Encephalopathy as a predictor of magnetic resonance imaging abnormalities in asphyxiated newborns

Kaufman, Seth A; Miller, Steven P; Ferriero, Donna M; Glidden, David H; Barkovich, A.James; Partridge, J.Colin

doi:10.1016/S0887-8994(03)00015-8

« Previous Next »Pediatric Neurology
Volume 28, Issue 5 , Pages 342-346, May 2003

Encephalopathy as a predictor of magnetic resonance imaging abnormalities in asphyxiated newborns

Seth A Kaufman, MD
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
Steven P Miller, MD
- Department of Neurology, University of California at San Francisco, San Francisco, California, USA
Donna M Ferriero, MD
- Department of Neurology, University of California at San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California at San Francisco, San Francisco, California, USA
David H Glidden, PhD
- Department of Pediatrics, University of California at San Francisco, San Francisco, California, USA
A.James Barkovich, MD
- Department of Neurology, University of California at San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California at San Francisco, San Francisco, California, USA
- Department of Radiology, University of California at San Francisco, San Francisco, California, USA
J.Colin Partridge, MD, MPH
- Department of Pediatrics, University of California at San Francisco, San Francisco, California, USA
- Communications should be addressed to: Dr. Partridge; Neonatal Brain Disorders Center; University of California, San Francisco; 521 Parnassus Ave, Box 0114; San Francisco, CA 94143-0114, USA.

Received 11 June 2002; accepted 17 December 2002.

Abstract

Basal ganglia abnormalities on magnetic resonance imaging predict neurodevelopmental impairment in newborns with perinatal depression. We determined the value of a clinical encephalopathy score as a predictor of abnormal magnetic resonance imaging results in newborns with perinatal depression.

We assigned a neonatal encephalopathy score to 101 newborns. The encephalopathy score, based on alertness, feeding, tone, respiratory status, reflexes, and seizure activity, was assigned once daily. The maximum score from the first 3 days of life was compared with abnormal magnetic resonance imaging results present globally or solely in the basal ganglia.

Eighty-one percent of patients manifested abnormalities on any magnetic resonance imaging sequence, and 37% manifested abnormalities in the basal ganglia alone. The encephalopathy score correlated well with magnetic resonance imaging abnormalities in the basal ganglia (Spearman Rho = 0.335, P < 0.0001). Newborns with mild and severe encephalopathy had likelihood ratios of 0.41 and 7.4, respectively, for abnormal basal ganglia magnetic resonance imaging results. Newborns with moderate encephalopathy (composing 47% of the cohort) manifested basal ganglia abnormalities with a likelihood ratio of 0.785.

Severe clinical encephalopathy correlates with abnormal basal ganglia magnetic resonance imaging results, and mild encephalopathy correlates with a normal magnetic resonance imaging result. However, standard clinical criteria do not alter the prior risk of abnormal basal ganglia magnetic resonance imaging results for newborns with moderate encephalopathy.

Keywords: neonate, encephalopathy, MRI, asphyxia