Encéphalopathie hypoxo-ischémique du nouveau-né à terme. Apport de l'électroencéphalogramme et de l'IRM ou de la TDM à l'évaluation pronostique. À propos de 26 observations

Abstract

Hypoxic-ischemic encephalopathy in the term newborn. Contribution of the electroencephalogram and magnetic resonance imaging (MRI) or computed tomography (CTS) to the prognostic assessment. A review of 26 cases. Objectives – Perinatal asphyxia complicated by hypoxic ischemic brain injury still remains the source of neurological lesions often serious and definitive. A major aim of neonatologists is to appreciate the severity of the hypoxic ischemic brain injury in the first days of life and to evaluate the forecast. The purpose of this work is to establish a relation between clinical signs, EEG, neuroimaging (MRI and CTS) and neurodevelopment. Materials and methods – 26 neonates from paediatric resuscitation unit (Hospital North, Marseille) were enrolled in a retrospective study since February 1994 to December 1997. All the newborns had at least one anamnestic criteria of perinatal asphyxia, an early electroencephalogram in the first two days of life and another between the third and the seventh day of life, and neuroimaging in the first 15 days of life: CTS in five cases and MRI in 21 cases. Results – There was a good electroclinic ( P: 0.01) and prognostic ( P: 0.03) correlation in patients within stage 3 of the “Sarnat classification”. In the stage 2, the EEG did not provide valuable information about severity of the injury, and neuroimaging (especially MRI) allowed better prognosis. Diffuse brain injury or lesions of basal ganglia in MRI were associated, independently of clinical settings and EEG tracings, with a poor neurodeveloppemental outcome ( P: 0.02). The MRI was diagnostic in four cases of congenital encephalopathy complicated with neonatal suffering. Conclusion – Our study confirms the interest of the association of clinical settings, EEG tracings and MRI in the diagnosis and the pronostic of the hypoxic-ischemic encephalopathy in term neonate.