Establishing an accurate prognosis for newborns with hypoxic-ischaemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) remains a challenge. The effect of intra-axial haemorrhage (IAH) detected on early brain magnetic resonance imaging (MRI) is poorly explored. The objectives were to assess the impact of IAH and MRI results on neurodevelopment at 18–36 months of age. Observational study of newborns with HIE admitted to a tertiary paediatric intensive care unit submitted to TH. MRI results were classified using the Weeke score, and the presence of IAH was recorded. The outcomes at 18–36 months were classified as favourable (normal outcome or mild-moderate deficit) or unfavourable (severe deficit or death). Sixty-four newborns were included with a median gestational age of 39 weeks (IQR 38–40) and a mean birth weight of 3208 ± 460 g. On MRI, 10 had IAH, and the median total Weeke score was 4 (IQR 1–19). Regarding the outcome, 40 were favourable, of which 13 (20.3%) had mild-moderate deficits; 24 were unfavourable, of which 12 (18.8%) had severe deficits. Of the newborns with unfavourable outcomes, 5 (20.8%) had IAH versus 19 (79.2%) without IAH (p = 0.392). The total MRI score obtained an AUC of 0.948 (p < 0.001) to predict an unfavourable outcome but an AUC of 0.670 (p = 0.086) to distinguish a mild-moderate deficit from a normal outcome.Conclusion: It appears that IAH does not influence the outcome at 18–36 months. Despite being an excellent predictor of unfavourable prognosis, MRI has an inferior performance distinguishing between mild-moderate deficit and normal outcome. <Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is Known: • Accurately determining the prognosis in newborns undergoing TH for HIE remains one of the most challenging tasks for neonatologists, particularly in mild to moderate cases. • The impact of IAH superimposed on HIE on the neurodevelopmental outcome is not clarified. </entry> </row> <row> <entry align="left" colname="c1"> What is New: • The prognosis of HIE at 18–36 months was not influenced by IAH. • Despite its accuracy in predicting death or severe disability, brain MRI has a reduced capacity to distinguish normal outcomes from mild to moderate deficits. </entry> </row> </tbody> </tgroup> </Table>

Neonatal hypoxic-ischaemic encephalopathy and therapeutic hypothermia: prognostic value of intra-axial haemorrhage

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发表日期：

2025年11月14日

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Rita Castanheira Rodrigues,
Inês Gameiro,
Ana Carolina Chaves,
Joana Pinto,
Cristina Pereira,
Carla Marques,
Inês Nunes Vicente,
Rita Moinho,
Leonor Carvalho,
Alexandra Dinis,
Carla Regina Pinto

摘要

Establishing an accurate prognosis for newborns with hypoxic-ischaemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) remains a challenge. The effect of intra-axial haemorrhage (IAH) detected on early brain magnetic resonance imaging (MRI) is poorly explored. The objectives were to assess the impact of IAH and MRI results on neurodevelopment at 18–36 months of age. Observational study of newborns with HIE admitted to a tertiary paediatric intensive care unit submitted to TH. MRI results were classified using the Weeke score, and the presence of IAH was recorded. The outcomes at 18–36 months were classified as favourable (normal outcome or mild-moderate deficit) or unfavourable (severe deficit or death). Sixty-four newborns were included with a median gestational age of 39 weeks (IQR 38–40) and a mean birth weight of 3208 ± 460 g. On MRI, 10 had IAH, and the median total Weeke score was 4 (IQR 1–19). Regarding the outcome, 40 were favourable, of which 13 (20.3%) had mild-moderate deficits; 24 were unfavourable, of which 12 (18.8%) had severe deficits. Of the newborns with unfavourable outcomes, 5 (20.8%) had IAH versus 19 (79.2%) without IAH (p = 0.392). The total MRI score obtained an AUC of 0.948 (p < 0.001) to predict an unfavourable outcome but an AUC of 0.670 (p = 0.086) to distinguish a mild-moderate deficit from a normal outcome.

Conclusion: It appears that IAH does not influence the outcome at 18–36 months. Despite being an excellent predictor of unfavourable prognosis, MRI has an inferior performance distinguishing between mild-moderate deficit and normal outcome.

What is Known:

• Accurately determining the prognosis in newborns undergoing TH for HIE remains one of the most challenging tasks for neonatologists, particularly in mild to moderate cases.

• The impact of IAH superimposed on HIE on the neurodevelopmental outcome is not clarified.

What is New:

• The prognosis of HIE at 18–36 months was not influenced by IAH.

• Despite its accuracy in predicting death or severe disability, brain MRI has a reduced capacity to distinguish normal outcomes from mild to moderate deficits.