The development and validation of a cerebral ultrasound scoring system for infants with hypoxic-ischaemic encephalopathy

Kim V Annink,Lauren C Weeke,Manon J N L Benders,Maarten Lequin,Floris Groenendaal,Irwin Reiss,Charles C Roehr,Jeroen Dudink,Linda S De Vries,Paul Govaert,Daniel C Vijlbrief

doi:10.1038/s41390-020-0782-0

Abstract

BackgroundHypoxic-ischaemic encephalopathy (HIE) is an important cause of morbidity and mortality in neonates. When the gold standard MRI is not feasible, cerebral ultrasound (CUS) might offer an alternative. In this study, the association between a novel CUS scoring system and neurodevelopmental outcome in neonates with HIE was assessed.Methods(Near-)term infants with HIE and therapeutic hypothermia, a CUS on day 1 and day 3–7 after birth and available outcome data were retrospectively included in cohort I. CUS findings on day 1 and day 3–7 were related to adverse outcome in univariate and the CUS of day 3–7 also in multivariable logistic regression analyses. The resistance index, the sum of deep grey matter and of white matter involvement were included in multivariable logistic regression analyses. A comparable cohort from another hospital was used for validation (cohort II).ResultsEighty-three infants were included in cohort I and 35 in cohort II. The final CUS scoring system contained the sum of white matter (OR = 2.6, 95% CI 1.5–4.7) and deep grey matter involvement (OR = 2.7, 95% CI 1.7–4.4). The CUS scoring system performed well in cohort I (AUC = 0.90) and II (AUC = 0.89).ConclusionThis validated CUS scoring system is associated with neurodevelopmental outcome in neonates with HIE.

Highlights

Hypoxic-ischaemic encephalopathy (HIE) following presumed perinatal asphyxia is an important cause of morbidity and mortality in neonates and can result in long-term neurological sequelae.[1,2]Perinatal asphyxia can be caused by acute or subacute perinatal hypoxia-ischaemia that both correspond with different patterns of brain injury.[3,4] Acute perinatal asphyxia often results in injury of the deep grey nuclei, such as the basal ganglia and thalamus, or even in near-total brain injury.[5]
In the Erasmus Medical Centre, 69 infants with HIE were treated with hypothermia in this period and 35 newborns were included in cohort II
We developed a scoring system to structurally score cerebral ultrasound (CUS) abnormalities in-term infants with HIE

Summary

Introduction

Hypoxic-ischaemic encephalopathy (HIE) following presumed perinatal asphyxia is an important cause of morbidity and mortality in neonates and can result in long-term neurological sequelae.[1,2]Perinatal asphyxia can be caused by acute or subacute perinatal hypoxia-ischaemia that both correspond with different patterns of brain injury.[3,4] Acute perinatal asphyxia often results in injury of the deep grey nuclei, such as the basal ganglia and thalamus, or even in near-total brain injury.[5]. Hypoxic-ischaemic encephalopathy (HIE) following presumed perinatal asphyxia is an important cause of morbidity and mortality in neonates and can result in long-term neurological sequelae.[1,2]. Hypoxic-ischaemic encephalopathy (HIE) is an important cause of morbidity and mortality in neonates. The association between a novel CUS scoring system and neurodevelopmental outcome in neonates with HIE was assessed. The resistance index, the sum of deep grey matter and of white matter involvement were included in multivariable logistic regression analyses. The final CUS scoring system contained the sum of white matter (OR = 2.6, 95% CI 1.5–4.7) and deep grey matter involvement (OR = 2.7, 95% CI 1.7–4.4). CONCLUSION: This validated CUS scoring system is associated with neurodevelopmental outcome in neonates with HIE.

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