Neurodevelopmental Outcome at 12 Months in Term Babies with Birth Asphyxia and Correlation with MRI Findings and Neonatal Complications
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 8
Abstract
Hypoxic Ischemic Encephalopathy (HIE) in term neonates is a leading cause of neurological disability worldwide. Survivors of severe HIE have longterm neurological disabilities like cerebral palsy, mental retardation and epilepsy. Several (complications with birth asphyxia) factors in immediate neonatal period are associated with adverse neurological outcome in future. MRI is one of the most sensitive and specific tool for assessing the severity of HIE and predicting the long term neurological outcome. The present study aimed to identify the immediate neonatal complications and MRI findings which are associated with adverse neurological outcome.180 term intramural babies with birth asphyxia were enrolled in the study. They were admitted in NICU and managed according to the protocol of the unit. Any complications during hospital stay were recorded. MRI brain was done in all babies with HIE after 2 weeks of age. At followup visits anthropometric data, immunization details and any other problems were recorded. Discharged cases were linked to follow up outpatient department (OPD) of NICU and one year follow up dates were mentioned in discharge summary. A telephonic remainder was given 48 hours prior to follow up date and cases were followed at 1, 3, 6, 9, 12 months of age. Neurodevelopmental screening was done with DDST II. Hearing screening was done by inhouse audiologist. This study tried to correlate the neonatal complications and MRI findings with neurological outcome of discharged babies. Among 180 intramural babies in study population, 154 (85.5%) babies had signs of HIE. Most common neonatal complication in babies with birth asphyxia was seizures (44.18%). The overall mortality rate was 26.7%. 88 babies completed 1 year followup, of them 71 (80%) babies had normal development and 17 (20%) had delayed development. Neonatal complications like hypoglycaemia, shock, respiratory distress and delayed initiation of direct oral feeds (paladai or breast feeds after 7 days of life) were more commonly associated with adverse neurodevelopmental outcome at one year which was statistically significant (p < 0.05). Fronto-parietal cortical and sub cortical white matter changes (watershed areas) were the common abnormal MRI findings observed in babies with HIE. MRI brain has a sensitivity of 82.4%, specificity of 92%, PPV of 73.7% and NPV of 94.7%, in predicting abnormal neurodevelopmental outcome at 1 year of age. Complications in new-born period like hypoglycaemia, shock and renal failure adversely affect the neurodevelopmental outcome of babies with HIE. MRI changes especially involving basal ganglia and thalamus can predict poor neurodevelopmental outcome with high sensitivity and specificity.
Authors and Affiliations
Dr. D. Manikyamba, Dr. N. Madhavi, Dr. K. T. V. Lakshman Kumar, Dr. M. Srinivasa Reddy, Dr. V. Rajyalakshmi
Keywords
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