Diffusion-weighted MRI and urinary Activin-A are potential predictors of severity in neonates with hypoxic ischemic encephalopathy

Abstract

BackgroundEarly diagnosis and treatment are important to reduce neonatal morbidity and mortality occurring from hypoxic ischemic encephalopathy (HIE). ObjectiveWe aimed to correlate between urinary Activin-A and MRI (conventional and diffusion-weighted) and the degree of HIE according to Sarnat and Sarnat staging. MethodsSixty full term neonates (37–42 weeks) selected from Minia University hospital for children from May 2014 to July 2016 were enrolled into the study. We measured urinary Activin-A using enzyme immunoassay and MRI using MRI scanner (Philips Achieva) and correlations between urinary Activin-A and MRI with the degree of HIE were done. ResultsNeonates with HIE had higher levels of urinary Activin-A than controls (P < .001) and it was positively correlated with the clinical grading of HIE at cutoff value of 0.08 µg/l on day-1 after birth with a sensitivity 98.2% and specificity 97.1% for prediction of HIE. DW-MRI detected HIE with a high sensitivity (85%) compared to the low sensitivity of conventional MRI (35%). Apparent diffusion coefficient (ADC) value of ≤0.8 was the best sensitivity-specificity cutoff point for detecting severe ischemic injury. DW-MRI imaging was positively correlated with the urinary Activin-A and both of them were positively correlated with the degree of HIE (P < .001). ConclusionsDW-MRI imaging is correlated well with urinary Activin-A in full-term neonates with HIE and both of them are correlated with the degree of HIE. Early determination of urinary Activin-A combined with DW-MRI imaging can early detect HIE and its degree of severity in full-term neonates with HIE.