Ultrasonographic evaluation of brain of newborn with hypoxic- ischaemic encephalopathy treated with anticonvulsant drug

Abstract

Introduction: The most serious consequence of perinatal asphyxia is hypoxic-ischemic encephalopathy (HIE) which causes permanent damage to CNS tissues that may result in neonatal death or manifest later as cerebral palsy or developmental delay. Despite major advances in fetal and neonatal care, hypoxic ischemic encephalopathy (HIE), sometimes called perinatal encephalopathy, continues to cause a significant number of deaths and bong-term disabilities in newborns. Cranial ultrasonography (CUS) in neonates is safe and radiation free. CUS can be initiated even immediately after birth and hence suitable for screening. This investigation is chosen as a tool to detect any early changes that might be a significant predictor of future neurological outcome. Objective: This study was done to identify the ultrasonographic findings of brain of newborn with hypoxic- ischaemic encephalopathy. Methods: A cross sectional study was conducted for ultrasonographic evaluation of brain of newborn with hypoxic ischemic encephalopathy treated with anticonvulsant drug. In this cross sectional study, total 100 neonates were selected according to selection criteria. Parents were interviewed with a specific pre-designed and pre-tested questionnaire and some information was gathered by reviewing the document and observation. Collected data were cleaned, edited and analyzed with the help of software SPSS 17. Results: Among the study subjects majority were delivered within 40 weeks (55.0%) More than one third was delivered within ≥40 weeks (45.0%) More than half of the study subjects were male (63.0%). Average age was 13.6±2.6 (SD) and average birth weight was 2632±94.56 (SD) More than two third of the study subjects had delayed cry after birth (88.0%) and no cry less than one third (12.0%). Respiratory distress was found (66.0%) cases. Half of the subjects had bluish coloration after birth (50.0%). All the patients had convulsion after birth. Majority of the study subjects were lethargic (43.0%). More than one third was in coma (35.0%). Twenty two percent were hyper alert (22.0%). Nearly one third of the study subjects had good activity (30.0%) and good reflexes (31.0%). Majority of the study subjects were hypotonic (70.0%). Hypertonic were 20.0%. Only 10.0% were normal. Less than one third of the study subjects had no HIE (30.0%). Majority of the study subjects were in stage II HIE (67.0%). Stage III and Stage I HIE were found 20.0% and 13.0% cases respectively. Among the study subjects, normal finding in cranial USG was found for 65 (65.0%). Dilatation of the ventricle was found in (15.0%) cases. Periventricular leukomalacia and Intraventricular haemorrhage were 12.0% and 8.0% respectively. No cerebral oedema was detected. Conclusion: Cranial ultrasonography is the most widely used technique for evaluating brain morphology and cerebral lesions in neonates. USG of brain can detect several abnormalities like dilatation of the ventricles, Intraventricular haemorrhage and periventricular leukomalacia in newborn which can lead to fatal neurological outcome in future. These cases are important candidates for early intervention to maximize a better outcome. So this test can be helpful for identification of vulnerable groups and counseling of the parents.