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Brain imaging as a predictor of neurodevelopmental outcomes in neonatal encephalopathy

Pediatric Research (2025)Cite this article

Neonatal encephalopathy (NE) encompasses a spectrum of abnormal neurological functions in newborns resulting from heterogeneous etiologies, including perinatal stroke, infection, inborn errors of metabolism, and genetic disorders. Hypoxic-ischemic encephalopathy (HIE) remains the predominant cause of NE, with an incidence of approximately 1.7 per 1000 live term or near-term births in high-income settings1 and rates as high as 8 per 1000 in low- and middle-income countries (LMICs).2 Brain magnetic resonance imaging (MRI) remains the modality of choice for characterizing both the pattern and severity of brain injury and is routinely employed by clinicians to assist in prognosticating neurological outcomes.3

In their consensus statement for the European Society for Paediatric Research (ESPR), Laptook et al.4 comprehensively reviewed the current evidence regarding the application of brain MRI in the management of NE. The authors recommend the inclusion of T1-weighted, T2-weighted, diffusion-weighted imaging (DWI), and magnetic resonance spectroscopy (MRS) sequences as standard components of neuroimaging protocols. These sequences best characterize the etiology and severity of NE, and can differentiate primary HIE injury patterns such as watershed, deep grey nuclei and near-total injury. Furthermore, they emphasize the necessity of harmonizing the timing of MRI acquisition in order to detect as the full extent of injury accurately. This is due to the natural evolution of HIE, with DWI changes most evident at 3 days after injury with pseudonormalization of diffusion restriction afterwards. Adoption of these strategies has been demonstrated to enhance both prognostic accuracy and prediction of neurodevelopmental outcomes at two years of age.5,6

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Authors and Affiliations

  1. Department of Pediatrics, University of British Columbia and BC Children’s Hospital Research Institute, Vancouver, BC, Canada

    Kia Anarna, Dawn Gano & Thiviya Selvanathan

  2. BC Women’s Hospital, Vancouver, BC, Canada

    Kia Anarna

  3. Department of Neurology, University of California, San Francisco, CA, USA

    Dawn Gano

  4. Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Thiviya Selvanathan

Authors
  1. Kia Anarna
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  2. Dawn Gano
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  3. Thiviya Selvanathan
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Correspondence to Thiviya Selvanathan.

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Competing interests

K.A. is supported by the Hudson Family Trainee Program at BC Children’s Hospital. D.G. serves on the Editorial Board of Pediatric Research. D.G. and T.S. receive support from BC Children’s Hospital Research Institute.

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Anarna, K., Gano, D. & Selvanathan, T. Brain imaging as a predictor of neurodevelopmental outcomes in neonatal encephalopathy. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04696-5

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