Brain injury patterns in hypoglycemia in neonatal encephalopathy.

Abstract

BACKGROUND AND PURPOSE:

Low glucose values are often seen in term infants with NE, including HIE, yet the contribution of hypoglycemia to the pattern of neurologic injury remains unclear. We hypothesized that MR features of neonatal hypoglycemia could be detected, superimposed on the predominant HIE injury pattern.

MATERIALS AND METHODS:

Term neonates (n = 179) with NE were prospectively imaged with day-3 MR studies and had glucose data available for review. The predominant imaging pattern of HIE was recorded as watershed, basal ganglia, total, focal-multifocal, or no injury. Radiologic hypoglycemia was diagnosed on the basis of selective edema in the posterior white matter, pulvinar, and anterior medial thalamic nuclei. Clinical charts were reviewed for evidence of NE, HIE, and hypoglycemia (<46 mg/dL).

RESULTS:

The predominant pattern of HIE injury imaged included 17 watershed, 25 basal ganglia, 10 total, 42 focal-multifocal, and 85 cases of no injury. A radiologic diagnosis of hypoglycemia was made in 34 cases. Compared with laboratory-confirmed hypoglycemia, MR findings had a positive predictive value of 82% and negative predictive value of 78%. Sixty (34%) neonates had clinical hypoglycemia before MR imaging. Adjusting for 5-minute Apgar scores and umbilical artery pH with logistic regression, clinical hypoglycemia was associated with a 17.6-fold higher odds of MR imaging identification (P < .001). Selective posterior white matter and pulvinar edema were most predictive of clinical hypoglycemia, and no injury (36%) or a watershed (32%) pattern of injury was seen more often in severe hypoglycemia.

CONCLUSIONS:

In term infants with NE and hypoglycemia, specific imaging features for both hypoglycemia and hypoxia-ischemia can be identified.

• Authors: D S T Wong, K J Poskitt, V Chau, S P Miller, E Roland, A Hill, E W Y Tam
• Journal: AJNR. American journal of neuroradiology (AJNR Am J Neuroradiol) Vol. 34 Issue 7 Pg. 1456-61 (Jul 2013) ISSN: 1936-959X [Electronic] United States
• PMID: 23436054 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose

Topics

• Acidosis (congenital)
• Apgar Score
• Basal Ganglia (pathology)
• Blood Glucose (analysis)
• Brain (pathology)
• Brain Edema (pathology)
• Cohort Studies
• Diffusion Magnetic Resonance Imaging
• Female
• Fetal Distress (complications)
• Humans
• Hypoglycemia (diagnosis, pathology)
• Hypoxia-Ischemia, Brain (diagnosis, pathology)
• Image Enhancement (methods)
• Infant, Newborn
• Infant, Newborn, Diseases (diagnosis, pathology)
• Magnetic Resonance Imaging (methods)
• Male
• Midline Thalamic Nuclei (pathology)
• Neuroimaging (methods)
• Predictive Value of Tests
• Prospective Studies
• Pulvinar (pathology)
• Resuscitation