[PS11-2C-2] Neuroimaging, Serum Biomarkers and Outcome of Neonatal Encephalopathy in the Cooling Era
Values of S100B and neuron-specific enolase were correlated with death and severe brain injuries detected by MRI in neonatal hypoxic ischemic encephalopathy (HIE). Levels of lactate have been used to predict severity and neurodevelopmental (ND) outcome of neonatal HIE in the pre-cooling era, and higher serum levels of lactate following therapeutic hypothermia (TH) were associated with poor ND outcomes in the cooling era. Data from a nested sub-study of the TOBY trial, MRI was undertaken at a median age of 8 days, showed that the lesions in the basal ganglia and thalami, the posterior limb of the internal capsule and white matter were reduced following TH. A comprehensive classification of MRI findings was correlated with death and disability at 18 months of age in the NICHD trial; furthermore, the MRI pattern of brain injury could be a biomarker of ND outcome at 6-7 years of age. Magnetic resonance spectroscopy has been shown to be a good prognostic predictor in meta-analysis. Deep grey matter Lac/NAA ratio was highly predictive of death or ND outcome at ≧12 months of age. In the pre-cooling era, transcranial Doppler examination showed that resistance index (RI) < 0.55 at 24-62 hours after birth was a strong marker for a very poor outcome and death; however, RI was a poor predictor in neonates treated with TH. Accurate prediction of ND outcome in neonatal HIE is important. Even though technical skills and possibilities are constantly improving, predicting outcome in asphyxiated cooled newborns remains an ongoing challenge.