Clinicoradiological correlation in birth asphyxia

Basavaraj Patil, Sandeep Harshangi, Bhagya Prabhu

Abstract


Background: Hypoxic Ischemic Encephalopathy (HIE) is the most dreaded neurological disease of the new-born. Assessment of severity of HIE would help proper parent counseling and early institution of stimulation therapy for better development of the infant.

Methods: This study was conducted between December 2012 and May 2014. 37 term neonates with perinatal asphyxia were the subjects. The cranial ultrasound, EEG and MRI findings of these babies are analysed and correlated with each other and with clinical staging and the neurological condition of the babies at discharge.

Results: Among the 37 neonates, 21 were of HIE stage 2 and 16 were of stage 3. Sensitivity of EEG in detecting abnormality in the neurological condition according to our study is 76.9%, specificity 87.5%, positive predictive value 76.9%, negative predictive value 87.5%. Sensitivity of severe pattern of injury in MRI brain in detecting abnormality in neurological condition according to our study is 76.9%, specificity 91.6%, positive predictive value 83.3%, negative predictive value 88%. Involvement of both basal ganglia and cortex in MRI brain had statistically significant correlation with abnormal neurological condition at discharge in our study (P = 0.04).

Conclusion: An abnormal EEG and MRI brain in a term new-born with Hypoxic Ischemic Encephalopathy (HIE) is associated with poor neurological outcome. Involvement of basal ganglia/thalamus and cortex together in the MRI are predictors of abnormal outcome.

 


Keywords


Hypoxic ischemic encephalopathy, Electroencephalogram, Magnetic resonance imaging brain, Cranial ultrasound

Full Text:

PDF

References


Nelson KB, Leviton A. How much of neonatal encephalopathy is due to birth asphyxia? Am J Dis Child. 1991;145:132-31.

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.

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.

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.

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.

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.

Edwards AD, Brocklehurst P, Gunn AJ, Halliday H, Juszczak E, Levene M, et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic-ischaemic encephalopathy: synthesis and meta-analysis of trial data. BMJ. 2010;340:c363.

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.

Perlman JM. Summary proceedings from the neurology group on hypoxic-ischemic encephalopathy. Pediatrics. 2006;117:S28-33.

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.

Sarnat H, Sarnat M. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol. 1976;33(10):696-705.

Shevell MI, Majnemer A, Miller SP. Neonatal neurologic prognostication: the asphyxiated term newborn. Pediatr Neurol. 1999;21(5):776-84.

Thayyil S, Chandrasekaran M, Taylor A, Bainbridge A, Ernest B. Cady, W. K. Kling Chong, et al. Cerebral magnetic resonance biomarkers for predicting neurodevelopmental outcome following neonatal encephalopathy: a meta-analysis. Pediatrics. 2010;125(2):e382-95.

Liauw L, van der Grond J, van den Berg- Huysmans AA, Laan LA, van Buchem MA, van Wezel-Meijler G. Is there a way to predict outcome in (near) term neonates with hypoxic-ischemic encephalopathy based on MR imaging? AJNR Am J Neuroradiol. 2008;29(9):1789-94.

Robertson NJ, Wyatt JS. The magnetic resonance revolution in brain imaging: impact on neonatal intensive care. Arch Dis Child Fetal Neonatal Ed. 2004;89(3):F193-7.

Rutherford M, Srinivasan L, Dyet L, Ward P, Allsop J, Counsell S, et al. Magnetic resonance imaging in perinatal brain injury: clinical presentation, lesions and outcome. Pediatr Radiol. 2006;36(7):582-92.

Barkovich AJ, Miller SP, Bartha A, Newton N, Hamrick SE, Mukherjee P, et al. MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy. AJNR Am J Neuroradiol. 2006;27(3):533-47.

F. Ralph Heinz, James M. Provenzale. A study by Imaging Findings in neonatal hypoxia; a practical review. AJR Am J Roentgenol. 2009;192:41-7.

Daneman A, Epelman M, Blaser S, Jarrin JR. Imaging of the brain in full-term neonates: does sonography still play a role? Pediatr Radiol. 2006;36:636-46.

Blankenberg FG, Loh NN, Bracci P, D’Arceuil HE, Rhine WD, Norbash AM, et al. Sonography CT, and MR imaging: a prospective comparison of neonates with suspected intracranial ischemia and hemorrhage. AJNR Am J Neuroradiol. 2000;21:213-8.

Barkovich AJ. The encephalopathic neonate: choosing the proper imaging technique. AJNR Am J Neuroradiol. 1997;18:1816-20.

Chen Y, Wang ZP, Zhang ZF, Shen ZY. Prognostic value of EEG background in full term neonates with asphyxia. Zhongguo Dang Dai Er Ke Za Zhi. 2007 Oct;9(5):425-8.

Akudo Okereafor, Joanna Allsop, Serena J. Counsell, Julie Fitzpatrick, Denis Azzopardi, Mary A. Rutherford, et al. Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics. 2008;121;906-14.

Barkovich AJ, Hajnal BL, Vigneron D, Sola A, Partridge JC, Allen F, et al. Prediction of neuromotor outcome in perinatal asphyxia: Evaluation of MR scoring systems. AJNR Am J Neuroradiol. 1998;19:143-9.

El-Ayouty M, Abdel-Hady H, El-Mogy S, Zaghlol-H, El-Beltagy M. Prognosis of term infants with Hypoxic ischemic encephalopathy: a clinical, EEG and MRI study. Int J Child Neuropsychiatr. 2005;2:56-73.

Ong LC, Kanaheswari Y, Chandran V, Rohana J, Yong SC, Boo NY. The usefulness of early ultrasonography, electroencephalography, and clinical parameters in predicting adverse outcome in asphyxiated term infants. Singapore Med J. 2009;50:705-9.

El-Ayouty M, Abdel-Hady H, El-Mogy S, Zaghlol H, El-Beltagy M, Aly H. Relationship between electroencephaolography and magnetic resonance imaging findings after hypoxic-ischemic encephalopathy at term. Am J Perinataol. 2007;24:467-73.

Caravale B, Allemand F, Libenson MH. Factors predictive of seizures and neurologic outcome in perinatal depression. Pediatr Neurol. 2003;29:18-25.

Presslan RM, Boylan GB, Morton M, Binnie CD, Rennie JM. Early serial EEG in hypoxic ischemic encephalopathy. Clin Neurophysiol. 2001;112:31-7.

Murray DM, Boylan GB, Ryan CA, Connolly S. Early EEG findings in hypoxic-ischemic encephalopathy predict outcomes at 2 years. Pediatrics. 2009;124:e459-67.

Ezgu FS, Atalay Y, Gucuyener K, Tunc S. Neuron specific enolase levels and Neuroimaging in asphyxiated term new-borns. J Child Neurol. 2002;17:824-9.

Rutherford MA, Pennock JM, Dubowitz LM. Cranial ultrasound and magnetic resonance imaging in hypoxic ischaemic encephalopathy: a comparison with outcome. Dev Med Child Neurol. 1994;36:813-25.

Mercuri E, Ricci D, Cowan FM, Lessing D, Frisone MF, Haataja L, et al. Head growth in infants with hypoxic-ischemic encephalopathy: correlation with neonatal magnetic resonance imaging. Pediatrics. 2000;106(2 Pt 1):235-43.

Barnett A, Mercuri E, Rutherford M, Haataja L, Frisone MF, Henderson S, et al. Neurological and perceptual-motor outcome at 5-6 years of age in children with neonatal encephalopathy: Relationship with neonatal brain MRI. Neuropediatrics. 2002;33:242-8.

Kaufman AS, Miller PS, Ferriero DM, Glidden DH, Barkovich AJ, Partridge JC. Encephalopathy as a predictor of magnetic resonance imaging abnormalities in asphyxiated new-borns. Pediatr Neurol. 2003;28:342-6.

Biagioni E, Mercuri E, Rutherford M, Cowan F, Azzopardi D, Frisone MF, et al. Combined use of electroencephalogram and magnetic resonance imaging in full-term neonates with acute encephalopathy. Pediatrics. 2001;107:461-8.