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Citation
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Xu Q, Chau V, Sanguansermsri C, Muir KE, Tam EWY, Miller SP, Wong DST, Chen H, Wong PKH, Zwicker JG, Poskitt KJ, Hill A, Roland EH. J. Child Neurol. 2019; ePub(ePub): 883073818822361. |
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Affiliation
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Department of Pediatrics, Neurology, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada. |
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Abstract
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OBJECTIVE:: To determine if patterns of hypoxic-ischemic brain injury on magnetic resonance imaging (MRI) in term newborns predict subsequent childhood epilepsy.
METHODS: This retrospective cohort study includes term newborns with encephalopathy (n = 181) born between 2004-2012 and admitted to British Columbia Children's Hospital. MRI was performed between 3 and 5 days of age. The predominant patterns of hypoxic-ischemic injury were classified as Normal, Watershed, Basal Nuclei, Total, and Focal-Multifocal. Lesions in hippocampus, motor and occipital cortex were noted.
RESULTS:: Of 181 newborns, 166 (92%) survived the neonatal period, and 132 (80%) had follow-up with a median duration of 61 months (IQR: 28-95). Twenty-three children (17%) developed epilepsy. A higher proportion with Watershed, Basal Nuclei, or Total patterns developed epilepsy ( P <.001). Injury to motor cortex, hippocampus, and occipital lobe ( P <.01) were independent risk factors for epilepsy. In the adjusting logistic model, Watershed (odds ratio = 16.0, 95% CI [1.3, 197.2], P =.03) and Basal Nuclei injury (odds ratio = 19.4, 95% CI [1.9, 196.3], P =.01) remained independent risk factors. Therapeutic hypothermia did not alter these associations. Severity of brain injury and recurrent neonatal seizures are other clinical risk factors. Significance: In term newborns with hypoxic-ischemic encephalopathy, the predominant pattern of Watershed and Basal Nuclei injury are valuable predictors for development of epilepsy in later childhood.
Language: en |