Myth: Cerebral palsy cannot be predicted by neonatal brain imaging

doi:10.1016/j.siny.2011.04.004

Seminars in Fetal and Neonatal Medicine

Volume 16, Issue 5, October 2011, Pages 279-287

https://doi.org/10.1016/j.siny.2011.04.004 Get rights and content

Summary

There is controversy in the literature about the value of brain imaging in neonates regarding the prediction of cerebral palsy (CP). The aim of this review was to unravel the myth that CP cannot be predicted by neuroimaging in neonates. Major intracranial lesions in the preterm infant should be recognized with sequential cranial ultrasound and will predict those with non-ambulatory CP. Magnetic resonance imaging (MRI) at term-equivalent age will refine the prediction by assessment of myelination of the posterior limb of the internal capsule. Prediction of motor outcome in preterm infants with subtle white matter injury remains difficult, even with conventional MRI. MRI is a better tool to predict outcome in the term infant with hypoxic-ischaemic encephalopathy or neonatal stroke. The use of diffusion-weighted imaging as an additional sequence adds to the predictive value for motor outcome. Sequential and dedicated neuroimaging should enable us to predict motor outcome in high risk newborns infants.

Introduction

The aim of this review is to refute the myth that cerebral palsy (CP) cannot be predicted by neonatal brain imaging in neonates when combining sequential cranial ultrasonography (cUS) for a sufficient length of time with conventional magnetic resonance imaging (MRI) at term-equivalent age (TEA) in the preterm infant and when using first week MRI including diffusion-weighted imaging (DWI) in the term infant.

Section snippets

The preterm infant

Preterm birth is still increasing. The rate of neurodevelopmental impairment in survivors remains high and recent data have failed to show an improvement in neurodevelopmental outcome in infants with a gestational age (GA) of ≤25 weeks.1, 2 Others have reported a significant decrease in the rates of CP, severe cognitive impairments, and overall neurodevelopmental impairment, but these studies include infants with a GA >25 weeks and are hospital- rather than population-based studies.3, 4, 5

The term infant

Newer techniques, such as evoked potentials, amplitude-integrated electroencephalography (aEEG), and neuroimaging have been used to predict outcome, in particular the development of CP, in term neonates with hypoxic-ischaemic encephalopathy. These techniques were used to assess the severity of the hypoxic-ischaemic insult, to evaluate the effects of neonatal intensive care, and to identify patients who might benefit from interventions such as physical therapy.53, 54

Although electrophysiology

Acknowledgements

The authors would like to thank Frances Cowan for her helpful comments when reading the manuscript and the enthusiasm and patience of magnetic resonance technicians.

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Myth: Cerebral palsy cannot be predicted by neonatal brain imaging

Summary

Introduction

Section snippets

The preterm infant

The term infant

Acknowledgements

Lancet Neurol

J Pediatr

Lancet

J Pediatr

J Pediatr

Early Hum Dev

Eur J Paediatr Neurol

J Pediatr

J Pediatr

Brain Dev

Semin Neonatol

Lancet

Early Hum Dev

Pediatr Neurol

Lancet Neurol

Annual summary of vital statistics

Pediatrics

Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks’ gestational age

Pediatrics

Center differences and outcomes of extremely low birth weight infants

Pediatrics

Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000–2002

Pediatrics

Trends in the rates of cerebral palsy associated with neonatal intensive care of preterm children

Clin Obstet Gynecol

Prenatal events and the risk of cerebral palsy in very low birth weight infants

Am J Epidemiol

Perinatal infection is an important risk factor for cerebral palsy in very low birthweight infants

Dev Med Child Neurol

Preventive care at home for very preterm infants improves infant and caregiver outcomes at 2 years

Pediatrics

Erythropoietin improves neurodevelopmental outcome of extremely preterm infants

Ann Neurol

A. Posterior fontanelle sonography: an acoustic window into the neonatal brain

Am J Neuroradiol

Posterior fossa abnormalities seen on magnetic resonance brain imaging in a cohort of newborn infants

J Perinatol

Cerebellar hemorrhage in the preterm infant: ultrasonographic findings and risk factors

Pediatrics

Cerebellar injury in preterm infants: incidence and findings on US and MR images

Radiology

Ultrasound diagnosis and neurodevelopmental outcome of localised and extensive cystic periventricular leucomalacia

Arch Dis Child Fetal Neonatal Ed

Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society

Neurology

Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term

J Pediatr

White matter damage in neonatal enterovirus meningoencephalitis

Neurology

Human parechovirus causes encephalitis with white matter injury in neonates

Ann Neurol

Interobserver reliability and accuracy of cranial ultrasound scanning interpretation in premature infants

J Pediatr

Variable interpretation of ultrasonograms may contribute to variation in the reported incidence of white matter damage between newborn intensive care units in New Zealand

Arch Dis Child Fetal Neonatal Ed

Ultrasound appearance of the brain in very preterm infants and neurodevelopmental outcome at 18 months of age

Arch Dis Child

Predictors of long-term outcome in very preterm infants: gestational age versus neonatal cranial ultrasound

Pediatrics

Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study

Pediatrics

Unilateral haemorrhagic parenchymal lesions in the preterm infant: shape, site and prognosis

Acta Paediatr

Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction

Pediatrics