Therapeutic hypothermia for hypoxic-ischemic encephalopathy after perinatal sentinel events: less brain injury on MRI and improved neurodevelopmental outcome at 18–36 months

Objective: To study the association between perinatal sentinel events (PSE) and brain MRI/neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH). Design: This is a retrospective single-center study. Data collection included perinatal history, brain MRI, and neurodevelopmental outcome. Results: Out of the 182 neonates, 53 (29%) neonates had PSE and 129 (71%) neonates did not have PSE. Neonates with PSE had more normal MRIs (76%) compared with neonates without PSE (55%), p = 0.01. PSE was associated with favorable motor (p = 0.02), language outcome (p = 0.03), and trend to better cognitive scores (p = 0.13). In PSE, favorable motor outcome persisted (OR for impairment 0.15 (0.003–0.84), p = 0.03) after adjusting for the degree of encephalopathy and brain MRI injury. Injury on brain MRI despite TH after PSE was associated with unfavorable neurodevelopmental outcome (p < 0.001). Conclusion: Neonates with HIE receiving TH after PSE had less severe injury on brain MRI after rewarming, and improved motor and language outcomes at 18–36 months.