) |
| Moderate | 93 | 54 (58) | 11 (12) | 12 (13) | 15 (16) | 1 (1) | 1.5 (0.8, 2.8) | 1.4 (0.7, 2.6) |
| Severe | 96 | 7 (7) | 7 (7) | 7 (7) | 34 (35) | 41 (43) | 66.3 (28.1, 156.3) | 39.6 (16.4, 95.6) |
| MRI patterns of injury | ||||||||
| No injury | 139 | 94 (68) | 21 (15) | 20 (14) | 4 (3) | 0 (0) | Ref | Ref |
| Central gray | 167 | 60 (36) | 13 (8) | 15 (9) | 39 (23) | 40 (24) | 6.1 (3.7, 10.0) | 4.3 (2.5, 7.3) |
| Peripheral watershed | 111 | 45 (41) | 13 (12) | 14 (13) | 27 (24) | 12 (11) | 4.4 (2.6, 7.6) | 4.1 (2.3, 7.0) |
| Global | 34 | 0 (0) | 0 (0) | 0 (0) | 11 (32) | 23 (68) | NA | NA |
| Only punctate white matter lesions | 38 | 22 (58) | 7 (18) | 8 (21) | 1 (3) | 0 (0) | 2.0 (0.9, 4.6) | 2.1 (0.9, 4.9) |
| Only atypical pattern | 29 | 16 (55) | 4 (14) | 5 (17) | 3 (10) | 1 (3) | 2.1 (0.9, 5.4) | 2.1 (0.8, 5.2) |
| MRI timing of injury | n = 408 | n = 212 | n = 49 | n = 54 | n = 52 | n = 41 | ||
| No injury | 125 | 87 (70) | 17 (14) | 17 (14) | 4 (3) | 0 (0) | Ref | Ref |
| Acute only | 93 | 32 (34) | 8 (9) | 8 (9) | 18 (19) | 27 (29) | 8.6 (4.6, 16.0) | 6.7 (3.5, 12.7) |
| Subacute only | 91 | 53 (58) | 10 (11) | 17 (19) | 10 (11) | 1 (1) | 1.9 (1.0, 3.5) | 1.9 (1.0, 3.6) |
| Acute + Subacute | 90 | 36 (40) | 12 (13) | 10 (11) | 19 (21) | 13 (14) | 5.2 (2.8, 9.7) | 4.0 (2.1, 7.7) |
| Chronic (±acute/sub) | 9 | 4 (44) | 2 (22) | 2 (22) | 1 (11) | 0 (0) | 4.0 (0.9, 18.5) | 3.8 (0.8, 17.7) |
| MRS thalamus, median (IQR) | n = 342 | n = 174 | n = 42 | n = 49 | n = 46 | n = 31 | ||
| Lactate/NAA | 0.07 (0.88, 0.16) | 0.06 (0, 0.11) | 0.07 (0.00, 0.13) | 0.03 (0.00, 0.12) | 0.20 (0.05, 0.45) | 1.32 (0.52, 3.67) | 1.7 (1.5, 1.9)c | 1.6 (1.4, 1.8)c |
| NAA/Creatine | 0.78 (0.69, 0.85) | 0.81 (0.75, 0.89) | 0.79 (0.69, 0.83) | 0.79 (0.69, 0.83) | 0.65 (0.60, 0.75) | 0.62 (0.58, 0.68) | 0.7 (0.7, 0.8)c | 0.8 (0.7, 0.8)c |
| MRS white matter, median (IQR) | n = 325 | n = 160 | n = 42 | n = 47 | n = 45 | n = 31 | ||
| Lactate/NAA | 0.08 (0.00, 0.31) | 0.04 (0.00, 0.22) | 0.02 (0.00, 0.27) | 0.03 (0.00, 0.20) | 0.17 (0.00, 0.98) | 0.89 (0.31, 2.86) | 1.5 (1.3, 1.7)c | 1.4 (1.2, 1.6)c |
| NAA/Creatine | 0.78 (0.71, 0.89) | 0.82 (0.75, 0.93) | 0.79 (0.73, 0.86) | 0.77 (0.69, 0.85) | 0.74 (0.65, 0.80) | 0.68 (0.58, 0.81) | 0.8 (0.8, 0.9)c | 0.8 (0.8, 0.9)c |
NA not able to compute.
n (row percent) shown unless otherwise noted.
aAdjusted for treatment assignment and site. Note that treatment assignment was not associated with death or NDI in the main study analyses, as previously described.20
bAdjusted for treatment assignment, site, and severity of encephalopathy.
cIn these models, spectroscopy scores were standardized to percentile; odds ratios are provided for a 10% increase in percentile.