Division of Pediatric Neurology, UT Southwestern Medical Center, Dallas, Texas.
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Pediatr Neurol. 2021 Mar;116:32-38. doi: 10.1016/j.pediatrneurol.2020.11.015. Epub 2020 Nov 28.
Magnetic resonance imaging (MRI) scores have been well validated in moderate/severe hypoxic-ischemic encephalopathy (HIE). Infants with mild HIE can have different patterns of injury, yet different scores have not been compared in this group of infants. Our objective was to compare the ability of three = MRI scores to detect abnormalities in infants with mild HIE, and infants with moderate/severe HIE were included for comparison.
This is a single-center prospective cohort study of infants ≥36 weeks' gestation with HIE born at a level III neonatal intensive care unit from 2017 to 2019. All infants with HIE underwent an MRI, but only infants with moderate/severe HIE underwent therapeutic hypothermia. At least two experienced MRI readers who were unaware of all clinical variables independently assigned three scores (Barkovich, NICHD NRN, and Weeke).
A total of 42 newborns with varying HIE severity underwent MRI on day five of life. In the overall cohort, abnormalities were reported in three (7%) infants using the Barkovich, in 10 (24%) using the NICHD NRN, and in 24 (57%) using the Weeke score. Agreement was excellent for each score: Barkovich score (k = 1.0), NICHD NRN (k = 0.92), and Weeke score (k = 0.9).
Subtle injury due to mild HIE was detected with the highest frequency using the Weeke score, while inter-rater reliability was excellent for all three scores. These findings suggest that infants with mild HIE and subtle MRI abnormalities may benefit from detailed scoring systems, which is important for studies investigating the benefit of hypothermia in mild HIE.
磁共振成像（MRI）评分已在中重度缺氧缺血性脑病（HIE）中得到很好的验证。轻度 HIE 的婴儿可能具有不同的损伤模式，但尚未在该组婴儿中比较不同的评分。我们的目的是比较三种 MRI 评分在轻度 HIE 婴儿中检测异常的能力，并纳入中重度 HIE 婴儿进行比较。
这是一项单中心前瞻性队列研究，纳入了 2017 年至 2019 年在三级新生儿重症监护病房出生的胎龄≥36 周的 HIE 婴儿。所有 HIE 婴儿均行 MRI 检查，但仅中重度 HIE 婴儿行亚低温治疗。至少有两名经验丰富的 MRI 读者，他们不知道所有的临床变量，独立分配了三种评分（Barkovich、NICHD NRN 和 Weeke）。
共有 42 名不同严重程度的 HIE 新生儿在出生后第 5 天行 MRI 检查。在整个队列中，3 名（7%）婴儿的 Barkovich 评分有异常，10 名（24%）婴儿的 NICHD NRN 评分有异常，24 名（57%）婴儿的 Weeke 评分有异常。每个评分的一致性都很好：Barkovich 评分（k=1.0）、NICHD NRN（k=0.92）和 Weeke 评分（k=0.9）。
使用 Weeke 评分检测到轻度 HIE 导致的细微损伤的频率最高，而三种评分的观察者间可靠性均很好。这些发现表明，轻度 HIE 伴有细微 MRI 异常的婴儿可能受益于详细的评分系统，这对于研究亚低温治疗轻度 HIE 的益处很重要。
