Sequential Neurological Examinations in Infants with Neonatal Encephalopathy and Low Apgar Scores: Relationship with Brain MRI

Abstract

Objective: The aims of this study were to (a) describe the evolution of neurological signs after the neonatal period in infants with neonatal encephalopathy and abnormal outcome and (b) to establish the relationship between the evolution of neurological signs and patterns of lesions on brain MRI. Patients: Fifteen children with low Apgar scores, abnormal neurological signs at the end of the neonatal period, and abnormal outcome were examined at 1 - 2 weeks, 5 - 7 weeks, and 6 months. All the infants had at least one MRI scan performed in the neonatal period. Results: All infants had persistent abnormalities on all examinations performed but the severity of neurological impairment was variable and was related to the pattern of brain lesions. Infants with severe basal ganglia and white matter lesions showed abnormal axial and limb tone, movements, and visual function on all the examinations and none achieved independent sitting. In infants with moderate basal ganglia lesions and/or severe white matter changes, visual function and feeding improved by 5 - 7 weeks and were still normal at 6 months while limb tone, which was reduced in the first weeks, appeared to be normal at 5 - 6 weeks but was found to be increased at 6 months; all were able to sit unsupported at 2 years and most of them achieved the ability to walk with support. Conclusions: Our results suggest that the evolution of the neurological patterns after the neonatal period in infants with persisting neonatal abnormalities depends on their pattern of brain lesions.

Neurological - infant - brain MRI - full term

References

• 1 Cioni G, Prechtl H F, Ferrari F, Paolicelli P B, Einspieler C, Roversi M F. Which better predicts later outcome in full-term infants: quality of general movements or neurological examination?.  Early Hum Dev. 1997;  50 71-85
• 2 Dubowitz L, Mercuri E, Dubowitz V. An optimality score for the neurologic examination of the term newborn.  J Pediatr. 1998;  133 406-416
• 3 Haataja L, Mercuri E, Regev R, Cowan F, Rutherford M, Dubowitz V. et al . Optimality score for the neurologic examination of the infant at 12 and 18 months of age.  J Pediatr. 1999;  135 (2 Pt 1) 153-161
• 4 Himmelmann K, Hagberg G, Beckung E, Hagberg B, Uvebrant P. The changing panorama of cerebral palsy in Sweden. IX. Prevalence and origin in the birth-year period 1995 - 1998.  Acta Paediatr Scand. 2005;  94 287-294
• 5 Kuenzle C, Baenziger O, Martin E, Thun-Hohenstein L, Steinlin M, Good M. et al . Prognostic value of early MR imaging in term infants with severe perinatal asphyxia.  Neuropediatrics. 1994;  25 191-200
• 6 Mercuri E, Guzzetta A, Haataja L, Cowan F, Rutherford M, Counsell S. et al . Neonatal neurological examination in infants with hypoxic ischaemic encephalopathy: correlation with MRI findings.  Neuropediatrics. 1999;  30 83-89
• 7 Mercuri E, Barnett A L. Neonatal brain MRI and motor outcome at school age in children with neonatal encephalopathy: a review of personal experience.  Neural Plast. 2003;  10 51-57
• 8 Palisano R, Rosenbaum P, Walter S, Russel D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy.  Dev Med Child Neurol. 1997;  39 214-223
• 9 Prechtl H F, Einspieler C, Cioni G, Bos A F, Ferrari F, Sontheimer D. An early marker for neurological deficits after perinatal brain lesions.  Lancet. 1997;  349 1361-1363
• 10 Rutherford M, Counsell S, Allsop J. et al . Diffusion-weighted magnetic resonance imaging in term perinatal brain injury: a comparison with site of lesion and time from birth.  Pediatrics. 2004;  114 1004-1014
• 11 Sarnat H B, Sarnat M S. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study.  Arch Neurol. 1976;  33 696-705