Therapeutic Hypothermia in Neonates and Selective Hippocampal Injury on Diffusion-Weighted Magnetic Resonance Imaging

Abstract Background Hippocampal injury is most often observed in conjunction with basal ganglia injury after hypoxia-ischemia in term newborns. Objective was to determine perinatal characteristics leading to selective hippocampal injury vs basal ganglia injury on diffusion-weighted imaging in term encephalopathic infants following intrapartum hypoxia-ischemia treated with selective head cooling and to correlate specific injury to subsequent neurodevelopmental outcome. Methods Retrospective chart review of obstetric and/or perinatal risk factors and patient characteristics in term infants treated with selective head cooling. All infants met standard enrollment criteria for cooling. MRI was obtained at a median of 7 days of life. Abnormal outcome was defined as spastic quadriplegia, cognitive delay, both, or death. Results Fifty-seven infants were included for analysis. Diffusion-weighted imaging findings included normal (n = 31), basal ganglia injury (n = 16), and selective hippocampal injury (n = 10). No differences in gestational age, birth weight, sex, or labor complications between groups. More infants in the basal ganglia vs hippocampal group required delivery room cardiopulmonary resuscitation ( P = 0.05), exhibited persistent severe acidosis, severe amplitude electroencephalography suppression, and encephalopathy at birth ( P