Perinatal asphyxia in fullterm infants: Do general movements and magnetic resonance predict the outcome?

Notwithstanding progress in perinatal-neonatal medicine, perinatal asphyxia has not disappeared. Nowadays, it can be observed in 0.5-2‰ of term-born infants; it is associated with a high rate of mortality and a wide range of disabilities. The link among perinatal asphyxia, hypoxic ischemic encephalopathy (HIE) and neuromotor outcome is complex. In the recent years, progress in cerebral magnetic resonance imaging (MRI) and in the spontaneous movement of the newborn led to a better comprehension of the pathogenesis and evolution of this event. Three major novelties were recently defined: first, the possibility of neuroprotection through hypothermia; second, the definition of the structure and the function of the brain through different MRI techniques; third, general movements (GMs) as an early marker of cerebral injury and predictors of later cerebral palsy (CP). Term-born infants present 2 typical patterns of cerebral injury: the most common affects basal ganglia and thalami (BGT), sometimes with cortical and white matter (WM) involvement; the other is limited to WM with or without cortical injury. The outcome depends on the extension, site and severity of the damage. Lesions other than these should cast doubt on the diagnosis of perinatal asphyxia, MRI in the neonatal period is therefore of relevance for medico-legal purposes. As for the prognosis, it is important to evaluate the severity of the HIE according to the three stages of Sarnat, the severity of abnormal electroencephalogram and the type of GMs abnormalities. MRI and sequential observation of GMs (abnormal developmental trajectories) are complementary tools for predicting motor outcome and for selecting infants who require early rehabilitation.