Background
Methods
Patients
Inclusion and exclusion criteria
Data collection
Statistical analysis
Results
Total (N = 123) | MRI change in splenium | |||
---|---|---|---|---|
Yes (N = 26) | No (N = 97) | P | ||
Gestation (weeks) | 39.16 ± 1.60 | 39.60 ± 1.48 | 39.05 ± 1.62 | 0.120 |
Preterm < 37 weeks gestationa | 15 (12.3%) | 3 (11.5%) | 12 (12.5%) | 0.895 |
Birth weight (grams) | 3199.07 ± 699.65 | 3224.04 ± 899.76 | 3192.37 ± 641.13 | 0.839 |
Female sex | 57 (46.3%) | 12 (46.2%) | 45 (46.4%) | 0.983 |
C-section | 81 (65.9%) | 18 (69.2%) | 63 (64.9%) | 0.683 |
Non-reassuring fetal heart tonea | 85 (69.7%) | 19 (73.1%) | 66 (68.8%) | 0.670 |
Pre-eclampsiaa | 6 (4.9%) | 0 (0.0%) | 6 (6.3%) | 0.191 |
Placental abruption, uterine rupture or cord prolapsea | 20 (16.4%) | 4 (15.4%) | 16 (16.7%) | 0.876 |
Meconium staina | 53 (43.4%) | 14 (53.8%) | 39 (40.6%) | 0.228 |
Nuchal corda | 24 (19.7%) | 5 (19.2%) | 19 (19.8%) | 0.949 |
Maternal chorioamnionitisa | 12 (9.8%) | 4 (15.4%) | 8 (8.3%) | 0.284 |
Intubation | 84 (68.3%) | 22 (84.6%) | 62 (63.9%) | < 0.05 |
Chest compressions | 37 (30.1%) | 10 (38.5%) | 27 (27.8%) | 0.294 |
Day of life MRI completed | 5.99 ± 1.13 | 6.38 ± 1.63 | 5.89 ± 0.93 | < 0.05 |
Mortality during hospitalization | 7 (5.7%) | 6 (23.1%) | 1 (1.0%) | < 0.001 |
Lowest blood pH < 7.1 | 100 (81.3%) | 22 (84.6%) | 78 (80.4%) | 0.625 |
Apgar 1 min ≤ 5a | 118 (96.7%) | 24 (92.3%) | 94 (97.9%) | 0.154 |
Apgar 5 min ≤ 5a | 86 (70.5%) | 21 (80.08%) | 65 (67.7%) | 0.195 |
Apgar 10 min ≤ 5b | 42 (37.8%) | 14 (60.9%) | 28 (31.8%) | < 0.05 |
Sarnat staging | ||||
Mild | 10 (8.1%) | 2 (7.7%) | 8 (8.2%) | 0.135 |
Moderate | 95 (77.2%) | 17 (65.4%) | 78 (80.4%) | |
Severe | 18 (14.6%) | 7 (26.9%) | 11 (11.3%) |
Total (N = 123) | MRI change in splenium | |||
---|---|---|---|---|
Yes (N = 26) | No (N = 97) | P | ||
Seizure present | 39 (31.7%) | 21 (80.8%) | 18 (18.6%) | < 0.001 |
Number of anti-epileptics | 0.54 ± 1.03 | 1.77 ± 1.56 | 0.21 ± 0.46 | < 0.001 |
Anti-epileptics used | ||||
None | 84 (68.3%) | 5 (19.2%) | 79 (81.4%) | < 0.001 |
1 anti-epileptic | 27 (22.0%) | 10 (38.5%) | 17 (17.5%) | |
2 or more anti-epileptics, not including midazolam drip | 7 (5.7%) | 6 (23.1%) | 1 (1.0%) | |
Includes midazolam drip | 5 (4.1%) | 5 (19.2%) | 0 (0.0%) | |
Seizure frequencya | ||||
None | 84 (68.9%) | 5 (20.0%) | 79 (81.4%) | < 0.001 |
1 seizure | 8 (6.6%) | 2 (8.0%) | 6 (6.2%) | |
2 or more seizures | 22 (18.0%) | 10 (40.0%) | 12 (12.4%) | |
Status epilepticus | 8 (6.6%) | 8 (32.0%) | 0 (0.0%) | |
Worst EEG background in first 24 hoursb | ||||
Normal | 12 (9.8%) | 1 (3.8%) | 11 (11.5%) | < 0.001 |
Mild to moderate | 90 (73.8%) | 13 (50.0%) | 77 (80.2%) | |
Severe | 20 (16.4%) | 12 (46.2%) | 8 (8.3%) | |
Seizure typec | ||||
Clinical only | 3 (7.7%) | 2 (9.5%) | 1 (5.6%) | 0.375 |
Electrographic only | 17 (43.6%) | 7 (33.3%) | 10 (55.6%) | |
Clinical and electrographic | 19 (48.7%) | 12 (57.1%) | 7 (38.9%) |
Areas | Number (%) of positive MRIs | Sensitivity | Specificity | PPV | NPV | Positive LR | Negative LR |
---|---|---|---|---|---|---|---|
Splenium | 26 (21.1%) | 53.85% | 94.05% | 80.77% | 81.44% | 9.05 | 0.49 |
Cortex | 34 (27.6%) | 58.97% | 86.90% | 67.65% | 82.02% | 4.50 | 0.47 |
Deep gray matter | 22 (17.9%) | 41.03% | 92.86% | 72.73% | 77.23% | 5.74 | 0.64 |
Subcortical white matter | 27 (22.0%) | 43.59% | 88.10% | 62.96% | 77.08% | 3.66 | 0.64 |
Any change | 50 (40.7%) | 69.23% | 72.62% | 54.00% | 83.56% | 2.53 | 0.42 |
Seizure | Lowest pH < 7.1 | APGAR ≤5 at 5 min | APGAR ≤5 at 10 min | |
---|---|---|---|---|
Splenium | 36.649, P < 0.001 | 0.238, N.S. | 1.678, N.S. | 6.543, P < 0.05 |
Cortex | 28.029, P < 0.001 | 0.493, N.S. | 1.497, N.S. | 8.585, P < 0.01 |
Deep gray matter | 26.819, P < 0.001 | 0.005, N.S. | 3.251, N.S. | 7.652, P < 0.01 |
Subcortical white matter | 15.607, P < 0.001 | 5.117, P < 0.05 | 0.885, N.S. | 0.832, N.S. |
Any change | 19.335, P < 0.001 | 0.027, N.S. | 1.962, N.S. | 6.458, P < 0.05 |
Normal/no delays (N = 21) | Moderate delays (N = 11) | Severe delays (N = 4) | P | |
---|---|---|---|---|
Splenium signal abnormality | ||||
Yes | 3 (42.9%) | 1 (14.3%) | 3 (42.9%) | < 0.05 |
No | 18 (62.1%) | 10 (34.5%) | 1 (3.4%) | |
Seizure | ||||
Yes | 5 (50.0%) | 1 (10.0%) | 4 (40.0%) | < 0.01 |
No | 16 (61.5%) | 10 (38.5%) | 0 (0.0%) | |
Apgar 5 min | ||||
≤ 5 | 15 (55.6%) | 8 (29.6%) | 4 (14.8%) | 0.471 |
> 5 | 6 (66.7%) | 3 (33.3%) | 0 (0.0%) | |
Apgar 10 min | ||||
≤ 5 | 7 (58.3%) | 3 (25.0%) | 2 (16.7%) | 0.830 |
> 5 | 13 (61.9%) | 6 (28.6%) | 2 (9.5%) | |
Lowest blood pH | ||||
< 7.1 | 19 (59.4%) | 9 (28.1%) | 4 (12.5%) | 1.110 |
≥ 7.1 | 2 (50.0%) | 2 (50.0%) | 0 (0.0%) |
Normal/no delays (N = 9) | Moderate delays (N = 2) | Severe delays (N = 3) | P | |
---|---|---|---|---|
Splenium signal abnormality | ||||
Yes | 2 (66.7%) | 1 (33.3%) | 0 (0.0%) | 0.438 |
No | 16 (76.2%) | 2 (9.5%) | 3 (14.3%) | |
Seizure | ||||
Yes | 6 (75.0%) | 1 (12.5%) | 1 (12.5%) | 1.000 |
No | 12 (75.0%) | 2 (12.5%) | 2 (12.5%) | |
Apgar 5 min | ||||
≤ 5 | 14 (70.0%) | 3 (15.0%) | 3 (15.0%) | 0.449 |
> 5 | 4 (100.0%) | 0 (0.0%) | 0 (0.0%) | |
Apgar 10 min | ||||
≤ 5 | 9 (81.8%) | 1 (9.1%) | 1 (9.1%) | 0.777 |
> 5 | 9 (69.2%) | 2 (15.4%) | 2 (15.4%) | |
Lowest blood pH | ||||
< 7.1 | 18 (75.0%) | 3 (12.5%) | 3 (12.5%) | 0.578 |
≥ 7.1 | 4 (80.0%) | 0 (0.0%) | 1 (20.0%) |