Abstract
Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method.
Highlights
Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children
While magnetic resonance imaging (MRI) is very useful for predicting the consequences of PA, it cannot be performed in an Intensive Care Unit (ICU), so it is not suitable for assessing neonatal brain damage during therapeutic hypothermia (TH) treatment
In newborns with PA treated with TH, we examined the correlation between Thermal Index (TI) and the MRI, which is an approved marker of hypoxic-ischemic encephalopathy (HIE)
Summary
Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. The proposed method, with roots in heat transfer theory, takes into account more factors influencing the heat transfer and employs only the non-invasive thermal measurements Following this methodology, a Thermal Index (TI) is proposed in order to early assess the degree of brain damage in newborns after PA treated with TH. The aim of the presented pilot study is to evaluate the usefulness of this method in clinical practice For this purpose, in newborns with PA treated with TH, we examined the correlation between TI and the MRI, which is an approved marker of HIE. We examined the correlation between MRI and other popular markers of PA, such as Apgar score, pH, AspAt, AlAt, CK-MB and HSTNT to find out if TI is a better-suited marker of brain damage
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