NICHD Magnetic Resonance Brain Imaging Score in Term Infants With Hypoxic-Ischemic Encephalopathy
Authors: Shankaran Seetha , Laptook Abbot R. , Guimaraes Carolina , Murnick Johnathan , McDonald Scott A. , Das Abhik , Petrie Huitema Carolyn M. , Pappas Athina , Higgins Rosemary D. , Hintz Susan R. , Zaterka-Baxter Kristin M. , Van Meurs Krisa P. , Sokol Gregory M. , Chalak Lina F. , Colaizy Tarah T. , Devaskar Uday , Tyson Jon E. , Reynolds Anne Marie , DeMauro Sara B. , Sánchez Pablo J. , Laughon Matthew M. , Carlo Waldemar A. , Watterberg Kristi , Puopolo Karen M. , Hibbs Anna Maria , Hamrick Shannon E. G. , Cotten C. Michael , Barks John , Poindexter Brenda B. , Truog William E. , D’Angio Carl T. ,   Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Ambalavanan Namasivayam , Carlo Waldemar A. , Collins Monica V. , Cosby Shirley S. , Alksninis Barbara , Burke Robert T. , Caskey Melinda , Guerina Nicholas , Hensman Angelita M. , Keszler Martin , Keszler Mary Lenore , Knoll Andrea M. , Laptook Abbot R. , Little Emilee , McGowan Elizabeth C. , Oh William , Shah Birju A. , Sommers Ross , Vieira Elisa , Vohr Betty R. , Guilford Stephanie , Lakshminrusimha Satyan , Sacilowski Michael G. , Williams Ashley , Wynn Karen , Hibbs Anna Maria , Newman Nancy S. , Siner Bonnie S. , Stork Eileen K. , Zadell Arlene , Caplan Michael S. , Alexander Barbara , Gratton Teresa L. , Grisby Cathy , Jackson Lenora Denise , Kallapur Suhas G. , Kirker Kristin , Merhar Stephanie L. , Muthig Greg , Poindexter Brenda B. , Schibler Kurt , Wuertz Sandra , Yolton Kimberly , Polin Richard A. , Adams Sally S. , Brion Luc P. , Chalak Lina F. , Chen Lijun , Guzman Alicia , Heyne Elizabeth T. , Heyne Roy J. , Lee Lizette E. , Madden Linda A. , Ramon Emma , Sánchez Pablo J. , Twell Boatman Catherine , Vasil Diana M. , Wyckoff Myra H. , Ashley Patricia L. , Cotten C. Michael , Fisher Kimberley A. , Goldberg Ronald N. , Goldstein Ricki F. , Grimes Sandra , Gustafson Kathryn E. , Malcolm William F. , Probst Joanne , Adams-Chapman (deceased) Ira , Bottcher Diane I. , Carlton David P. , Carter Sheena L. , Hale Ellen C. , Hamrick Shannon E. G. , Loggins Yvonne C. , Mackie Colleen , Patel Ravi M. , Stoll Barbara J. , Arldt-McAlister Julie , Burson Katrina , Dempsey Allison G. , Duncan Andrea F. , Garcia Carmen , John Janice , Jones Patrick M. , Kennedy Kathleen A. , Khan Amir M. , Lillie M. Layne , Martin Sara C. , McDavid Georgia Elaine , Pedroza Claudia , Pierce Tate Patti L. , Siddiki Saba Khan , Sperry Daniel K. , Tyson Jon E. , Wright Sharon L. , Gunn Susan , Herron Dianne E. , Hines Abbey C. , Joyce (deceased) Jeffery , Miller Lucy C. , Papile Lu-Ann , Smiley Lucy C. , Sokol Gregory M. , Wilson Leslie Dawn , Bell Edward F. , Bhavsar Vipinchandra , Colaizy Tarah T. , Dagle John M. , Eastman Diane L. , Johnson Karen J. , Klein Jonathan M. , Lindauer Claire A. , Lindower Julie B. , McElroy Steven J. , Meyer Lauritz R. , Murphy Cary R. , Rabe Glenda K. , Roghair Robert D. , Segar Jeffrey L. , Walker Jacky R. , Widness John A. , Campbell Donia B. , Ellsbury Dan L. , Gaetano Lisa , Gauldin Cheri , Holmes Anne M. , Johnson Kathy , Pallotto Eugenia K. , Scott Allison , Truog William E. , Fortney Christine A. , Jadcherla Sudarshan R. , Luzader Patricia , Nelin Mary Ann , Parikh Nehal A. , Bremer Andrew A. , Higgins Rosemary D. , Walsh Michele C. , Wilson Archer Stephanie , Abbasi Soraya , Bernbaum Judy C. , Chaudhary Aasma S. , Cucinotta Dara M. , DeMauro Sara B. , Dysart Kevin C. , Eichenwald Eric C. , Gerdes Marsha , Hurt Hallam , Kirpalani Haresh , Mancini Toni , Puopolo Karen M. , Schmidt Barbara , Binion Kyle , Conway Patrick , D'Angio Carl T. , Farooq Osman , Guillet Ronnie , Horihan Cassandra A. , Jensen Rosemary L. , Laroira Nirupama , Merzbach Joan , Myers Gary J. , Sabaratnam Premini , Scorsone Ann Marie , Wadkins Holly I.M. , Yost Kelley , Bann Carla M. , Bayard Annie M. , Crawford Margaret M. , Das Abhik , Gabrio Jenna , Gantz Marie G. , McDonald Scott A. , Newman Jamie E. , O’Donnell Auman Jeanette , Petrie Huitema Carolyn M. , Pickett James W. , VonLehmden Annie M. , Wallace Dennis , Zaterka-Baxter Kristin M. , Ball M. Bethany , Chock Valerie Y. , DeAnda Maria Elena , DeBattista Anne M. , Hintz Susan R. , Huffman Lynne C. , Krueger Casey E. , Proud Melinda S. , Stevenson David K. , Taylor Heather L. , Van Meurs Krisa P. , Weiss Hali E. , Chanlaw Teresa , Devaskar Uday , Garg Meena , Geller Rachel , Aliaga Sofia , Bernhardt Janice , Bose Carl L. , Clark Cynthia L. , Guimaraes Carolina , Laughon Matthew Maxwell , Warner Diane D. , Wereszczak Janice Kay , Backstrom Lacy Conra , Fuller Janell , Hartenberger Carol H. , Lowe Jean R. , Ohls Robin K. , Ruffner Hanson Mary , Sundquist Beauman Sandra , Watterberg Kristi L. , Barks John , Christensen Mary K. , Wiggins Stephanie A. , Bajaj Monika , Bara Rebecca , Chawla Sanjay , Childs Kirsten , De Jesus Lilia C. , Hinz Woldt Eunice , Johnson Mary E. , Natarajan Girija , Panaitescu Bogdan , Pappas Athina , Prentice Jeannette E. , Shankaran Seetha , Sood Beena G. , Murnick Johnathan 
Published: February 2025

Importance

The neonatal brain injury score on magnetic resonance imaging following moderate or severe hypoxic-ischemic encephalopathy developed by the National Institute of Child Health and Human Development Neonatal Research Network has been revised to separate watershed and basal ganglia or thalamic injury and their associated outcomes.

Objective

To evaluate the association of the injury score with outcomes of death or moderate or severe disability among all infants, and with neurodevelopment among survivors in a trial of deeper and longer cooling.

Design, Setting, and Participants

In this secondary analysis of a multicenter randomized clinical trial, brain imaging was obtained from infants between October 2010 and November 2013. Infants were followed up to 18 months of age, with follow-up completed in January 2016. Data analysis was performed from August 2021 to September 2024.

Interventions

Infants were assigned to 4 hypothermia groups based on depth and duration of cooling, stratified by center and level of encephalopathy in a 2 × 2 factorial design to cooling at 33.5 °C or 32.0 °C and to 72 or 120 hours. A 10-level brain injury score was examined.

Main Outcomes and Measures

The primary outcome was death or moderate or severe disability measured by the Bayley Scales of Infant and Toddler Development III, the Gross Motor Function Classification System level, vision, and hearing.

Results

This study included 298 infants who had magnetic resonance imaging (MRI) and primary outcome data among 364 infants of the initial cohort (mean [SD] age at MRI, 9.18 [4.49] days). Death or moderate or severe disability occurred in 72 of 298 infants (24%), and disability occurred in 52 of 278 surviving infants (19%). Death or disability occurred in 12 of 28 infants (43%) with any or predominant watershed injury and in 17 of 46 (37%) of those with any or predominant basal ganglia or thalamic injury. Among the 32 infants with hemispheric devastation, 30 (94%) had death or disability, and 17 (89%) survived with moderate or severe disability. Injury scores of increasing severity were associated with death or disability among all infants (odds ratio, 13.66 [95% CI, 7.47-24.95]; area under the curve, 0.84 [95% CI, 0.78-0.90]) and with disability among surviving infants (odds ratio, 10.52 [95% CI, 5.46-20.28]; area under the curve, 0.80 [95% CI, 0.73-0.88]). There were no differences in the injury score between infants undergoing usual care cooling and those cooled to a greater depth or longer duration.

Conclusions

Among infants with hypoxic-ischemic encephalopathy, outcomes were similar between infants with watershed and basal ganglia injury. Higher imaging scores were associated with risk of death or disability among all infants and with neurodevelopmental disability among surviving infants.

Trial Registration

ClinicalTrials.gov Identifier: NCT01192776