Basilar artery flow velocities and optic nerve sheath diameter as adjuvant tools for early diagnosis of hypoxic ischemic encephalopathy in neonates.

Abstract

OBJECTIVE: We investigated potentiality ultrasonography measured optic nerve sheath diameter (ONSD) and basilar artery (BA) velocities to identify neonates with HIE-requiring-TH. METHODS: Study was of a case-control-design. Thirty- five neonates with mild-to-severe HIE admitted to NICU of Alexandria-University-Maternity-Hospital and were monitored by ultrasound-measured ONSD and BA velocities, in first-12-hours, during TH, and after rewarming. First scan measures of patients were compared to healthy-control-neonates. Comparative statistics, ROC-curves, and correlation of different clinical and imaging parameters were used in analysis. RESULTS: Mean value of left-and-right-ONSD measurements in control group (0.31 cm, 0.30 cm, respectively) were significantly higher than asphyxiated-group (0.35 cm), with p-value<0.001. ONSDs of > 0.32 cm in right-and-left eyes carry 91% and 88% sensitivity, respectively, and 100% specificity in identifying patients with mild-to-severe HIE. Resistive index (RI) of BA decreased and EDV of BA increased in HIE-patients than healthy-control-neonates, with p value<0.001. Left-and-right-ONSD diameters are negatively correlated with BA-RI, with r=-.432; p < .01and r=-.34; P.046, respectively. ONSDs in both eyes, BA-RI and BA-EDV showed significant changes throughout three time points in HIE-patients. CONCLUSION: ONSD and BA-velocities can help in early identification of asphyxiated-neonates and therefore can be used to select patients candidate for TH. They also help in monitoring of asphyxiated-patient before, during and after TH.