Brain Injury in Infants Evaluated for, But Not Treated with, Therapeutic Hypothermia.

Defining neonatal encephalopathy clinically to qualify for therapeutic hypothermia is challenging. This study examines magnetic resonance imaging outcomes of 39 infants who were evaluated and not cooled using criteria inclusive of mild encephalopathy. Infants evaluated for therapeutic hypothermia are at risk for brain injury and may benefit from neuroimaging and follow-up.

Clinical experience with an in-NICU magnetic resonance imaging system.

OBJECTIVE: To evaluate the utility of the 1 Tesla (1 T) Embrace (Aspect Imaging) neonatal magnetic resonance imaging (MRI) scanner in a level III NICU. STUDY DESIGN: Embrace brain MRI findings for 207 infants were reviewed, including 32 scans directly compared within 5 days with imaging on a 3 T Siemens Trio. Clinical MRI scan abnormalities were also compared to cranial ultrasound findings. RESULT: Of the 207 Embrace brain MRIs, 146 (70.5%) were obtained for clinical indications and 61 (29.5%) were research cases. Abnormal findings were found in 80 scans, most commonly hemorrhage and white matter injury. Notable findings included a stroke, medullary brainstem tumor, and polymicrogyria. In the 1 T versus 3 T comparison cohort, results were discordant in only one infant with punctate foci of susceptibility noted only on the 3 T scan. CONCLUSION: The Embrace MRI scans detected clinically relevant brain abnormalities and in a subset were clinically comparable to 3 T scans.

Value of cranial ultrasound at initiation of therapeutic hypothermia for neonatal encephalopathy.

OBJECTIVE: There is variation in the clinical practice for the use of cranial ultrasound (cUS) at the time of initiation of therapeutic hypothermia (TH) for neonatal encephalopathy. The role of cUS in selecting patients who may benefit from TH or excluding those where TH may impose risk is unknown. STUDY DESIGN: A retrospective study was conducted on infants who received TH at a single tertiary center. Findings from cUS at initiation of TH were compared to findings from MRI following the completion of TH. RESULTS: One hundred and eight infants were studied. Of the 55 with abnormalities on early cUS, 50 did not have corresponding MRI abnormalities. In contrast, 16 infants had some degree of intracranial hemorrhage detected on their MRI that was not noted on earlier cUS. CONCLUSIONS: This study challenges whether cUS is an essential universal screening tool prior to the commencement of TH.