Abstract
Introduction. Prediction of outcome in HIE could be very useful in counselling parents and selecting patients for possible therapeutic intervention. To compare the predictive performance of various diagnostic tools for identifying infants at risk of developing neurological sequelae we are performing a prospective follow-up study in newborns with HIE.
Patients and methods. Newborns fulfilling the following criteria are eligible: 1)GA >=38 wks, 2) heart rate abnormalities during labour and/or meconium stained amniotic fluid and/or need for birth resuscitation, 3) 5 min AS <=5 or umbilical artery pH <=7.1 and BE >12 mmol/L. Clinical data were recorded; amplitude integrated EEG (aEEG), EEG, cranial US, 1H-MRS were performed in the neonatal period. Evaluation of general movements, physiatric examination, visual evoked potentials and ABR are scheduled at 3 months of age; psychomotor development (Griffith test) and Dubowitz examination are performed at 3, 6, 12, 24 months of age.
Results. In one year 24 newborns were recruited. In 13 of them follow-up at 6 months is available; 8 newborns are under 6 months, 3 were lost at follow-up. N-acethyl aspartate/Creatine (NAA/Cr) at basal ganglia level in the first 24 hrs of life decreased in newborns with motor impairment (MI) compared to newborns without MI (0.77 vs 0.82, p> 0.05); moreover NAA/Cr showed a good correlation with developmental quotient (DQ) (r=0.88, p>0.05). At 1 week of age NAA/Cr was 0.3 in newborns with MI vs 0.86 in newborns without MI (p<0.01); there was a correlation between NAA/Cr and DQ (r=0.86 p=0.015). Grade HIE, aEEG and US anomalies were also associated with MI (p<0.05); in particular aEEG had a 100% sensitivity and specificity in early identifying newborns with MI.
Discussion: These preliminary data show that Sarnat grading, aEEG and 1H-MRS performed together in the first 24 hours of life can predict outcome in HIE.
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Soffritti, S., Ancora, G., Sandri, F. et al. 356 Proton Mr Spectroscopy (1H-MRS) and Amplitude Integrated Eeg in Predicting Outcome in Newborns Affected by Hypoxic-Ischemic Encephalopathy (HIE). Pediatr Res 58, 415 (2005). https://doi.org/10.1203/00006450-200508000-00385
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DOI: https://doi.org/10.1203/00006450-200508000-00385
