Details
Category: Volume 09 Issue 01 January 2021
Hits: 1382

Title: Correlation between Cranial Ultrasonography Findings in Term Neonates with Perinatal Asphyxia and Severity of Hypoxic Ischaemic Encephalopathy

Authors: Bidyut Bhusan Nath, Anupama Deka, Arindam Ganguly

 DOI: https://dx.doi.org/10.18535/jmscr/v9i1.05

Abstract

Introduction: Perinatal asphyxia leading to Hypoxic Ischemic Encephalopathy is a dreaded neurological disease of the newborn. The pattern of injury in brain imaging has crucial implications in therapies and predicted neurodevelopmental outcomes. Concurrent use of cranial ultrasound and clinical staging systems are evolving to predict the prognosis.

Objective: To study the cranial ultrasonographic finding in neonates with perinatal asphyxia and its clinical correlation.

Method: It is a prospective observational study of 100 term neonates with perinatal asphyxia admitted in the Neonatal ICU of Silchar Medical College & Hospital. Cranial Ultrasonography was done within 3-7 days of life.

Result: Correlation of initial cranial USG grading with mortality showed an increasing trend, as the USG grading increases, with 50 % and 80% mortality in cases presenting with Grade III & Grade IV intra-cranial hemorrhage respectively.

Conclusion: The cranial USG findings in asphyxiated neonates, when done within 3-7 days of life, reveal strong positive correlation with the severity of HIE. Ideally, MRI brain should be performed on all neonates with HIE but due to cost effectiveness and easy availability cranial USG can be used for initial assessment.

Keywords: HIE, Cranial USG, Intra-cranial hemorrhage, Perinatal asphyxia.

References

  1. Kurinczuk JJ, White-Koning M, Badawi N: Epidemiology of neonatal encephalopathy and hypoxic-ischemic encephalopathy. Early Hum Dev 2010; 86: 329–338.
  2. Marlow N, Budge H. Prevalence, causes, and outcome at 2 years of age of new-born encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2005;90:F193-4.
  3. Pierrat V, Haouari N, Liska A, Thomas D, Subtil D, Truffert P. Prevalence, causes, and outcome at 2 years of age of new-born encephalopathy: population based study. Arch Dis Child Fetal Neonatal Ed. 2005;90:F257-61.
  4. Barkovich AJ. Brain and spine injuries in infancy and childhood. In: Barkovich AJ, eds. Pediatric Neuroimaging: 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005: 190-290.
  5. Ellis M, Manandhar DS, Wyatt J, Bolam AJ, Costello AM. Stillbirths and neonatal encephalopathy in Kathmandu, Nepal: an estimate of the contribution of birth asphyxia to perinatal mortality in a low-income urban population. Paediatr Perinat Epidemiol. 2000;14:39-52.
  6. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375:1969-87.
  7. Nelson KB, Leviton A. How much of neonatal encephalopathy is due to birth asphyxia? Am J Dis Child. 1991;145:132-31.
  8. Sarnat HB, Sarnat MS: Neonatal encephalopathy following fetal distress: A clinical and electroencephalographic study. Arch Neurol 1976; 33: 695-706.
  9. Finer NN, Robertson CM, Richards RT, Pinnell LE, Peters KL. Hypoxic-ischemic encephalopathy in term neonates: perinatal factors and outcome. J Pediatr. 1992; 98:112-7.
  10. Perlman JM. Summary proceedings from the neurology group on hypoxic-ischemic encephalopathy. Pediatrics. 2006;117:S28-33.
  11. Lindström K, Hallberg B, Blennow M, Wolff K, Fernell E, Westgren M. Moderate neonatal encephalopathy: pre- and perinatal risk factors and long-term outcome. Acta Obstet Gynecol Scand. 2008;87:503-9.
  12. Miller SP, Ramaswamy V, Michelson D, Barkovich AJ, Holshouser B, Wycliffe N, Glidden DV, Deming D, Partridge JC, Wu YW, Ashwal S, Ferriero DM: Patterns of brain injury in term neonatal encephalopathy. J Pediatr 2005; 146: 453–460.
  13. Martinez-Biarge M, Bregant T, Wusthoff CJ, Chew AT, Diez-Sebastian J, Rutherford MA, Cowan FM: White matter and cortical injury in hypoxic-ischemic encephalopathy: antecedent factors and 2-year outcome. J Pediatr 2012; 161: 799–807.
  14. Okereafor A, Allsop J, Counsell SJ, Fitzpatrick J, Azzopardi D, Rutherford MA, Cowan FM: Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics 2008; 121: 906–914.
  15. van Kooij BJ, van Handel M, Nievelstein RA, Groenendaal F, Jongmans MJ, de Vries LS: Serial MRI and neurodevelopmental outcome in 9- to 10-year-old children with neonatal encephalopathy. J Pediatr 2010; 157: 221–227.e2.
  16. Margaretha J. Brouwer, Britt J. M. van Kooij, Ingrid C. van Haastert, Corine Koopman-Esseboom, 1Floris Groenendaal, Linda S. de Vries, and Manon J. N. L. Benders Sequential Cranial Ultrasound and Cerebellar Diffusion Weighted Imaging Contribute to the Early Prognosis of Neurodevelopmental Outcome in Preterm Infants PLoS One. 2014; 9(10): e109556.
  17. Papile LA, Burstein R, et al. Incidence and evolution of subependymal and intraventricular haemorrhage: a study of infants. J Pediatr 1978;92(4):529-534.
  18. Zhu L, Zhou C, Liu Y Effect of obstetric factors on neonatal hypoxic-ischemic brain injuries. Zhonghua Fu Chan Ke Za Zhi. 1995 Aug;30(8):463-6.
  19. Prithviraj D, Reddy B, Reddy R, Shruthi B. Neurosonogram in Critically Ill Neonates in Neonatal Intensive Care Unit. Int J Sci Stud 2016;4(1):124-128.
  20. Anand NK, Gupta AK, Lamba IM. Neurosonographic abnormalities in neonates with hypoxic ischemic encephalopathy. Indian Pediatr. 1994 Jul;31(7):767-74.
  21. Bijay Laxmi Malick, Mangal Charan Murmu, and Anil Kumar Mohanty.(2018). Study of Cranial Ultrasound Finding In Hypoxic Ischaemic Encephalopathy in Term Infants And Its Clinical Correlation. International Journal of Research- Granthaalayah, 6(4), 157-165.
  22. Indira Raghupathy et al 1990 Aug cranial ultrasonogram in birth asphyxia Child Trust Hospital, Madras
  23. Correlation between grades of Intra ventricular haemorrhage and severity of HIE in perinatal asphyxia: Khan RH et al Mymensingh Med J 2014.

Corresponding Author

Dr Arindam Ganguly

Deptt. of Paediatrics, Silchar Medical College & Hospital, Assam, India