Role of grayscale transcranial ultrasound in the diagnosis of neonatal hypoxic–ischemic encephalopathy: a clinical audit study

Abstract

Background Neonatal hypoxic–ischemic encephalopathy (HIE) is still accounts for a significant percentage of mortality and morbidity in the neonates. Transcranial ultrasound (US) is the investigation of choice for the initial assessment of these cases. Aim To evaluate the practice of transcranial US in the diagnosis of suspected cases of neonatal HIE in the ICU of Assiut University Hospital (AUH). Patients and methods This clinical audit study was conducted during the period from April 2017 till June 2018 (first audit cycle about 13 months and second audit cycle about 2 months) in the ICU in AUH on neonates who underwent transcranial US for the diagnosis of neonatal HIE. Six criteria were set and were measured with 40 indicators with a 100% standard set for each indicator. Results The study included 110 neonates (90 in the first audit cycle and 20 in the second audit cycle). The adherence to the audit criteria was about 17.5% in the first audit cycle and 25% in the second audit cycle, which indicates that there was just a slight improvement in the second audit cycle. Conclusion Transcranial US is the modality of choice in the initial evaluation of suspected cases of neonatal HIE. Adherence to the audit criteria of this study in the neonatal ICU of AUH fell below expected standards in both the audit cycles with a slight improvement in the second audit cycle. Further reauditing is recommended.