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