Early instrumental predictors of long term neurodevelopmental impairment in newborns with perinatal asphyxia treated with therapeutic hypothermia

Alice Monzani ,Gianluca Cosi ,Giulia Genoni ,Maria Lavrano ,Cinzia Peruzzi ,Roberta Pomella ,Federica Ferrero

doi:10.22514/sv141.042018.14

Abstract

Background. Hypoxic-ischemic encepha-lopathy (HIE) is a leading cause of dis-ability in full-term newborns. Long-term consequences of HIE, even when treated by hypothermia, are not easily predictable. Aims. To assess the potential role of elec-troencephalography and neuroimaging parameters as early predictors of neurode-velopmental outcome in HIE newborns treated with hypothermia.Methods. We retrospectively evaluated 13 HIE patients treated with hypothermia in January 2012-September 2014. We re-viewed their amplitude-integrated electro-encephalography (a-EEG) at 6, 12 and 24 hours (h), cranial ultrasonography (US) at 12, 72 h and >7 days of life (DOL) and brain magnetic resonance (MRI) performed at 7-28 DOL, according to validated scores. aEEG, US and MRI patterns were correlat-ed to neurodevelopmental outcome at 18-24 months, considered as negative if one of the following was present: Mental Devel-opment Index (MDI)<85, motor, visual or hearing impairment.Results. The severity of a-EEG, US and MRI alterations at each time point was not different according to the outcome. MDI was negatively correlated with aEEG score at 12h (R= -0.571, p=0.04) and with US score at 72h (R= -0.630, p=0.02). A positive correlation was found between aEEG score at 6h and US score at >7DOL(R=0.690, p=0.013). US alterations of the cortical matter at 72h were directly corre-lated with a-EEG score at 12h (R = 0.606, p=0.028) and 24h (R=0.605, p=0.029). Conclusions. Early instrumental evalua-tions, in particular aEEG and US, seem to predict neurodevelopmental outcome at 18-24 months in HIE newborns treated with hypothermia.&nbsp

Highlights

Hypoxic-ischemic encephalopathy (HIE), following neonatal asphyxia, is a leading cause of neurological disability in newborns: [1] it can result in serious consequences such as death, cerebral palsy, epilepsy, cognitive, behavioural and developmental deficits. [2,3] Brain damage is an evolutionary process characterized by an acute stage of neuronal necrosis followed by a phase of reperfusion injury characterized by neural apoptosis
We reviewed their amplitude-integrated electroencephalography (a-EEG) at 6, 12 and 24 hours (h), cranial ultrasonography (US) at 12, 72 h and >7 days of life (DOL) and brain magnetic resonance (MRI) performed at 7-28 DOL, according to validated scores. aEEG, US and magnetic resonance imaging (MRI) patterns were correlated to neurodevelopmental outcome at 1824 months, considered as negative if one of the following was present: Mental Development Index (MDI)
This study aimed to analyse the presence of early anomalies detected by a-EEG, cranial US and brain MRI, in neonates undergoing therapeutic hypothermia for HIE, and to assess their potential prognostic value with respect to neurodevelopmental outcomes at 18 -24 months

Summary

Introduction

Hypoxic-ischemic encephalopathy (HIE), following neonatal asphyxia, is a leading cause of neurological disability in newborns: [1] it can result in serious consequences such as death, cerebral palsy, epilepsy, cognitive, behavioural and developmental deficits. [2,3] Brain damage is an evolutionary process characterized by an acute stage of neuronal necrosis followed by a phase of reperfusion injury characterized by neural apoptosis. [3] the aim of this study was to assess the potential role of amplitude-integrated electroencephalography (a-EEG) background patterns, cranial ultrasonography (US) and cerebral magnetic resonance imaging (MRI) findings as early predictors of neurodevelopmental outcome at 18 -24 months in neonates undergoing therapeutic hypothermia for HIE. We retrospectively evaluated 13 HIE patients treated with hypothermia in January 2012-September 2014 We reviewed their amplitude-integrated electroencephalography (a-EEG) at 6, 12 and 24 hours (h), cranial ultrasonography (US) at 12, 72 h and >7 days of life (DOL) and brain magnetic resonance (MRI) performed at 7-28 DOL, according to validated scores. In particular aEEG and US, seem to predict neurodevelopmental outcome at 18-24 months in HIE newborns treated with hypothermia.

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