- Neuroimaging Evidence of Acute Brain Injury Seen on Brain MRI or Magnetic Resonance Spectroscopy Consistent With Hypoxia–Ischemia
- 1. MRI is the neuroimaging modality that best defines the nature and extent of cerebral injury in neonatal encephalopathy. Cranial ultrasonography and computed tomography lack sensitivity for the evaluation of the nature and extent of brain injury in the term encephalopathic infant.
- 2. Distinct patterns of neuroimaging abnormalities are recognized in hypoxic–ischemic cerebral injury in the infant born at or beyond 35 weeks of gestation and have prognostic value for predicting later neurodevelopmental impairments. If the results of the MRI or magnetic resonance spectroscopy, obtained after the first 24 hours of life, are interpreted by a trained neuroradiologist and no areas of injury are noted, then it is unlikely that significant peripartum or intrapartum hypoxic–ischemic brain injury was a significant factor in neonatal encephalopathy. It is important to note that the full extent of injury may not be evident on MRI until after the first week of life.
- 3. Early MRI obtained between 24 hours and 96 hours of life may be more sensitive for the delineation of the timing of perinatal cerebral injury, whereas an MRIundertaken optimally at 10 days of life (with an acceptable window between 7 days and 21 days of life) will best delineate the full extent of cerebral injury.
- 4. Despite the advances in neuroimaging, the ability to precisely time the occurrence (estimating within days rather than hours or minutes) of a hypoxic–ischemic event is still limited.
- D. Presence of Multisystem Organ Failure Consistent With Hypoxic–Ischemic Encephalopathy 1. Multisystem organ failure can include renal injury, hepatic injury, hematologic abnormalities, cardiac dysfunction, metabolic derangements, and gastrointestinal injury, or a combination of these. 2. Although the presence of organ dysfunction increases the risk of hypoxic–ischemic encephalopathy in the setting of neonatal encephalopathy, the severity of brain injury seen on neuroimaging does not always correlate with the degree of injury to other organ systems.
Superintendent, ICH.