PREDICTION OF CEREBRAL-PALSY IN HIGH-RISK NEONATES - A TECHNETIUM-99M-HMPAO SPECT STUDY

In infants who have experienced prenatal or perinatal injury, it is often difficult, on the basis of clinical examination and conventional investigations (electroencephalogram, cranial ultrasound scan), to diagnose those with brain damage and to predict the type and the severity of subsequent neurological handicaps. We investigated the predictive value of Tc-99m-HMPAO brain SPECT performed in the first weeks of life in high-risk neonates. Right-left asymmetries in tracer uptake had no predictive value, regardless of their localization or severity. On the other hand, a change in antero-posterior rCBF distribution was found in 7/10 of neonates with adverse outcome (death, major neurological sequelae) and in none of the 78 neonates with no major motor neurological sequelae. Compared to conventional investigations, Tc-99m-HMPAO brain SPECT did not provide additional predictive information when neurological examination, electroencephalogram and cranial ultrasonography were all normal or all abnormal. Conversely, in the 30 patients with anomalies on one or two of the above investigations, SPECT showed an abnormal antero-posterior pattern in 4/6 neonates with major neurological sequelae and no change in the antero-posterior rCBF distribution in the 24 infants who developed normally. In conclusion, our results suggest that Tc-99m-HMPAO brain SPECT, when performed in the first weeks of life, can be useful in high-risk neonates to predict occurrence of major neurological handicaps. Because of the relative invasive character of HMPAO scan in neonates and the overall accuracy of the noninvasive tests, radionuclide examination should not be performed in every high-risk neonate. According to our results, Tc-99m-HMPAO brain SPECT might be indicated in those children where noncongruent results were obtained with conventional studies.