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Neuroprognostication in neonatal encephalopathy due to presumed hypoxic-ischemic encephalopathy

Pediatric Research (2025)Cite this article

Abstract

Over the last two decades, significant progress has been made in the management of neonatal encephalopathy due to presumed hypoxic-ischemic encephalopathy. One key area that requires improvement is timely and accurate neuroprognostication in this population to identify infants who may benefit from early interventions and harness the maximum neuroplastic capacity of the developing brain. Improved neuroprognostication also has the potential to foster more effective communication of findings to caregivers. In this review, we explore whether improved neuroprognostication is possible by assessing clinical, biochemical, electrographic, neurophysiological, and neuroimaging biomarkers and their role in neuroprognostication.

Impact statement

  • Over the last two decades, significant progress has been made in the management of neonatal encephalopathy due to presumed hypoxic-ischemic encephalopathy. One key area that requires improvement is timely and accurate neuroprognostication in this population to identify infants who may benefit from early interventions and harness the maximum neuroplastic capacity of the developing brain.

  • In this review article, we discuss general concepts and principles of neuroprognostication and the role of each prognostic marker.

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Fig. 1: Post-rewarming brain MRI of a neonate presenting with hypoxic-ischemic encephalopathy.
Fig. 2: Post-rewarming brain MRI of a neonate with hypoxic-ischemic encephalopathy.
Fig. 3: Post-rewarming brain MRI of a neonate presenting with hypoxic-ischemic encephalopathy.
Fig. 4: Diffusion-weighted brain MR images of neonates with hypoxic-ischemic encephalopathy.

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Funding

No funding was secured for this study. M.N.C. is supported by the Dr. Karen Pape Program in Neuroplasticity for neuroprognostication research.

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Authors and Affiliations

  1. Division of Neonatology, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Mehmet N. Cizmeci

  2. Division of Neurology, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Rhandi Christensen

  3. Willem-Alexander Children’s Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands

    Andrea van Steenis & Linda S. de Vries

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MNC conceptualized the review article, designed the manuscript, analyzed and interpreted the data in the literature, drafted the article, and approved the final version to be published. RC critically reviewed the article and approved the final version to be published. AvS critically reviewed the article and approved the final version to be published. LSdV analyzed and interpreted the data in the literature, critically reviewed the article, and approved the final version to be published.

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Cizmeci, M.N., Christensen, R., van Steenis, A. et al. Neuroprognostication in neonatal encephalopathy due to presumed hypoxic-ischemic encephalopathy. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04058-1

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