Mahmoud Abdelreheem & Hassanein Moustafa from UK review the paper 'Li Y, Wisnowski JL and Chalak L, et al. Mild hypoxic-ischemic encephalopathy (HIE): timing and pattern of MRI brain injury. Pediatr Res. 2022 Dec;92(6):1731-1736. doi: 10.1038/s41390-022-02026-7. Epub 2022 Mar 30. PMID: 35354930; PMCID: PMC9771796.' for EbNeo.Read Here!ACTA Commentary:Acta Paediatrica - 2025 - Abdelreheem - EBNEO Commentary Mild Hypoxic Ischemic Encephalopathy HIE Timing and Pattern of.pdf"Neonatal hypoxic-ischaemic encephalopathy (HIE) remains one of the leading causes of neonatal mortality and long-term disability worldwide. Infants with mild HIE, representing 50% of all HIE cases, are often perceived as low risk, with excellent prognosis and no long-term disability. However, recent studies have shown that one-quarter of infants with mild HIE have abnormal outcomes defined as death, motor impairment, or developmental delay at follow-up up to 18 months [1].This study examines the evolution and spatial distribution of brain injuries on MRI in neonates with mild HIE. It addresses a significant gap in literature and has important implications for early diagnosis, prognosis, and treatment strategies. Brain parenchymal injury was present in 87 (61%) infants, and intracranial hemorrhage was observed in 60 (42%) infants.The authors recruited 142 neonates, although only 125 were included in certain analyses, likely due to incomplete imaging. This transparent reporting enhances the credibility of the findings by ensuring that the data analyzed were of high quality. This study highlights how subtle brain injuries evolve over time, confirming that early detection may allow for timely interventions [2, 3]. Moreover, this study explores brain injury patterns, revealing that even mild HIE can cause noticeable changes in brain structure. Identifying these patterns is vital, as it helps clinicians differentiate HIE-related changes from other neonatal brain pathologies. This informs clinical decisions, including whether to consider therapeutic hypothermia (TH) in borderline cases [4]. Additionally, the study’s use of advanced MRI techniques underscores the potential of neuroimaging as both a diagnostic and prognostic tool in neonatal care.However, the study has limitations, notably the small number of infants who did not receive TH, which may limit the generalizability of the findings. The authors also acknowledge variability in MRI protocols across institutions, the lack of EEG data, and potential selection bias toward initiating TH in more severely affected infants within the mild HIE spectrum. Notably, there have been no randomized controlled trials evaluating the efficacy of TH in mild HIE, and many centers continue to question its utility in this population.Clinically, the implications of this work are twofold. First, it emphasizes the need to monitor neonates with mild HIE, as subtle injuries may have long-term neurodevelopmental consequences. Second, it supports incorporating MRI into routine evaluation, facilitating identification of infants who could benefit from neuroprotective interventions. The findings also advocate for further studies to evaluate the efficacy of TH and other therapeutic agents, leading to individualized management strategies for affected infants [5, 6].In summary, this study delivers a well-designed investigation that enhances our understanding of mild HIE. It lays the groundwork for future research aimed at optimizing the timing of neuroimaging and improving outcomes through early intervention. The study serves as a reminder that even mild insults to the neonatal brain warrant careful attention due to their potential to impact long-term development [7]. Future studies with larger cohorts and standardized imaging protocols are needed to confirm these observations and refine MRI timing in mild HIE cases."
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