Cerebral perfusion-weighted imaging (PWI) in neonates is known to be technically difficult and there are very few published studies on its use in preterm infants. In this paper, we describe one convenient method to perform PWI in neonates, a method only recently used in newborns. A device was used to manually inject gadolinium contrast material intravenously in an easy, quick and reproducible way. We studied 28 newborn infants, with various gestational ages and weights, including both normal infants and those suffering from different brain pathologies. A signal intensity-time curve was obtained for each infant, allowing us to build perfusion maps. This technique offered a fast and easy method to manually inject a bolus gadolinium contrast material, which is essential in performing PWI in neonates. Cerebral PWI is technically feasible and reproducible in neonates of various gestational age and with various pathologies.

PURPOSE:To determine whether an early magnetic resonance imaging (MRI) study using perfusion-weighted imaging (PWI) may define the pattern of brain injury in term neonatal hypoxic-ischemic (HI) encephalopathy. MATERIALS AND METHODS:Five newborns with HI encephalopathy or a marker of perinatal depression, and 2 controls underwent an early MRI (at 2 to 4 days), including PWI. Relative cerebral blood flow (rCBF) values were measured. RESULTS:On early (<or=4 days) PWI-MRI, marked hyperperfusion was seen in areas of HI brain damage, allowing the classification of the children into different patterns according to the predominant site of injury: 1 with a "normal pattern"; 1 with a "watershed pattern" with increased rCBF ratios in white matter; 1 with a "basal ganglia pattern" with increased rCBF ratios in basal ganglia; and 2 with a "total cortical pattern" with increased rCBF ratios in cortical gray matter, white matter, and basal ganglia. These patterns were confirmed in all infants on late (9 to 11 days) conventional MRI (T2-weighted images) (4 of 5 patients) or on postmortem examination (1 of 5 patients). CONCLUSION:PWI is technically feasible in neonates with HI encephalopathy in a reproducible way, permitting comparisons between children. It provides a practical means to identify early after birth the future definitive ischemic areas that may be shown on conventional MRI only later.

Purpose: To illustrate the evolution of brain perfusion-weighted magnetic resonance imaging (PWI-MRI) in severe neonatal hypoxic-ischemic (HI) encephalopathy, and its possible relation to further neurodevelopmental outcome.Materials and Methods: Two term neonates with HI encephalopathy underwent an early and a late MRI, including PWI They were followed until eight months of age. A total of three "normal controls" were also included. Perfusion maps were obtained, and relative cerebral blood flow (rCBF) and cerebral blood volume (rCBV) values were measured.Results: Compared to normal neonates, a hyperperfusion (increased rCBF and rCBV) was present on early scans in the whole brain. On late scans, hyperperfusion persisted in cortical gray matter (normalization of rCBF and rCBV ratios in white matter and basal ganglia, but not in cortical gray matter). Diffusion-weighted imaging (DWI) was normalized, and extensive lesions became visible on T2-weighted images. Both patients displayed very abnormal outcome: Patient 2 with the more abnormal early and late hyperperfusion being the worst.Conclusion: PWI in HI encephalopathy did not have the same temporal evolution as DWI, and remained abnormal for more than one week after injury. This could be a marker of an ongoing mechanism underlying severe neonatal HI encephalopathy. Evolution of PWI might help to predict further neurodevelopmental outcome.

This study’s aim was to assess neurodevelopmental and growth outcome until the age of 4 years of premature infants placed on early nCPAP, in the setting of the neonatal intensive care unit (NICU) and follow-up program of the Division of Neonatology of the Department of Pediatrics of the University Hospital, Lausanne, Switzerland. All consecutive inborn infants weighing <1500 g or <32 weeks of gestational age admitted to the NICU during two periods of 12 months—7.1996–6.1997 and 7.1998–6.1999—were compared before and after the systematic application of early nCPAP. Of 172 infants admitted to the NICU, 150 (87%) survived. 126 (84%) were tested at 6 months’ corrected age, 121 (81%) at 18 months’ corrected age, and 117 (78%) at the age of 4 years. Detailed perinatal data were collected. Follow-up included neurological examination, developmental testing and measurement of growth parameters. Statistical analyses were performed. Early application of nCPAP and avoidance of mechanical ventilation showed no adverse effects on neurodevelopment and growth. A significantly higher developmental quotient was found in the nCPAP group at 18 months’ corrected age. Several trends were also noted in the nCPAP group with a decrease of intraventricular hemorrhage and in “abnormal neurodevelopment” at 6 months corrected age, a bigger head circumference at all different tested ages and a greater height at 6 and 18 months corrected ages. In conclusion, our study of developmental outcome documents the absence of any harmful effect of early application of nCPAP to treat respiratory failure in very low birthweight infants.