Association between Early Basal Ganglia and Thalami Perfusion Assessed by Color Doppler Ultrasonography and Brain Injury in Infants with Hypoxic-Ischemic Encephalopathy: A Prospective Cohort Study

R Faingold; C Prempunpong; J Garfinkle; C St Martin; F Menegotto; R Boyle; J M A Donoso; K A Nguyen; G M Sant'Anna

doi:10.1016/j.jpeds.2024.114086

Association between Early Basal Ganglia and Thalami Perfusion Assessed by Color Doppler Ultrasonography and Brain Injury in Infants with Hypoxic-Ischemic Encephalopathy: A Prospective Cohort Study

J Pediatr. 2024 May 3:114086. doi: 10.1016/j.jpeds.2024.114086. Online ahead of print.

Authors

R Faingold¹, C Prempunpong², J Garfinkle³, C St Martin⁴, F Menegotto⁵, R Boyle⁶, J M A Donoso⁷, K A Nguyen⁸, G M Sant'Anna⁹

Affiliations

¹ Associate Professor of Pediatric Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario.
² Associate Professor of Pediatrics, Neonatal Division, Mahidol University, Bangkok, Thailand.
³ Assistant Professor of Pediatrics, Neonatal Division, McGill University Health Center, Montreal, Canada.
⁴ Associate Professor of Pediatric Radiology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.
⁵ Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK.
⁶ Neonatal Nurse Practitioner, Neonatal Division, Edmonton, Canada.
⁷ Masters Student of Experimental Surgery, McGill University, Montreal, Canada.
⁸ Assistant Professor of Pediatrics, Neonatal Follow-up Division, Jewish General Hospital, McGill University Health Center, Montreal, Canada.
⁹ Full Professor of Pediatrics, Neonatal Division, Senior Scientist of the Research Institute and Member of the Experimental Medicine Department, McGill University Health Center, Montreal, Canada. Electronic address: guilherme.santanna@mcgill.ca.

PMID: 38705232
DOI: 10.1016/j.jpeds.2024.114086

Abstract

Objective: To evaluate associations between neurologic outcomes and early measurements of basal ganglia (BG) and thalamic (Th) perfusion using color Doppler ultrasonography (CDUS) in infants with hypoxic-ischemic encephalopathy (HIE).

Study design: Prospective study of infants with mild (n=18), moderate (n=17), and severe HIE (n=14) and controls (n=17). Infants with moderate-severe HIE received therapeutic hypothermia (TH). CDUS was performed at 24-36h and brain magnetic resonance imaging (MRI) at a median of 10 days. Development was followed through 2.5 to 5 years. The primary outcome was the association between BG and Th perfusion and brain MRI injury. Secondary analyses focused on associations between perfusion measurements and admission neurologic examinations, MRI scores in infants treated with TH, and motor and sensory disability, or death. An exploratory analysis assessed the accuracy of BG and Th perfusion to predict brain MRI injury in infants treated with TH.

Results: Increased BG and Th perfusion on CDUS was observed in infants with severe MRI scores and those with significant motor and neurosensory disability or death through 2.5 to 5 years (p<0.05). Infants with severe HIE showed increased BG and Th perfusion (p< .005) compared with infants with moderate HIE. No differences were identified between the between the control and mild HIE groups. Th perfusion ≥ 0.237 cm/sec (AUC of 0.824) correctly classified 80% of infants with severe MRI scores.

Conclusion: Early dynamic CDUS of the BG and Th is a potential biomarker of severe brain injury in infants with HIE and may be a useful adjunct to currently used assessments.

Keywords: brain perfusion; neonatal encephalopathy; neurodevelopmental impairment.