Frequency, severity, and patterns of magnetic resonance imaging abnormalities in neonatal encephalopathy after therapeutic hypothermia and short-term outcomes.

Information on magnetic resonance imaging (MRI) abnormalities in neonatal encephalopathy (NE) is limited in upper middle-income countries, and their association with short-term outcomes. This study aimed to evaluate frequency, severity, and patterns of MRI abnormalities in infants with NE who underwent therapeutic hypothermia (TH), and to assess the association between MRI injury and outcomes. This retrospective study evaluated MRI injuries using the Weeke score in infants with varying NE severity, who were treated with TH between 2017 and 2023. Short-term outcomes assessed included death and length of stay (LOS). Fifty-one infants were included, with 15 having mild NE, 24 with moderate NE, and 12 with severe NE. The median total MRI scores were 3, 3.5, and 9.5 for mild, moderate, and severe NE, respectively. MRI abnormalities were found in 87% of those with mild NE and 83% with moderate or severe NE. Hypoxic-ischemic encephalopathy-related injuries were identified in 60% of infants with mild NE, 54% with moderate NE, and 67% with severe NE. Central grey matter injury was the most predominant pattern, affecting in 31% of infants across all NE severities. Total MRI score was associated with LOS after adjusting for NE severity (β = 0.79, p = 0.02) but not with neonatal death (aOR 1.17; 95% Cl 0.99, 1.39, p = 0.07). MRI abnormalities were identified in 84% of infants across NE severities, with central grey matter injury being most common. The total MRI score was associated with LOS, suggesting its potential in guiding clinical decision-making.