Relationship between volumetric differences in the brain in children with hypoxic ischemic encephalopathy after therapeutic hypothermia.

Dr. Priyadarshini  Subramani; Dr. Karthik  Shunmugavelu

doi:10.51168/sjhrafrica.v3i12.2475

Authors

Dr. Priyadarshini Subramani Assistant Professor, Department of Radiology, PSP medical college hospital and research institute Tambaram Kanchipuram main road Oragadam Panruti Kanchipuram district Tamilnadu 631604 India.
Dr. Karthik Shunmugavelu Assistant Professor, Department of Dentistry, PSP medical college hospital and research institute Tambaram Kanchipuram main road Oragadam Panruti Kanchipuram district Tamilnadu 631604 India

DOI:

https://doi.org/10.51168/sjhrafrica.v3i12.2475

Keywords:

Hypoxic-ischemic encephalopathy, Therapeutic hypothermia, Volumetric MRI, Neurodevelopmental outcomes, Brain injury biomarkers

Abstract

Background

Therapeutic hypothermia (TH) is the standard neuroprotective treatment for moderate-to-severe hypoxic-ischemic encephalopathy (HIE) in neonates. Although TH reduces mortality and severe disability, many survivors develop subtle cognitive, memory and motor impairments later in childhood.

Objective

This systematic review synthesizes evidence on volumetric brain differences detected using magnetic resonance imaging (MRI) in children with HIE treated with therapeutic hypothermia and evaluates associations with neurodevelopmental outcomes.

Methods

A structured search of PubMed/MEDLINE, Embase, Scopus, Web of Science and Google Scholar identified peer-reviewed studies including term or near-term infants with HIE treated with TH that reported quantitative volumetric MRI data and neurodevelopmental outcomes. Study selection followed PRISMA guidelines. Data on imaging timing, segmentation methods, regional brain volumes and outcome correlations were extracted. Methodological quality was appraised using validated tools for observational studies.

Results

Across included cohorts, consistent volumetric alterations were reported in deep gray matter structures, hippocampus, cerebellum, brainstem and global brain volume. In a neonatal cohort, brainstem volume reduction (p < 0.05) and ventricular enlargement (p < 0.01) were associated with abnormal neurodevelopment after TH. At 5-year follow-up, hippocampal volumes were significantly smaller in HIE survivors compared with controls (p = 0.02), with positive correlations between hippocampal volume and memory performance (r = 0.66, p = 0.038). In school-age children without cerebral palsy, reduced hippocampal and thalamic volumes correlated with full-scale IQ (hippocampus r = 0.477, p = 0.010; thalamus r = 0.452, p = 0.016) and motor performance (p < 0.01).

Conclusions

Despite therapeutic hypothermia, measurable regional brain volume differences persist in children with HIE and show statistically significant associations with cognitive and motor outcomes. Volumetric MRI represents a promising quantitative biomarker for injury severity and long-term prognosis; however, methodological standardization and longitudinal validation remain necessary.

Author Biographies

Dr. Priyadarshini Subramani, Assistant Professor, Department of Radiology, PSP medical college hospital and research institute Tambaram Kanchipuram main road Oragadam Panruti Kanchipuram district Tamilnadu 631604 India.

MD (Radiology) is an Assistant Professor in the Department of Radiology at PSP Medical College Hospital and Research Institute, Tamil Nadu, India. Her academic interests include pediatric neuroimaging, perinatal brain injury and advanced MRI applications in neurological disorders.

Dr. Karthik Shunmugavelu, Assistant Professor, Department of Dentistry, PSP medical college hospital and research institute Tambaram Kanchipuram main road Oragadam Panruti Kanchipuram district Tamilnadu 631604 India

BDS, MDS (OMFP), MSc (London) is an Assistant Professor in the Department of Dentistry at PSP Medical College Hospital and Research Institute. He has multidisciplinary academic training and research interests spanning oral medicine, radiologic imaging interpretation and evidence-based healthcare research methodologies.

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