Original ArticlePatterns of brain injury in term neonatal encephalopathy
Section snippets
Methods
Two cohorts of term newborns were studied at the University of California San Francisco (UCSF) and at Loma Linda University Children's Hospital (LLUCH). The Committees on Human Research at each site approved the protocol.
The UCSF cohort consists of 121 newborns studied with MRI (1994-2000), all of whom had neonatal encephalopathy or a marker of perinatal depression: umbilical artery pH <7.1, umbilical artery base deficit >10, or a 5-minute Apgar score ≤5. These inclusion criteria were chosen to
Patterns of Injury
MRI findings consistent with acute or subacute brain injury were common in this cohort, particularly the watershed predominant pattern. At UCSF, 63 newborns had the watershed pattern (52%), 26 had the basal ganglia/thalamus pattern (22%), and 32 had normal MRI results (26%). At LLUCH, 15 newborns had the watershed pattern (29%), 18 had the basal ganglia/thalamus pattern (35%) and 19 had normal MRI results (37%). The predominant region of injury was often accompanied by lesser damage to the
Discussion
In this cohort representative of the spectrum of severity of term neonatal encephalopathy, the watershed predominant injury pattern was most common, seen in 45% of the cohort, and was often accompanied by less severe basal ganglia/thalamus injury. The basal ganglia/thalamus predominant pattern was less common, seen in 25% of the cohort, and was frequently accompanied by more diffuse cortical injury. These patterns are consistent with the regional vulnerability of the term neonatal brain.1, 11,
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Supported by the National Center for Research Resources (5 M01 RR-01271), US Public Health Service, and by the National Institutes of Health (NS35902). Dr Miller is supported by the Canadian Institutes of Health Research. Mr Ramaswamy was supported by the American Pediatric Society - Society for Pediatric Research summer research program (NIH grant HD007446).