The correlation between scores on a standardized neurologic examination at age 9 to 14 months and early MRI findings (within 4 weeks of delivery) was determined in 53 term infants with hypoxic-ischemic encephalopathy evaluated at 2 and 4 year follow-up at Hammersmith Hospital, London, UK. Scans at 1 week after birth were normal in 16 and abnormal in 37. Neurologic scores were optimal in 31 and suboptimal in 22. The maximum Hammersmith optimality global score for neurologic examination of cranial nerves, posture, motion, tone, and reflexes is 78. Scores <40 were associated with severe disability, and between 40 and 67 reflected a restricted mobility. Lowest scores were correlated with severe basal ganglia and white matter lesions on MRI, and intermediate scores with moderate lesions. The neurologic exam was normal in 29 infants, and 35 children could walk independently at age 2 and without restrictions by age 4 year follow-up. Eight had motor restrictions and 10 showed severely limited mobility and sitting at 2 and 4 years. The magnitude of suboptimal scores on neurologic examination at approximately 1 year was related to the pattern of MRI lesions defined soon after birth and was reflective of the functional motor disability and outcome at 2 and 4 years. [1]

COMMENT. A standardized neurologic examination at approximately 1 year of age in an infant suffering hypoxic-ischemic encephalopathy at birth is a useful measure of functional motor outcome in later infancy and early childhood. The examination at 1 year correlates with the MRI findings at or soon after birth.

Prognostic value of EEG and MRI combined in full-term infants with acute encephalopathy. The correlation between an early EEG (within 72 hours after birth) and an MRI (end of 1 week) in assessing outcome of acute neonatal encephalopathy was studied in 25 full-term infants treated at Hammersmith Hospital, London, UK. [2]. Both EEG and MRI were predictive of the outcome at 2 year follow-up. Seven infants with normal EEG background activity and 14 with discontinuous abnormality showed normal and abnormal outcomes, respectively. Eight with normal MRI or minimal abnormalities had a normal outcome, whereas 17 with moderate to severe MRI lesions were moderately to severely impaired neurologically and 5 died.

Hypothermic therapy for hypoxic-ischemic encephalopathy. The neurodevelopmental outcome at 18 month follow-up of 40 term infants with HIE treated with head cooling and systemic hypothermia or standard normothermic care was determined at the National Women’s Hospital, Auckland, New Zealand [3]. The mildly cooled groups showed no worsening of outcome and a trend toward better outcome (26% adverse outcome cf 44% among controls). The authors conclude that the short-term safety of cooling is demonstrated but the long-term efficacy is not proven. Multicenter trials are in progress.