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Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic–ischemic encephalopathy: a feasibility study using magnetic resonance imaging

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Abstract

Background

Therapeutic hypothermia is the standard-of-care treatment for infants diagnosed with moderate-to-severe hypoxic–ischemic encephalopathy (HIE). MRI for assessing brain injury is usually performed after hypothermia because of logistical challenges in bringing acutely sick infants receiving hypothermia from the neonatal intensive care unit (NICU) to the MRI suite. Perhaps examining and comparing early cerebral oxygen metabolism disturbances to those after rewarming will lead to a better understanding of the mechanisms of brain injury in HIE and the effects of therapeutic hypothermia.

Objective

The objectives were to assess the feasibility of performing a novel T2-relaxation under spin tagging (TRUST) MRI technique to measure venous oxygen saturation very early in the time course of treatment, 18–24 h after the initiation of therapeutic hypothermia, to provide a framework to measure neonatal cerebral oxygen metabolism noninvasively, and to compare parameters between early and post-hypothermia MRIs.

Materials and methods

Early (18–24 h after initiating hypothermia) MRIs were performed during hypothermia treatment in nine infants with HIE (six with moderate and three with severe HIE). Six infants subsequently had an MRI after hypothermia. Mean values of cerebral blood flow, oxygen extraction fraction, and cerebral metabolic rate of oxygen from MRIs during hypothermia were compared between infants with moderate and severe HIE; and in those with moderate HIE, we compared cerebral oxygen metabolism parameters between MRIs performed during and after hypothermia.

Results

During the initial hypothermia MRI at 23.5±5.2 h after birth, infants with severe HIE had lower oxygen extraction fraction (P=0.04) and cerebral metabolic rate of oxygen (P=0.03) and a trend toward lower cerebral blood flow (P=0.33) compared to infants with moderate HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between MRIs during and after hypothermia (although not significantly); cerebral metabolic rate of oxygen (P=0.93) was not different.

Conclusion

Early MRIs were technically feasible while maintaining hypothermic goal temperatures in infants with HIE. Cerebral oxygen metabolism early during hypothermia is more disturbed in severe HIE. In infants with moderate HIE, cerebral blood flow decreased and oxygen extraction fraction increased between early and post-hypothermia scans. A comparison of cerebral oxygen metabolism parameters between early and post-hypothermia MRIs might improve our understanding of the evolution of HIE and the benefits of hypothermia. This approach could guide the use of adjunctive neuroprotective strategies in affected infants.

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Acknowledgments

This research was supported in part by a grant from the Evangelina “Evie” Whitlock Foundation and the Baylor College of Medicine Clinician-Scientist Training Program (awarded to A.M.L.) and by the National Institutes of Health (NIH R21 NS085634 to P.L.). The authors wish to thank the neonatal team responsible for infant transport between the NICU and MRI suite and the MR technicians responsible for operating the scanner.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children’s Hospital, Pavilion for Women, 6651 Main St., Houston, TX, 77030, USA

    Anil N. Shetty, Magdalena Sanz Cortes & Wesley Lee

  2. Department of Pediatrics (Neonatology), Baylor College of Medicine, Houston, TX, USA

    Ashley M. Lucke & Joseph L. Hagan

  3. Department of Radiology, Johns Hopkins University, Baltimore, MD, USA

    Peiying Liu & Hanzhang Lu

  4. Department of Radiology, Baylor College of Medicine, Houston, TX, USA

    Zili D. Chu & Jill V. Hunter

  5. Department of Pediatrics (Neonatal-Perinatal Medicine), Department of Obstetrics and Gynecology, Penn State Health Children’s Hospital, Hershey, PA, USA

    Jeffrey R. Kaiser

Authors
  1. Anil N. Shetty
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  2. Ashley M. Lucke
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  3. Peiying Liu
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  4. Magdalena Sanz Cortes
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  5. Joseph L. Hagan
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  6. Zili D. Chu
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  7. Jill V. Hunter
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  8. Hanzhang Lu
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  9. Wesley Lee
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  10. Jeffrey R. Kaiser
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Correspondence to Anil N. Shetty.

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Shetty, A.N., Lucke, A.M., Liu, P. et al. Cerebral oxygen metabolism during and after therapeutic hypothermia in neonatal hypoxic–ischemic encephalopathy: a feasibility study using magnetic resonance imaging. Pediatr Radiol 49, 224–233 (2019). https://doi.org/10.1007/s00247-018-4283-9

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  • DOI: https://doi.org/10.1007/s00247-018-4283-9

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