New research released June 16, 2017 in Pediatric Neurology validates a new clinical MRI scoring system for hypoxic-ischemic encephalopathy (HIE). This new scoring system can help medical practitioners more accurately counsel parents about what their child’s short- and long-term outcomes may look like and help guide treatment and therapy decisions for the child.
MRI Injury Scoring Systems for Hypoxic-Ischemic Encephalopathy: Why Are They Important?
It can be difficult to predict outcomes in babies who’ve had hypoxic-ischemic encephalopathy (HIE). Medical professionals and researchers are continuously looking for methods to help provide insight into the range of a child’s disability. A new scoring system proposed by researchers at the Washington University School of Medicine can help predict neurodevelopmental outcome at 18-24 months in infants with HIE.
Background: Advances in Predicting Neurodevelopmental Outcome in HIE
HIE can cause a broad range of neurodevelopmental disabilities ranging from mild to severe depending on the child’s individual circumstances. The recent introduction of hypothermia therapy (brain cooling, CoolCap, or cooling blanket therapy) has helped decrease mortality in children with HIE, and has increased survival in newborns with HIE. However, a significant percentage of children with HIE still have neurological and developmental limitations, even after cooling therapy.
Technological advancements in MRI has improved our ability to evaluate:
- The timing of HIE injury
- The extent of brain damage
- The severity of brain damage
Medical professionals can use MRI to help counsel parents about their children. This can mean helping inform parents about possible long-term effects of HIE, or, in the most severe of cases, enable end-of-life discussions.
New MRI Scoring System for HIE Focuses on Specific Areas of Injury
MRI scoring systems already exist, including the Barkovich system, the National Institutes for Child Health and Development (NICHD) system, and the Rutherford system. This new system focuses on a few parts of the brain where injury are associated with worse outcomes: the deep nuclear grey matter and the posterior limb of the internal capsule. The system combines T1-weighted, T2-weighted, and diffusion-weighted imaging (DWI) and uses MRIs taken at two different times: in the first 6 days of life and in the first 7-14 days of life. The children (who had all had moderate-to-severe HIE and received hypothermia therapy) were then administered a developmental test called the Bayley Scales of Infant and Toddler Development-III (Bayley-III) between 18-24 months that measured their cognitive, language and motor skills.
The researchers analyzed the system and found that higher injury scores were associated with lower Bayley-III scores (ie, worse developmental outcomes). This means that the greater the grade of injury on MRI, the greater the risk of poor motor, cognitive and language development.
This research validates the scoring system using the established gold-standard test for neurodevelopmental outcome (the Bayley-III); this means that this scoring system can help:
- Potentially identify functional impairments earlier
- Provide physicians with information key to guiding medical management
- Help physicians inform parents about the need for developmental therapy via Early Intervention
The Bottom Line
This new MRI injury scoring system may not be something that parents use, but it is a key tool to help doctors inform parents about their child’s potential health outcomes. This system could help physicians in their decisions to recommend that parents seek out key early therapies to maximize the development of children with HIE.
- Trivedi SB et al. A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy. Pediatr Radiol. 2017 Jun 16. doi: 10.1007/s00247-017-3893-y. [Epub ahead of print]