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Am J Perinatol 2022; 39(10): 1124-1131
DOI: 10.1055/s-0040-1721692
Original Article

Intrapartum Basal Ganglia–Thalamic Pattern Injury and Radiologically Termed “Acute Profound Hypoxic–Ischemic Brain Injury” Are Not Synonymous

Johan Smith
1   Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
,
Regan Solomons
1   Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
,
Lindi Vollmer
2   Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
,
Eduard J. Langenegger
2   Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
,
Jan W. Lotz
3   Division of Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
,
Savvas Andronikou
4   Department of Radiology, the Children's Hospital of Philadelphia and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
,
John Anthony
5   Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
,
Ronald van Toorn
1   Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Abstract

Objective Human cases of acute profound hypoxic-ischemic (HI) injury (HII), in which the insult duration timed with precision had been identified, remains rare, and there is often uncertainty of the prior state of fetal health.

Study Design A retrospective analysis of 10 medicolegal cases of neonatal encephalopathy-cerebral palsy survivors who sustained intrapartum HI basal ganglia-thalamic (BGT) pattern injury in the absence of an obstetric sentinel event.

Results Cardiotocography (CTG) admission status was reassuring in six and suspicious in four of the cases. The median time from assessment by admission CTG or auscultation to birth was 687.5 minutes (interquartile range [IQR]: 373.5–817.5 minutes), while the median time interval between first pathological CTG and delivery of the infant was 179 minutes (IQR: 137–199.25 minutes). The mode of delivery in the majority of infants (60%) was by unassisted vaginal birth; four were delivered by delayed caesarean section. The median (IQR) interval between the decision to perform a caesarean section and delivery was 169 minutes (range: 124–192.5 minutes).

Conclusion The study shows that if a nonreassuring fetal status develops during labor and is prolonged, a BGT pattern HI injury may result, in the absence of a perinatal sentinel event. Intrapartum BGT pattern injury and radiologically termed “acute profound HI brain injury” are not necessarily synonymous. A visualized magnetic resonance imaging (MRI) pattern should preferably solely reflect the patterns description and severity, rather than a causative mechanism of injury.

Key Points

  • BGT HI injury pattern on MRI may develop in the absence of a perinatal sentinel event.

  • BGT pattern injury may not be synonymous with “acute profound HI brain injury.”

  • MRI pattern and severity thereof should be described rather than a causative mechanism of injury.

Keywords

hypoxic–ischemic encephalopathy - acute profound - basal ganglia thalamus injury pattern - cerebral palsy

Authors' Contribution

J.S., R.S., and R.v.T. contributed to conceptualization, data collection, data analysis and/or data interpretation, drafting, revision, and approval of the final manuscript. L.V., S.A., and J.A. contributed to data collection, data analysis and/or data interpretation, drafting, revision, and approval of the final manuscript. E.J.L. and J.W.L. contributed to data collection, data analysis and/or data interpretation, revision, and approval of the final manuscript.


Note

The study was approved by the Health Research Ethics Committee of Stellenbosch University (HREC no.: C20/02/005).




Publication History

Received: 21 September 2020

Accepted: 04 November 2020

Article published online:
15 December 2020

© 2020. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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