Objective To evaluate the accuracy of neonatal MRI and general movements assessment (GMA) in predicting neurodevelopmental outcomes in infants with hypoxic-ischaemic encephalopathy (HIE). Design Secondary analyses of a randomised controlled trial (RCT). Setting Tertiary neonatal intensive care unit in India. Methods Fifty infants with HIE were included in an RCT of therapeutic hypothermia (25 cooled and 25 non-cooled). All infants underwent brain MRI at day 5, GMA at 10–15 weeks and outcome assessments including Bayley Scales of Infant and Toddler Development, third edition, at 18 months. Associations between patterns of brain injury, presence/absence of fidgety movements (FMs) and outcomes were assessed. Results Seventeen of 47 (36%) had adverse outcome (5 (21%) cooled vs 12 (52%) non-cooled, p=0.025). Eight infants died (four before an MRI, another three before GMA). Two developed severe cerebral palsy and seven had Bayley-III motor/cognitive composite score <85. Twelve (26%) had moderately/severely abnormal MRI and nine (23%) had absent FMs. The positive predictive value (95% CI) of an adverse outcome was 89% (53% to 98%) for moderate/severe basal ganglia and thalami (BGT) injury, 83% (56% to 95%) for absent/equivocal signal in the posterior limb of the internal capsule (PLIC) and 67% (38% to 87%) for absent FMs. Negative predictive values (95% CI) were 85% (74% to 92%) for normal/mild BGT injury, 90% (78% to 96%) for normal PLIC and 86% (74% to 93%) for present FMs. Conclusion(s) Neonatal MRI and GMA predicted outcomes with high accuracy in infants with HIE. The GMA is a feasible low-cost method which can be used alone or complementary to MRI in low-resource settings to prognosticate and direct follow-up. Trial registration number CTRI/2013/05/003693. Data are available on reasonable request. Anonymised data (including data dictionaries) will be made available on request to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal.

中文翻译：

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低收入和中等收入国家缺氧缺血性脑病后 MRI 和全身运动评估结果的预测：来自随机对照试验的数据

目的 评估新生儿 MRI 和全身运动评估（GMA）在预测缺氧缺血性脑病（HIE）婴儿神经发育结局中的准确性。设计 随机对照试验 (RCT) 的二次分析。在印度设置三级新生儿重症监护病房。方法 50 名患有 HIE 的婴儿被纳入治疗性低温的 RCT（25 名冷却和 25 名非冷却）。所有婴儿在第 5 天接受脑部 MRI，在第 10-15 周接受 GMA，并在 18 个月时接受包括贝利婴幼儿发育量表第三版在内的结果评估。评估了脑损伤模式、烦躁运动 (FM) 的存在/不存在与结果之间的关联。结果 47 人中有 17 人 (36%) 出现不良结果（5 人（21%）冷却对比 12 人（52%）未冷却，p=0.025）。八名婴儿死亡（四名在 MRI 前死亡，GMA 之前的另外三个）。2 人发展为严重脑瘫，7 人的 Bayley-III 运动/认知综合评分 <85。12 人 (26%) 有中度/重度 MRI 异常，9 人 (23%) 没有 FM。中度/重度基底节和丘脑 (BGT) 损伤的不良结果的阳性预测值 (95% CI) 为 89%（53% 至 98%），信号缺失/模棱两可的为 83%（56% 至 95%）在内囊后肢 (PLIC) 和 67% (38% 至 87%) 的无 FMs。正常/轻度 BGT 损伤的阴性预测值 (95% CI) 为 85%（74% 至 92%），正常 PLIC 为 90%（78% 至 96%），当前 FM 为 86%（74% 至 93%） . 结论 (s) 新生儿 MRI 和 GMA 可以高度准确地预测 HIE 婴儿的结果。GMA 是一种可行的低成本方法，可在资源匮乏的环境中单独使用或补充 MRI，以预测和直接随访。试验注册号 CTRI/2013/05/003693。可应合理要求提供数据。匿名数据（包括数据字典）将应要求提供给提供方法上合理的建议以用于实现已批准建议目标的研究人员。