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

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.

Assessing pupil reaction to light using ultrasound in a sick neonate with Hypoxic Ischemic Encephalopathy

2020 ◽  
Vol 13 (4) ◽  
pp. 459-461
Author(s):  
K. Mohammad
Keyword(s):  
Therapeutic Hypothermia ◽  
Neurological Examination ◽  
Simple Technique ◽  
Point Of Care ◽  
Hypoxic Ischemic Encephalopathy ◽  
Point Of Care Ultrasound ◽  
Neurological Assessment ◽  
Sick Neonate ◽  
Pupil Reaction ◽  
Ischemic Encephalopathy

Examining pupil reaction to light is an important component of the neurological examination in infants with hypoxic ischemic encephalopathy (HIE) to determine eligibility for therapeutic hypothermia (TH) and as part of serial neurological assessment for prognostication. Pupil examination can be challenging in critically ill infants with generalized edema. In this paper I report a simple technique using bedside point of care ultrasound to examine the pupil reaction to light in an infant with moderate HIE undergoing therapeutic hypothermia.

MRI IN HYPOXIC ISCHEMIC ENCEPHALOPATHY WITH CLINICAL FOLLOW UP

2021 ◽  
pp. 43-48
Author(s):  
M R Shashikumar ◽  
Narasipur Lingaiah Rajendrakumar ◽  
Sanjay P ◽  
Nanjaraj Chakenalli Puttaraj ◽  
Shruti Shruti ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Mr Imaging ◽  
Developmental Disorders ◽  
Brain Mri ◽  
Birth Asphyxia ◽  
Hypoxic Ischemic Encephalopathy ◽  
Preterm Neonates ◽  
Diffusion Restriction ◽  
Ischemic Encephalopathy

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.

scholarly journals Correlation Between White Matter Injury Identified by Neonatal Diffusion Tensor Imaging and Neurodevelopmental Outcomes Following Term Neonatal Asphyxia and Therapeutic Hypothermia: An Exploratory Pilot Study

2019 ◽  
Vol 34 (10) ◽  
pp. 556-566 ◽  
Author(s):  
Gwendolyn J. Gerner ◽  
Eric I. Newman ◽  
V. Joanna Burton ◽  
Brenton Roman ◽  
Elizabeth A. Cristofalo ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Pilot Study ◽  
Therapeutic Hypothermia ◽  
Diffusion Tensor ◽  
White Matter Injury ◽  
Hypoxic Ischemic Encephalopathy ◽  
Group Differences ◽  
Neurodevelopmental Outcomes ◽  
Ischemic Encephalopathy

Aim: Hypoxic-ischemic encephalopathy is associated with damage to deep gray matter; however, white matter involvement has become recognized. This study explored differences between patients and clinical controls on diffusion tensor imaging, and relationships between diffusion tensor imaging and neurodevelopmental outcomes. Method: Diffusion tensor imaging was obtained for 31 neonates after hypoxic-ischemic encephalopathy treated with therapeutic hypothermia and 10 clinical controls. A subgroup of patients with hypoxic-ischemic encephalopathy (n = 14) had neurodevelopmental outcomes correlated with diffusion tensor imaging scalars. Results: Group differences in diffusion tensor imaging scalars were observed in the putamen, anterior and posterior centrum semiovale, and the splenium of the corpus callosum. Differences in these regions of interest were correlated with neurodevelopmental outcomes between ages 20 and 32 months. Conclusion: Therapeutic hypothermia may not be a complete intervention for hypoxic-ischemic encephalopathy, as neonatal white matter changes may continue to be evident, but further research is warranted. Patterns of white matter change on neonatal diffusion tensor imaging correlated with neurodevelopmental outcomes in this exploratory pilot study.

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 Outcomes of Infants with Mild Hypoxic Ischemic Encephalopathy Who Did Not Receive Therapeutic Hypothermia

2019 ◽  
Vol 4 (3) ◽  
pp. 1-9 ◽  
Author(s):  
Jonathan Reiss ◽  
Mridu Sinha ◽  
Jeffrey Gold ◽  
Julie Bykowski ◽  
Shelley M. Lawrence
Keyword(s):  
Therapeutic Hypothermia ◽  
Severe Disease ◽  
Significant Risk ◽  
Brain Magnetic Resonance Imaging ◽  
Adverse Outcomes ◽  
Hypoxic Ischemic Encephalopathy ◽  
Neurodevelopmental Outcomes ◽  
Specific Patient ◽  
Increased Risk ◽  
Ischemic Encephalopathy

Introduction: Accurately diagnosing and treating infants with mild forms of hypoxic ischemic encephalopathy (HIE) is important, as the majority of neonates with signs and symptoms of HIE after birth do not meet clinical criteria for moderate or severe disease. Emerging evidence, however, suggests that infants with mild HIE (mHIE) have an increased risk for neurodevelopmental impairment (NDI). Methods: This retrospective descriptive study examined all inborn infants ≥35 week’s gestational age at a single, level III neonatal intensive care unit (NICU) in California between January 1, 2012, and December 31, 2015. International Classification of Diseases codes were used as a proxy to identify neonates with mHIE but who did not receive therapeutic hypothermia (TH). Short- and long-term neurodevelopmental outcomes were documented, including abnormal (1) brain magnetic resonance imaging within 10 days of birth suggestive of HIE, (2) electroencephalogram with electrographic seizures, (3) neurologic discharge examination, or (4) NDI following NICU discharge. Results: Over the 4-year study period, 25 infants met inclusion criteria. Eight of 25 (32%) infants demonstrated neurologic impairment, defined by an abnormality in at least one of the four categories. The remaining 17 infants were without documented evidence for adverse outcomes. Conclusion: Our results indicate that children with mHIE are at significant risk for neurologic injury and may benefit from more aggressive interventions. Further prospective studies should be completed to determine the efficacy of TH in this specific patient population.

The Use of Whole Body Cooling in the Treatment of Hypoxic-Ischemic Encephalopathy

2017 ◽  
Vol 36 (5) ◽  
pp. 273-279 ◽  
Author(s):  
Tiffany Harriman ◽  
Wanda T. Bradshaw ◽  
Stephanie M. Blake
Keyword(s):  
English Language ◽  
Current Treatment ◽  
Hypoxic Ischemic Encephalopathy ◽  
Whole Body ◽  
Neurodevelopmental Outcomes ◽  
Near Term ◽  
Body Cooling ◽  
Whole Body Cooling ◽  
Ischemic Encephalopathy

AbstractHypoxic-ischemic encephalopathy (HIE) is a major cause of morbidity and mortality in neonates. Hypoxic-ischemic encephalopathy occurs as a result of a perinatal hypoxic-ischemic event just prior to or during delivery. Therapeutic hypothermia using whole body cooling is the current treatment of choice to reduce brain injury and improve long-term neurodevelopmental outcomes for neonates with HIE. All English language articles published since 2005 in PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were analyzed for existing evidence-based methods for whole body cooling. Whole body cooling is effective in the treatment of HIE in term and near-term neonates. Further research is needed to investigate the use of adjunctive therapies in conjunction with whole body cooling for improved neuroprotection.

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