Mild neonatal hypoxic ischemic encephalopathy; 2-7 years follow up of a nation-wide cohort

Introduction: HIE is often clinically suspected in the setting of a known perinatal stress event arising from a complicated or difcult delivery. The most sensitive and specic imaging technique for examining infants with suspected hypoxicischemic brain injury is MR imaging. It also gives information about the timing and specic patterns of injury and also suggest diagnoses other than HIE such as metabolic disorders and developmental disorders of the brain. MRI is also a useful tool in the determination of prognosis and also follow-up of HIE. Aim: This study was undertaken to evaluate the various MRI appearances of hypoxic ischemic encephalopathy in term and preterm neonates and to correlate the MRI appearances with clinical outcome. Materials and Methods: All neonates with history of birth asphyxia, referred for MRI examination to the Department of Radio-Diagnosis, K. R. Hospital attached to Mysore Medical College and Research Institute, during January 2018 to January 2019. All MRI scans were performed on GE optima MR360 1.5 Tesla. Sequences used were T1W axial, T1 FLAIR axial, T2W axial, T2 FLAIR axial, T1W sag, T2W coronal, T2W GRE axial, DWI axial and ADC maps. Results: 30 babies with clinically suspicion of HIE and positive ndings on MR imaging were evaluated in our study. Out of 30 babies, 18 were term and 12 babies were preterm. Periventricular luecomalacia is most common MRI pattern in preterm and central pattern in term neonates. 16 babies had abnormal developmental outcome at 6 months follow up study. 16 babies with diffusion restriction in corpus callosum, 12 had abnormal outcome. 7 out of 10 babies with loss of normal signal in internal capsule had abnormal outcome. Babies with diffusion restriction in basal ganglia had gross developmental delay. Conclusion: MRI is the modality of choice for evaluation of HIE because of excellent gray – white matter resolution, well-depiction of myelination pattern and multi-planar imaging capabilities. There is a strong relation between the MRI appearances of birth asphyxia and the clinical outcome. Therefore MRI has a strong role in prognosticating lesions.

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Early Neurological Assessment in Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia

Journal of Clinical Medicine ◽

10.3390/jcm8081247 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1247

Author(s):

Domenico M. Romeo ◽

Sarah Bompard ◽

Francesca Serrao ◽

Giuseppina Leo ◽

Gianpaolo Cicala ◽

...

Keyword(s):

Neurological Examination ◽

Motor Impairment ◽

Hypoxic Ischemic Encephalopathy ◽

Neurological Assessment ◽

Neurodevelopmental Outcomes ◽

Good Tool ◽

Motor Disabilities ◽

High Risk Infants ◽

Ischemic Encephalopathy

Early neurological assessment in infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia has not been systematically explored. The aims of the present study were to assess whether the Hammersmith Infant Neurological Examination (HINE) is a good tool to predict later neurodevelopmental outcomes at 2 year from birth in this population of infants. A total of 41 term born infants with HIE treated with hypothermia performed the HINE at 12 months and a neurodevelopmental assessment at 24 months. All the infants who had a global HINE score between 67 and 78 were able to walk independently at 2 years and reported a normal developmental quotient; language disorders were observed in a limited number of infants. HINE scores <67 were always associated with motor impairment. In conclusion, the HINE confirms its role as one of the early neurological examination tools for the diagnosis of high risk infants, even in infants with HIE treated with hypothermia. These results can be useful for clinicians involved in the follow up of these infants for early identification of motor disabilities and in planning appropriate intervention.

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Factors associated with follow-up of infants with hypoxic–ischemic encephalopathy in a high-risk infant clinic in California

Journal of Perinatology ◽

10.1038/s41372-020-00898-3 ◽

2020 ◽

Author(s):

Vidya V. Pai ◽

Peiyi Kan ◽

Tianyao Lu ◽

Erika E. Gray ◽

Mihoko Bennett ◽

...

Keyword(s):

High Risk ◽

Hypoxic Ischemic Encephalopathy ◽

High Risk Infant ◽

Factors Associated ◽

Ischemic Encephalopathy

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Profile of hypoxic ischemic encephalopathy in newborns in a tertiary care centre of Bhilai, Chhattisgarh, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20184268 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2032

Author(s):

C. Sudhakar ◽

Pallavi Jindal

Keyword(s):

Tertiary Care ◽

Birth Asphyxia ◽

Hypoxic Ischemic Encephalopathy ◽

Obstetrics And Gynecology ◽

Long Term Outcome ◽

Study Population ◽

One Year ◽

Prospective Longitudinal ◽

Ischemic Encephalopathy

Background: Birth asphyxia is an important cause of static development and neurological handicap in both term and preterm infants. Birth asphyxia is found to be responsible for 28.7% deaths in hospital settings and 20% deaths in rural/tribal areas. Approximately the same number develops serious sequelae which cripples these children both physically and mentally. Children who have suffered moderate encephalopathy had varying rates of infant death and morbidity. Precise determination of the prognosis in the term new born, who sustains a hypoxic ischemic insult is hindered by difficulty in determining the severity of insult.Methods: This was a prospective longitudinal, observational study was conducted in the Department of Paediatrics, CMC Bhilai with close association with the Department of Obstetrics and Gynecology, Department of Radio diagnosis and Department of Neurology. All deliveries taking place in the Department of Obstetrics and Gynecology of CMC Bhilai were enrolled for the study. Each enrolled infant underwent a detailed neurologic examination within the first 12 hours after birth. During the period of data collection 180 babies with birth asphyxia were admitted to NICU. Out of which 126 babies had fulfilled the inclusion criteria and completed one year follow up, hence as cases. Babies who lost follow up were not included in study. The neurological examination was performed 14 days after discharge, then at 1 month, 3-month, 6-month, 9 month and 12 months. Long term outcome in this study is defined as outcome at one year of age in terms of morbidity and mortality.Results: The female and male ratio is 0.4:1. Most of the asphyxiated newborn, 81 (64%) were in 2500-3000gm. Among the study population, maximum number of cases 76 (60%) were suffering from HIE-I. Majority of study population, 87 (69%) were born by LSCS. Normal CUS in 93 babies and abnormal in 33 babies; with normal CUS, there were no death in study population and out of 33 abnormal CUS, 12 deaths occurred. Out of the different complications enlisted in the table convulsions (66.7%) is most common followed by Apnea (65.08%). Recurrent infections (45.24%) is the most common complication followed by seizure disorders (22.63%) and failure to thrive (20.63%).Conclusions: Hypoxic ischemic encephalopathy is one of the major consequences of perinatal asphyxia. Despite of best care, some babies are likely to develop it.

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Neuro developmental outcome of preterm babies with hypoxic ischemic encephalopathy

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192035 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1315

Author(s):

Ramya H. S. ◽

Rajendra Prasad T. C. ◽

Nisar Ahamed A. R. ◽

Muragesh Awati ◽

Maria George

Keyword(s):

Preterm Infants ◽

Stage I ◽

Stage Ii ◽

Hypoxic Ischemic Encephalopathy ◽

Stage Iii ◽

Research Centre ◽

Long Term Outcome ◽

Preterm Babies ◽

Ischemic Encephalopathy

Background: Neonatal encephalopathy, following severe birth asphyxia or perinatal hypoxia is referred to as hypoxic ischemic encephalopathy (HIE). Cerebral ischemia occurs as a consequence of cerebral oedema and reduced cerebral perfusion due to myocardial dysfunction as a result of hypoxic cardiomyopathy. Sarnat stage I -100% recovery, HIE stage II - 80% normal and 20% mortality and HIE stage III - 50% mortality and 50% morbidity. Relatively few studies have been made on outcome in HIE affected preterm infants. The aims and objectives of this study was to find out the neurodevelopmental outcome in preterm infants with HIE.Methods: This study is an observational clinical study, undertaken in Kempegowda Institute of Medical sciences and research centre, Bangalore, India. Study was performed between November 2016 to September 2018. 31 preterm infants with HIE were included in the study. Regular follow-up was done at 3, 6, 9, 12.15, 18 months by using Trivandrum development screening chart (TDSC) to stage II HIE infants.Results: The incidence of abnormal neurological outcome was 12.9%. Out of 31 preterm babies, stage I were 24, stage II was 4 (100% morbidity) and stage III were 3 (100% mortality).Conclusions: In present study, stage II HIE had 100% morbidity and moderate disability, stage III 100% mortality. Thus at 3-5 months of age during follow-up, when authors identify developmental delay, it is an ideal time to start interventional therapy to improve long term outcome.

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Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0391 ◽

2020 ◽

Vol 48 (3) ◽

pp. 296-303

Author(s):

Beate Grass ◽

Simone Scheidegger ◽

Beatrice Latal ◽

Cornelia Hagmann ◽

Ulrike Held ◽

...

Keyword(s):

Neonatal Period ◽

Comprehensive Evaluation ◽

Neurodevelopmental Outcome ◽

Unfavorable Outcome ◽

Hypoxic Ischemic Encephalopathy ◽

National Guidelines ◽

Short Term ◽

Neurological Improvement ◽

Ischemic Encephalopathy

AbstractObjectivesTo evaluate the association of short-term neurological improvement until day of life 4 in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) with neurodevelopmental outcome at 18–24 months.MethodsThis is a retrospective analysis of prospectively collected data of 174 neonates with HIE registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2013. TH was initiated according to national guidelines, and Sarnat staging was performed daily. Short-term neurological improvement was defined if Sarnat stage improved from admission until day 4 of life. Standardized neurodevelopmental assessments were performed at 18–24 months. Unfavorable outcome was defined as death before 2 years of age or severe or moderate disability at follow-up.ResultsOne hundred and sixty-four of 174 neonates (94%) received TH, of those 30 (18%) died in the neonatal period (no late mortality). Eighty-one percent of the survivors (109/134) were seen at 18–24 months. Of the 164 cooled neonates, 62% had a short-term neurological improvement, and the Sarnat score remained unchanged in 33%. Short-term neurological improvement was associated with an odds ratio (OR) of 0.118 [95% confidence interval (CI) 0.051–0.271] for an unfavorable outcome at 18–24 months.ConclusionShort-term neurological improvement predicts neurodevelopmental outcome at 18–24 months in the era of TH. Clinical examination must be part of a comprehensive evaluation for prognostication in HIE.

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A two years follow up of a neonatal hypoxic–ischemic encephalopathy risk population

Early Human Development ◽

10.1016/j.earlhumdev.2008.09.022 ◽

2008 ◽

Vol 84 ◽

pp. S9

Author(s):

Grilo Marta ◽

Espinheira Maria do Céu ◽

Rocha Gustavo ◽

Guedes Beatriz ◽

Guimarães Hercília

Keyword(s):

Hypoxic Ischemic Encephalopathy ◽

Risk Population ◽

Ischemic Encephalopathy

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Magnetic Resonance Imaging Evaluation of Perinatal Hypoxic Ischemic Encephalopathy: An Institutional Experience

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1742157 ◽

2022 ◽

Author(s):

Ravikanth Reddy

Keyword(s):

Magnetic Resonance Imaging ◽

Retrospective Study ◽

Magnetic Resonance ◽

Prognostic Significance ◽

Full Term ◽

Hypoxic Ischemic Encephalopathy ◽

Resonance Imaging ◽

Mri Findings ◽

Ischemic Encephalopathy

Abstract Background Hypoxic–ischemic encephalopathy (HIE) is the most commonly diagnosed neurological abnormality affecting children leading to severe neurological deficits and a cause of neonatal mortality. HIE constitutes a diagnostic challenge in the prematurely born and full-term neonates. HIE causes severe neurological deficit in children and many a times goes unnoticed in early stages. The various patterns of central nervous system (CNS) involvement in HIE are dependent on factors, such as severity and duration of hypoxia, and brain maturity in preterm and full-term patients. Magnetic resonance imaging (MRI) has prognostic significance in detecting patterns of HIE secondary to mild-to-moderate and severe hypoxias and the imaging findings are highly dependent on the time at which imaging is done. MRI helps determine the prognosis of brain development in patients with HIE. Objective This retrospective study elucidates the spectrum of MRI findings in preterm and full-term patients with HIE on MRI. Materials and Methods This retrospective descriptive study was conducted at a tertiary care center between April 2017 and May 2019 on 50 patients with a clinical diagnosis of HIE using a General Electric (GE) 1.5-Tesla MRI scanner. Various patterns of HIE were evaluated on MRI in preterm and full-term patients. Results This retrospective study evaluated MRI findings in 50 infants diagnosed with HIE. Eighteen (36%) were preterm and 32 (64%) were full-term patients. Thirty-five (70%) were male and 15 (30%) were female patients. In the current study, developmental delay was the most commonly associated clinical entity in both preterm and full-term patients. In preterm patients, periventricular leukomalacia was the most prevalent MRI finding, and in full-term patients, subcortical and periventricular white matter hyperintensities on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences were most commonly encountered. Conclusion MRI is the primary imaging modality of choice in preterm and full-term patients with HIE, as it helps determine the severity of hypoxic–ischemic injury by understanding the pattern of brain involvement. In the current study, distinguishable patterns of MRI findings secondary to birth asphyxia and ischemic insult were elucidated in both preterm and full-term patients who are highly dependent on the level of brain maturity at the time of imaging. Regular MRI follow-up has a prognostic significance in HIE with accurate prediction of neurodevelopmental outcome on follow-up studies.

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Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0583 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Laura D. Benz ◽

Peter K. Bode ◽

Simone Brandt ◽

Beate Grass ◽

Cornelia Hagmann ◽

...

Keyword(s):

Neurodevelopmental Outcome ◽

Descriptive Study ◽

Hypoxic Ischemic Encephalopathy ◽

Study Cohort ◽

Placental Pathology ◽

Single Center Experience ◽

Pathologic Findings ◽

Placenta Pathology ◽

Ischemic Encephalopathy

Abstract Objectives Although neonates with moderate to severe hypoxic ischemic encephalopathy (HIE) receive therapeutic hypothermia (TH), 40–50% die or have significant neurological disability. The aim of this study is to analyse the association of placental pathology and neurodevelopmental outcome in cooled neonates with HIE at 18–24 months of age. Methods Retrospective analysis of prospectively collected data on 120 neonates registered in the Swiss National Asphyxia and Cooling Register born between 2007 and 2017. This descriptive study examines the frequency and range of pathologic findings in placentas of neonates with HIE. Placenta pathology was available of 69/120 neonates, whose results are summarized as placental findings. As neonates with HIE staged Sarnat score 1 (21/69) did not routinely undergo follow-up assessments and of six neonates staged Sarnat Score 2/3 no follow-up assessments were available, 42/48 (88%) neonates remain to assess the association between placental findings and outcome. Results Of the 42/48 (88%) neonates with available follow up 29% (12/42) neonates died. Major placenta abnormalities occurred in 48% (20/42). Major placenta abnormality was neither associated with outcome at 18–24 months of age (OR 1.75 [95% CI 0.50–6.36, p=0.381]), nor with death by 2 years of age (OR 1.96 [95% CI 0.53–7.78, p=0.320]). Conclusions In this study cohort there could not be shown an association between the placenta findings and the neurodevelopmental outcome at 18–24 months of age.

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Case series of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy during extracorporeal life support

Perfusion ◽

10.1177/0267659119899521 ◽

2020 ◽

Vol 35 (7) ◽

pp. 700-706

Author(s):

Prasad Bhandary ◽

John M Daniel ◽

Sean C Skinner ◽

Matthew K Bacon ◽

Mina Hanna ◽

...

Keyword(s):

Therapeutic Hypothermia ◽

Life Support ◽

Extracorporeal Life Support ◽

Case Series ◽

Standard Of Care ◽

Hypoxic Ischemic Encephalopathy ◽

Short Term ◽

Ischemic Encephalopathy

Therapeutic hypothermia initiated within 6 hours of birth is currently the standard of care for the management of neonates with hypoxic-ischemic encephalopathy. Neonates undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy are also at risk for severe respiratory failure and need for extracorporeal life support. The risks and benefits of therapeutic hypothermia for hypoxic-ischemic encephalopathy during extracorporeal life support are still not well defined. We report our experience of a case series of six neonates who underwent therapeutic hypothermia for hypoxic-ischemic encephalopathy during extracorporeal life support. We also report long-term neurodevelopmental follow-up from 6 to 24 months and add to the current body of evidence regarding feasibility, clinical experience, and short-term complications.

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