Cerebral Deoxyhemoglobin Imaging A biomarker for poor neurological

Cerebral Deoxyhemoglobin Imaging A biomarker for poor neurological outcomes in neonates who suffered hypoxic ischemic brain injury Austin Trinh MD, Brenda Bartnik-Olson Ph. D, Matthew Phelps BS, Daniel Kido MD, Paul Jacobson MD, Paggie Kim MD

Hypothesis 1. Absent and extremely prominent cerebral veins on SWI are associated with poor neurological outcomes in neonates who suffered hypoxic ischemic brain injury (HI-BI)

Secondary Aims 2. Does hypothermia therapy have an affect on this relationship? Do the cerebral venous appearances differ between the hypothermia and nonhypothermia patients?

Background 1 -2 neonates per 1000 live births High mortality and morbidity rate

SWI Studies have shown that increased levels of deoxygenated blood is seen with HI-BI Sequence is particularly sensitive at detecting extravascular blood products and deoxygenated blood

POV Scores 1 2 3 4

POV Scores 5 6 7

Normal Abnormal

Outcomes Measurement Poor Outcomes Death Seizure

Data Collection Inclusion Criteria Exclusion Criteria 77 patients

Statistical Analysis Fischer’s Exact Test and Student t-test Cochron-Mantel-Haenszel Cool and Noncooled

Results n=77 (%) Mean Age +/- SD (days) 8 +/-3. 75 Hypothermia Therapy 37 (48. 1) Abnormal prominence of veins score 19 (24. 7) Diagnosis of seizure disorder 38 (49. 3) Death 9 (11. 7)

Results Cooled n=37 (%) Non-cooled n=40 (%) p-value 8. 6 +/- 4. 1 7. 4 +/-3. 3 0. 16 Abnormal prominence of veins score 3 (8. 1) 24 (60) <0. 001 Death 3 (8. 1) 6 (15) 0. 48 18 (48. 7) 20 (50) 1. 00 Mean Age +/- SD (days) Diagnosis of seizure disorder

Results p value: <. 001 100% 90% 80% 70% 60% Good Outcomes Poor Outcomes 50% 40% 30% 20% 10% 0% Abnormal POVS Normal POVS

Results Poor Outcomes Good Outcomes Abnormal POVS 16 3 Normal POVs 28 30 Odds Ratio (95% CI) p-value 5. 71 (1. 5 -21. 7) <0. 001

Results 18 14 16 12 14 10 12 8 Poor Outcomes 10 Poor Outcomes Good Outcomes Normal Outcomes 6 OR: 6. 07 [1. 3627. 05] 4 2 8 OR: 7. 80 [1. 78 -34. 2] 6 4 2 0 0 Abnormal POVS Noncooled Abnormal POVS Normal POVS Cooled p-value =0. 50

Discussion In our subject population, there was an association with abnormal POV with outcomes. Non-cooled neonates who suffered HI-BI have more abnormal POV appearance as compared to cooled neonates. Hypothermia therapy does appear to affect the association.

Conclusion Abnormal POV score is associated with poor outcomes in neonates with HIBI. Potential biomarker in this population with potential to guide future HIBI therapies.

References 1. Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early human development 2010; 86: 329 -38. 2. Fatemi A, Wilson MA, Johnston MV. Hypoxic-ischemic encephalopathy in the term infant. Clinics in perinatology 2009; 36: 835 -58, vii. 3. Corbo ET, Bartnik-Olson BL, Machado S, et al. The effect of whole-body cooling on brain metabolism following perinatal hypoxic-ischemic injury. Pediatric research 2012; 71: 85 -92.

Poor Outcomes Good Outcomes Odds Ratio (95% CI) Abnormal POVS 16 3 Normal POVs 28 5. 71 (1. 5 21. 7) 30 p-value Adjusted Odds Ratio (95% CI) p-value <0. 001 7. 32 (1. 7 -30. 5) <0. 001 The adjusted odds ratio and 95%CL were calculated using logistic regression analysis, adjusting for hypothermia therapy. The association between POVS and outcomes was tested using Fisher’s Exact test. Statistical significance was defied at p <0. 05 level.