scholarly journals Predictive value of color doppler neuro-sonography for the development of neurological sequels in newborn infants with hypoxic ischemic encephalopathy

2011 ◽  
Vol 68 (10) ◽  
pp. 825-831
Author(s):  
Brankica Vasiljevic ◽  
Svjetlana Maglajlic-Djukic ◽  
Sanja Stankovic ◽  
Dragana Lutovac ◽  
Miroslava Gojnic
Keyword(s):  
Predictive Value ◽  
Color Doppler ◽  
Newborn Infants ◽  
Neurodevelopmental Outcome ◽  
Staging System ◽  
Hypoxic Ischemic Encephalopathy ◽  
Clinical Staging ◽  
Neurodevelopmental Outcomes ◽  
Significant Difference ◽  
Ischemic Encephalopathy

Background/Aim. The use of color Doppler neurosonography (cD-US) allows simultaneous examination of parenchymal and vascular cerebral structures. Evaluation of cerebral blood flow velocities (CBFV) and vascular resistance are important in assessment of cerebral circulation in neonates with hypoxic ischemic encephalopathy (HIE). The aim of this study was to evaluate the predictive value of cD-US for abnormal neurodevelopmental outcome in the neonates with HIE. Methods. A total of 90 neonates (>32 weeks gestational age) with HIE were enrolled prospectively. All the neonates with HIE were categorized into three grades according to the Sarnat and Sarnat clinical staging system: mild HIE, moderate HIE, and severe HIE. cD-US was performed simultaneously during the first 24 h of life. Neurodevelopment outcome was assessed at 12 months of age in all the neonates. Resluts. The values of CBFV and the values of index resistance (RI) correlated with the severity of HIE (p < 0.0001) and subsequent neurodevelopmental outcome (p < 0.001). We detected a significant difference in values of CBFV and in values of RI between preterm and full-term neonates (p < 0.01). The cut-off value of RI for poor neurodevelopmental outcomes was 0.81. Conclusions. cD-US could be very useful and safe diagnostic tool for assessing severity of HIE and subsequent adverse neurodevelopmental outcome.

scholarly journals Effect of Elevated Temperature on Immediate Neurodevelopmental Outcome in Term Neonates with Hypoxic-Ischemic Encephalopathy

2019 ◽  
Vol 9 (3) ◽  
pp. 160-165
Author(s):  
Bithi Debnath ◽  
Naila Zaman Khan ◽  
Dilara Begum ◽  
Asma Begum Shilpi ◽  
Shaheen Akter
Keyword(s):  
Elevated Temperature ◽  
Rectal Temperature ◽  
Neurodevelopmental Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Neurodevelopmental Outcomes ◽  
Term Infants ◽  
Term Neonates ◽  
Risk Of Death ◽  
The Mean ◽  
Ischemic Encephalopathy

Background: Among term infants, hypoxic-ischemic encephalopathy due to acute perinatal asphyxia remains an important cause of neurodevelopmental deficits in childhood. Treatment is currently limited to supportive intensive care, without any specific brain-oriented therapy. Objective: To determine whether the risk of death or moderate/severe neurodevelopmental impairment in term infants with hypoxic-ischemic encephalopathy increases with relatively high skin or rectal temperature between 12 and 72 hours of birth. Materials and Methods: This was a prospective observational study. Asphyxiated newborns who came within 12 hours of birth were enrolled in this study. Both axillary and rectal temperature were recorded 6 hourly for 72 hours and each infant`s temperature for each site were rank ordered. Then mean of all axillary and rectal temperatures of each neonate was calculated. Outcomes were related to temperatures in logistic regression analyses for the elevated/relatively high temperatures and normal/low temperatures group, with adjustment of the level of encephalopathy and gender. Results: The mean axillary temperature was 36.07 ± 6.10C and in 25.71%, 11.92% and 6.32% cases axillary temperatures were >370C, >37.50C and >380C respectively. The mean rectal temperature was 36.8 ± 60C, and in 43.53%, 30.02% and 19.97% cases rectal temperatures were >370C, >37.50C and >380C respectively. Mean ambient temperature was 26.170C. There was significant correlation between axillary and rectal temperatures (r=0.889). For elevated temperature, the odds of death or moderate to severe impairment increased 8.9-fold (CI 0.906–88.18) and the odds of death alone increased 4.6-fold (CI 0.373–56.83). The odds of impairment increased 1.84-fold (CI 0.45– 7.50). Conclusion: Relatively high temperature during usual care after hypoxic-ischemia in term neonates was associated with adverse neurodevelopmental outcomes. J Enam Med Col 2019; 9(3): 160-165

scholarly journals Magnetic resonance imaging and spectroscopy in evaluation of hypoxic ischemic encephalopathy in pediatric age group

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Fatma Ibrahim Soliman Elshal ◽  
Walid Ahmed Elshehaby ◽  
Mahmoud Abd elaziz Dawoud ◽  
Ekhlas Abdelmonem Shaban
Keyword(s):  
White Matter ◽  
Basal Ganglia ◽  
Magnetic Resonance ◽  
Motor Development ◽  
Perinatal Asphyxia ◽  
Neurodevelopmental Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Resonance Spectroscopy ◽  
Significant Difference ◽  
Ischemic Encephalopathy

Abstract Background Hypoxic ischemic encephalopathy is a major cause of pediatric mortality and morbidity, with possible long-term neurologic sequel, such as cerebral palsy. With improvements in care of at-risk neonates, more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. The aim of the study was to assess the additive role of magnetic resonance spectroscopy over conventional MRI in diagnosis and early prediction of pathological motor development in neonates with hypoxic ischemic encephalopathy. Results MRS ratios showed significant difference between unfavorable and normal outcome infants. MRS ratios as Lac/Cr, NAA/Cr and NAA/Cho within basal ganglia, thalamus and white matter can significantly differentiate between patients with normal and pathological outcome at 1 year. Lac/Cr positively correlates with the severity of HIE. Both NAA/Cr and NAA/Cho negatively correlate with the severity of the disease. Ratios cutoff values as Lac/Cr above 0.38 and 0.42 in basal ganglia and white matter, respectively, NAA/Cr below 0.9 and 0.8 in basal ganglia and occipital white matter, respectively, and NAA/Cho below 0.29 and 0.31 in basal ganglia and frontal white matter, respectively, were significantly predictive of pathological outcome. Conclusion High Lac/Cr, low NAA/Cr and low NAA/Cho ratios within examined regions of the brain including deep grey matter nuclei as well as white matter are associated with an adverse outcome in infants with perinatal asphyxia. MRS is an accurate quantitative MR biomarker within the neonatal period for prediction of neurodevelopmental outcome after perinatal HIE. MRS may be useful in early clinical management decisions, and counseling parents thereby ensuring appropriate early intervention and rehabilitation.

scholarly journals Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions

2021 ◽  
Vol 22 (13) ◽  
pp. 7121
Author(s):  
Kelly Q. Zhou ◽  
Alice McDouall ◽  
Paul P. Drury ◽  
Christopher A. Lear ◽  
Kenta H. T. Cho ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Newborn Infants ◽  
Developing Brain ◽  
Hypoxic Ischemic Encephalopathy ◽  
Neurodevelopmental Outcomes ◽  
High Quality ◽  
Future Directions ◽  
Phenobarbital Administration ◽  
The Impact ◽  
Ischemic Encephalopathy

Seizures are common in newborn infants with hypoxic-ischemic encephalopathy and are highly associated with adverse neurodevelopmental outcomes. The impact of seizure activity on the developing brain and the most effective way to manage these seizures remain surprisingly poorly understood, particularly in the era of therapeutic hypothermia. Critically, the extent to which seizures exacerbate brain injury or merely reflect the underlying evolution of injury is unclear. Current anticonvulsants, such as phenobarbital and phenytoin have poor efficacy and preclinical studies suggest that most anticonvulsants are associated with adverse effects on the developing brain. Levetiracetam seems to have less potential neurotoxic effects than other anticonvulsants but may not be more effective. Given that therapeutic hypothermia itself has significant anticonvulsant effects, randomized controlled trials of anticonvulsants combined with therapeutic hypothermia, are required to properly determine the safety and efficacy of these drugs. Small clinical studies suggest that prophylactic phenobarbital administration may improve neurodevelopmental outcomes compared to delayed administration; however, larger high-quality studies are required to confirm this. In conclusion, there is a distinct lack of high-quality evidence for whether and to what extent neonatal seizures exacerbate brain damage after hypoxia-ischemia and how best to manage them in the era of therapeutic hypothermia.

scholarly journals Evaluation of the role of ischemia modified albumin in neonatal hypoxic-ischemic encephalopathy

2020 ◽  
Vol 63 (8) ◽  
pp. 329-334
Author(s):  
Mohamed A. Talat ◽  
Rabab M. Saleh ◽  
Mohammed M. Shehab ◽  
Naglaa A. Khalifa ◽  
Maha Mahmoud Hamed Sakr ◽  
...  
Keyword(s):  
Cord Blood ◽  
Predictive Value ◽  
Hypoxic Ischemic Encephalopathy ◽  
Renal Diseases ◽  
Control Group ◽  
Cord Blood Sample ◽  
Ischemia Modified Albumin ◽  
Significant Difference ◽  
History Of ◽  
Ischemic Encephalopathy

Background: Birth asphyxia is a leading cause of neonatal mortality. Ischemia-modified albumin (IMA) levels may have a predictive role in the identification and prevention of hypoxic disorders, as they increase in cases of ischemia of the liver, heart, brain, bowel, and kidney.Purpose: This study aimed to assess the value of IMA levels as a diagnostic marker for neonatal hypoxic-ischemic encephalopathy (HIE).Methods: Sixty newborns who fulfilled 3 or more of the clinical and biochemical criteria and developed HIE as defined by Levene staging were included in our study as the asphyxia group. Neonates with congenital malformation, systemic infection, intrauterine growth retardation, low-birth weight, cardiac or hemolytic disease, family history of neurological diseases, congenital or perinatal infections, preeclampsia, diabetes, and renal diseases were excluded from the study. Sixty healthy neonates matched for gestational age and with no maternal history of illness, established respiration at birth, and an Apgar score ≥7 at 1 and 5 minutes were included as the control group. IMA was determined by double-antibody enzymelinked immunosorbent assay of a cord blood sample collected within 30 minutes after birth.Results: Cord blood IMA levels were higher in asphyxiated newborns than in controls (250.83±36.07 pmol/mL vs. 120.24±38.9 pmol/mL). Comparison of IMA levels by HIE stage revealed a highly significant difference among them (207.3±26.65, 259.28±11.68, 294.99±4.41 pmol/mL for mild, moderate, and severe, respectively). At a cutoff of 197.6 pmol/mL, the sensitivity was 84.5%, specificity was 86%, positive predictive value was 82.8%, negative predictive value was 88.3%, and area under the curve was 0.963 (<i>P</i><0.001).Conclusion: IMA levels can be a reliable marker for the early diagnosis of neonatal HIE and can be a predictor of injury severity.

scholarly journals Early Biomarkers and Hearing Impairments in Patients with Neonatal Hypoxic–Ischemic Encephalopathy

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2056
Author(s):  
Da-Yang Chen ◽  
Inn-Chi Lee ◽  
Xing-An Wang ◽  
Swee-Hee Wong
Keyword(s):  
Blood Lactate ◽  
Predictive Factors ◽  
Serum Glucose ◽  
Hypoxic Ischemic Encephalopathy ◽  
Clinical Staging ◽  
Hearing Impairments ◽  
Neurodevelopmental Outcomes ◽  
Glucose Levels ◽  
Brain Anomalies ◽  
Ischemic Encephalopathy

Identifying biomarkers for hearing impairments (HIs) in patients with neonatal hypoxic–ischemic encephalopathy (HIE), to initialize early hearing habilitation, is crucial. Seventy-eight neonates with HIE were divided into the following two groups: those with HIs and those without HIs. We compared those patients with 11,837 newborns without HIE, and analyzed the risk factors of HIs among neonatal HIE. Of the 78 patients, 11 were confirmed to have an HI, which is a substantially higher percentage than in the 11,837 newborns without HIE (14.1% vs. 0.87%; p < 0.001). More patients with moderate-to-severe HIE had confirmed HIs (p = 0.020; odds ratio, 8.61) than those with mild HIE. Clinical staging, and blood lactate and glucose levels could be predictive factors for HIs among patients with HIE. The patients who exhibited HIs had significantly higher lactate (104.8 ± 51.0 vs. 71.4 ± 48.4; U = 181, p = 0.032) and serum glucose (159.5 ± 86.1 vs. 112.1 ± 62.3; U = 166, p = 0.036) levels than those without HIs. A higher prevalence of HIs was noted in the patients with stage III HIE than those with stage II HIE (43.8% vs. 10%; p = 0.008). The degree of HI correlated with brain anomalies and neurodevelopmental outcomes at 1 year of age. Clinical staging, and blood lactate and glucose levels could be predictive factors for HIs among patients with HIE.

scholarly journals Predictors of Outcomes in Hypoxic-Ischemic Encephalopathy following Hypothermia: A Meta-Analysis

Neonatology ◽  
2020 ◽  
Vol 117 (4) ◽  
pp. 411-427 ◽  
Author(s):  
Sabine Ouwehand ◽  
Lisanne C.A. Smidt ◽  
Jeroen Dudink ◽  
Manon J.N.L. Benders ◽  
Linda S. de Vries ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Therapeutic Hypothermia ◽  
Meta Analysis ◽  
Neurodevelopmental Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Resonance Spectroscopy ◽  
Test Accuracy ◽  
Neurodevelopmental Outcomes ◽  
Posterior Limb ◽  
Ischemic Encephalopathy

<b><i>Introduction:</i></b> Prediction of neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy remains an important challenge. Various studies have shown that the predictive ability of different modalities changed after the introduction of therapeutic hypothermia. This paper reviews the diagnostic test accuracy of the different modalities that are being used to predict neurodevelopmental outcomes following therapeutic hypothermia. <b><i>Methods:</i></b> A systematic literature search was performed using Embase and PubMed. Two reviewers independently included eligible studies and extracted data. The quality of the studies was assessed using the Quality in Prognosis Studies Tool. Meta-analyses were performed where possible. <b><i>Results:</i></b> Forty-seven articles and 3 conference abstracts were included, reporting on 3,072<i></i>infants of whom 39% died or had an adverse neurodevelopmental outcome. A meta-analysis could be performed using 37 articles on (amplitude-integrated) electroencephalography (EEG), conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and proton magnetic resonance spectroscopy (<sup>1</sup>H-MRS). Amplitude-integrated EEG (aEEG) at 24 and 72 h showed similar high diagnostic OR, while aEEG at 6 h and EEG performed less, both due to a low specificity. For MRI, most studies reported scoring systems in which early (&#x3c;8 days) MRI performed better than late (≥8 days) MRI. Injury to the posterior limb of the internal capsule on MRI or to the thalami on DWI were strong individual predictors, as was an increased lactate/N-acetylaspartate peak on <sup>1</sup>H-MRS. <b><i>Conclusions:</i></b> In the era of therapeutic hypothermia, the different modalities remain good predictors of neurodevelopmental outcome. However, timing should be taken into account. aEEG may initially be false positive and gets more reliable after 24 h. In contrast, MRI should be used during the first week, as its predictive value decreases afterwards.

scholarly journals Severity and immediate neurodevelopmental outcome in term neonates with hypoxic-ischemic encephalopathy admitted in NICU at a tertiary hospital in Bangladesh

2021 ◽  
Vol 9 (1) ◽  
pp. 22-27
Author(s):  
Bithi Debnath ◽  
Naila Zaman Khan ◽  
Rumana Mahfuz ◽  
Abid Hossain Mollah
Keyword(s):  
Assessment Tool ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Neurodevelopmental Outcome ◽  
Hypoxic Ischemic Encephalopathy ◽  
Neurological Deficits ◽  
Care Hospital ◽  
Neurodevelopmental Outcomes ◽  
Term Neonates ◽  
Ischemic Encephalopathy

Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a major cause of mortality, morbidity and long-term neurological deficits. Objective: The aim of the study was to determine the severity of encephalopathy and immediate neurodevelopmental outcomes in term neonates with HIE admitted in NICU at a tertiary care hospital. Materials and Methods: This was a Prospective Cohort study conducted between July 2016 and June 2017 at Dhaka Medical college Hospital, Dhaka. Asphyxiated term newborns who came within 12 hours of birth were enrolled in this study. Sarnat and Sarnat score was used to assess newborns immediately after birth to classify HIE. Neurodevelopmental assessment was performed using age specific rapid neurodevelopmental assessment tool (RNDA) at and 3 months after discharge to identify impairment in specific developmental domains. We determined the relation between severity of HIE and clinical outcome. Results: 60 patients were included in this study and their mean duration of hospital stay was 7.19 ± 5.26 days. The majority, 40% had moderate HIE, followed by 33.33%, 26.67% that had mild and severe HIE respectively. A total of 20% died, and most of them had severe HIE (83.33%). Normal development was found in only 11.67% cases. Moderate and severe neurodevelopmental impairment (NDI) was found in 33.33% and 25% cases respectively. At discharge, the most severely impaired domains were speech, seizure, primitive reflex and behaviour whereas at 3 months of age it was gross motor and seizure. When neurodevelopmental outcome was compared with different stages of encephalopathy, significant association was found between moderate to severe impairment/death with stage III of HIE. Conclusion: Apart from mortality, a significant proportion of term neonates with HIE developed NDIs and adverse neurodevelopmental outcomes was significantly associated with severity of encephalopathy. Bangladesh Crit Care J March 2021; 9(1): 22-27

scholarly journals Mammillary body atrophy and other MRI correlates of school-age outcome following neonatal hypoxic-ischemic encephalopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kim V. Annink ◽  
Linda S. de Vries ◽  
Floris Groenendaal ◽  
Rian M. J. C. Eijsermans ◽  
Manouk Mocking ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Memory Function ◽  
Neurodevelopmental Outcome ◽  
Standard Of Care ◽  
Hypoxic Ischemic Encephalopathy ◽  
School Age ◽  
Brain Volumes ◽  
Mammillary Bodies ◽  
Memory Problems ◽  
Ischemic Encephalopathy

AbstractThe mammillary bodies (MB) and hippocampi are important for memory function and are often affected following neonatal hypoxic ischemic encephalopathy (HIE). The aim of this study was to assess neurodevelopmental outcome in 10-year-old children with HIE with and without therapeutic hypothermia. Additional aims were to assess the associations between MB atrophy, brain volumes (including the hippocampi), white matter microstructure and neurodevelopmental outcome at school-age. Ten-year-old children with HIE were included, who were treated with therapeutic hypothermia (n = 22) or would have qualified but were born before this became standard of care (n = 28). Children completed a neuropsychological and motor assessment and MRI. Mammillary bodies were scored as normal or atrophic at 10 years. Brain volumes were segmented on childhood MRI and DTI scans were analysed using tract-based spatial statistics. Children with HIE suffered from neurocognitive and memory problems at school-age, irrespective of hypothermia. Hippocampal volumes and MB atrophy were associated with total and performance IQ, processing speed and episodic memory in both groups. Normal MB and larger hippocampi were positively associated with global fractional anisotropy. In conclusion, injury to the MB and hippocampi was associated with neurocognition and memory at school-age in HIE and might be an early biomarker for neurocognitive and memory problems.

Development and Evaluation of Computable Phenotypes in Pediatric Epilepsy:3 Cases

2021 ◽  
pp. 088307382110195
Author(s):  
Sabrina Pan ◽  
Alan Wu ◽  
Mark Weiner ◽  
Zachary M Grinspan
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Juvenile Myoclonic Epilepsy ◽  
Myoclonic Epilepsy ◽  
Hypoxic Ischemic Encephalopathy ◽  
Pediatric Epilepsy ◽  
Health Record ◽  
Treatment Resistant ◽  
Ischemic Encephalopathy ◽  
F Measure

Introduction: Computable phenotypes allow identification of well-defined patient cohorts from electronic health record data. Little is known about the accuracy of diagnostic codes for important clinical concepts in pediatric epilepsy, such as (1) risk factors like neonatal hypoxic-ischemic encephalopathy; (2) clinical concepts like treatment resistance; (3) and syndromes like juvenile myoclonic epilepsy. We developed and evaluated the performance of computable phenotypes for these examples using electronic health record data at one center. Methods: We identified gold standard cohorts for neonatal hypoxic-ischemic encephalopathy, pediatric treatment-resistant epilepsy, and juvenile myoclonic epilepsy via existing registries and review of clinical notes. From the electronic health record, we extracted diagnostic and procedure codes for all children with a diagnosis of epilepsy and seizures. We used these codes to develop computable phenotypes and evaluated by sensitivity, positive predictive value, and the F-measure. Results: For neonatal hypoxic-ischemic encephalopathy, the best-performing computable phenotype (HIE ICD-9 /10 and [brain magnetic resonance imaging (MRI) or electroencephalography (EEG) within 120 days of life] and absence of commonly miscoded conditions) had high sensitivity (95.7%, 95% confidence interval [CI] 85-99), positive predictive value (100%, 95% CI 95-100), and F measure (0.98). For treatment-resistant epilepsy, the best-performing computable phenotype (3 or more antiseizure medicines in the last 2 years or treatment-resistant ICD-10) had a sensitivity of 86.9% (95% CI 79-93), positive predictive value of 69.6% (95% CI 60-79), and F-measure of 0.77. For juvenile myoclonic epilepsy, the best performing computable phenotype (JME ICD-10) had poor sensitivity (52%, 95% CI 43-60) but high positive predictive value (90.4%, 95% CI 81-96); the F measure was 0.66. Conclusion: The variable accuracy of our computable phenotypes (hypoxic-ischemic encephalopathy high, treatment resistance medium, and juvenile myoclonic epilepsy low) demonstrates the heterogeneity of success using administrative data to identify cohorts important for pediatric epilepsy research.

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