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Cerebral Magnetic Resonance Biomarkers in Neonatal Encephalopathy: A Meta-analysis

Thayyil, S; Chandrasekaran, M; Taylor, A; Bainbridge, A; Cady, EB; Chong, WKK; ... Robertson, NJ; + view all (2010) Cerebral Magnetic Resonance Biomarkers in Neonatal Encephalopathy: A Meta-analysis. PEDIATRICS , 125 (2) E382 - E395. 10.1542/peds.2009-1046.

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Abstract

OBJECTIVE: Accurate prediction of neurodevelopmental outcome in neonatal encephalopathy (NE) is important for clinical management and to evaluate neuroprotective therapies. We undertook a metaanalysis of the prognostic accuracy of cerebral magnetic resonance (MR) biomarkers in infants with neonatal encephalopathy.METHODS: We reviewed all studies that compared an MR biomarker performed during the neonatal period with neurodevelopmental outcome at >= 1 year. We followed standard methods recommended by the Cochrane Diagnostic Accuracy Method group and used a random-effects model for meta-analysis. Summary receiver operating characteristic curves and forest plots of each MR biomarker were calculated. chi (2) tests examined heterogeneity.RESULTS: Thirty-two studies (860 infants with NE) were included in the meta-analysis. For predicting adverse outcome, conventional MRI during the neonatal period (days 1-30) had a pooled sensitivity of 91% (95% confidence interval [CI]: 87%-94%) and specificity of 51% (95% CI: 45%-58%). Late MRI (days 8-30) had higher sensitivity but lower specificity than early MRI (days 1-7). Proton MR spectroscopy deep gray matter lactate/N-acetyl aspartate (Lac/NAA) peak-area ratio (days 1-30) had 82% overall pooled sensitivity (95% CI: 74%-89%) and 95% specificity (95% CI: 88%-99%). On common study analysis, Lac/NAA had better diagnostic accuracy than conventional MRI performed at any time during neonatal period. The discriminatory powers of the posterior limb of internal capsule sign and brain-water apparent diffusion coefficient were poor.CONCLUSIONS: Deep gray matter Lac/NAA is the most accurate quantitative MR biomarker within the neonatal period for prediction of neurodevelopmental outcome after NE. Lac/NAA may be useful in early clinical management decisions and counseling parents and as a surrogate end point in clinical trials that evaluate novel neuroprotective therapies. Pediatrics 2010;125:e382-e395

Type:Article
Title:Cerebral Magnetic Resonance Biomarkers in Neonatal Encephalopathy: A Meta-analysis
DOI:10.1542/peds.2009-1046
Keywords:sensitivity, specificity, meta-analysis, hypoxic-ischemic encephalopathy, magnetic resonance imaging, magnetic resonance spectroscopy, HYPOXIC-ISCHEMIC ENCEPHALOPATHY, APPARENT DIFFUSION-COEFFICIENT, WHOLE-BODY HYPOTHERMIA, PROTON MR SPECTROSCOPY, TERM INFANTS, PERINATAL ASPHYXIA, PROGNOSTIC VALUE, BIRTH ASPHYXIA, BRAIN-INJURY, NEWBORN ENCEPHALOPATHY
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Women's Health > Neonatology
UCL > School of BEAMS > Faculty of Engineering Science > Medical Physics and Bioengineering
UCL > School of BEAMS > Faculty of Maths and Physical Sciences > Statistical Science

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