Comparison of the efficacy of diffusion weighted magnetic resonance imaging and conventional magnetic resonance imaging in determining the prognosis in newborns with hypoxic ischemic encephalopathy

Abstract

Aim: To investigate the effect of whole body hypothermia on short term neonatal morbidities and long term neurodevelopmental outcome in term neonates with hypoxic ischemic encephalopathy Material and Method: Neonates with perinatal asphyxia and hypoxic ischemic encepholopathy stage 2 and 3 were enrolled Patients were divided into 2 groups according to findings observed on amplitude integrated electroencephalography aEEG Patients with abnormal aEEG pattern in the first six hours after birth were defined as group 1 and others as group 2 Patients in group 1 were treated with whole body hypothermia Neurodevelopmental outcome was evaluated at 18 months of age in survivors using Bayley Scales of Infant Development II Mental developmental index and psychomotor development index scores were calculated Results: Thirty five patients were enrolled M F=17 18 18 51 of whom were treated with hypothermia Bradycardia was observed in 44 4 of patients in group 1 and 5 9 of patients in group 2 p=0 04 Incidence of other possible adverse events related to hypothermia were similar between the two groups Mortality was higher in group 1 p=0 03 In group 1 70 of the patients and in group 2 86 of the patients were evaluated using Bayley Scales of Infant Development II Although patients treated with hypothermia had a higher mental developmental index and psychomotor development index scores the difference was not statistically significant Conclusions: Whole body hypothermia can be safely applied in term neonates with HIE Hypothermia may improve neurodevelopmental outcome Turk Arch Ped 2011; 46: 286 91

Keywords

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Difüzyon ağırlıklı ve konvansiyonel manyetik rezonans görüntülemenin hipoksik iskemik ansefalopatili yenidoğanlarda seyrin belirlenmesindeki etkinliğinin karşılaştırılması

Öz

Amaç: Bu çalışmada hipoksik iskemik ansefalopatili zamanında doğmuş yenidoğanlara tüm vücut soğutma yöntemi ile uygulanan hipotermi tedavisinin hem doğum sonrası erken sorunlara hem de uzun dönem nörogelişimsel sonuçlara olan etkisinin değerlendirilmesi amaçlandı.

Gereç ve Yöntem: Çalışmaya perinatal asfiksi ve hipoksik iskemik ansefalopati evre 2 3 tanılı yenidoğan bebekler alındı Olgular ilk altı saatteki amplitüt entegre elektroansefalogram aEEG bulgularına göre iki gruba ayrıldı; Grup 1: aEEG bulguları anormal olan veya klinik nöbet gözlenen ve hipotermi tedavisi uygulananlar Grup 2: aEEG bulguları normal olan ve hipotermi tedavisi uygulanmayanlar Yaşayan olguların 18 ayda Bayley Gelişim Ölçeği 2 kullanılarak mental gelişim indeksi ve psikomotor gelişim indeksi puanları hesaplandı Çalışma için yerel etik kuruldan onay alındı Onay no:8

Bulgular: Toplam 35 hasta Kız=18 Erkek=17 çalışmaya alındı On sekiz olguya 51 hipotermi tedavisi uygulandı Grup 1 rsquo;deki olguların 44 4 rsquo;ünde grup 2 rsquo;deki olguların ise 5 9 rsquo;unda bradikardi saptandı p=0 04 Diğer klinik bozuklukların görülme sıklığı bakımından gruplar arasında önemli bir fark yoktu Grup 1 rsquo;deki olguların ölüm oranı grup 2 rsquo;den yüksekti p=0 03 Grup 1 rsquo;deki olguların 70 rsquo;i; grup 2 rsquo;deki olguların ise 86 rsquo;sı nörogelişimsel açıdan değerlendirilebildi Hipotermi uygulanan olguların nörogelişimsel değerlendirme sonuçları diğer gruba göre daha iyi olmakla birlikte aradaki fark istatistiksel olarak anlamlı değildi.

Çıkarımlar: Hipotermi tedavisi hipoksik iskemik ansefalopatili olgularda uygulanabilir Hipotermi uzun dönemde nörogelişimsel sonuçların daha iyi olmasına katkı sağlayabilir Türk Ped Arfl 2011; 46: 286 91

Anahtar Kelimeler

• Difüzyon ağırlıklı MR görüntüleme
• hipoksik iskemik ansefalopati
• konvansiyonel beyin MR görüntüleme
• Sarnat evre 2
• seyir

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