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

Yıl 2011, Cilt: 46 Sayı: 4, 292 - 295, 01.12.2011

Salih Kalay Osman Öztekin Gönül Tezel İsmail Çetiner Sevil Turgut Turan Mustafa Akçakuş Nihal Oygür

https://doi.org/10.4274/tpa.46.555

Öz

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

Anahtar Kelimeler

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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

Kaynakça

• Volpe JJ . Neurology of the newborn. 5 th ed. Chapter 6. Philadelphia: Saunders, 2008: 247-324.
• Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365: 891-900.
• Evans K, Rigby AS, Hamilton P, Titchiner N, Hall DM. The relationships between neonatal encephalopathy and cerebral palsy: a cohort study. J Obstet Gynaecol 2001; 21: 114-20.
• Dixon G, Badawi N, Kurinczuk JJ, et al. Early developmental outcomes after newborn encephalopathy. Pediatrics 2002; 109: 26-33.
• Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol 1976; 33: 696-705.
• Nagy Z, Lindström K, Westerberg H, et al. Diffusion tensor imaging
• on teenagers, born at term with moderate hypoxic-ischemic encephalopathy. Pediatr Res 2005; 58: 936-40.
• Patel J, Edwards AD. Prediction of outcome after perinatal asphyxia.
• Curr Opin Pediatr 1997; 9: 128-32.
• Klinger G, Beyene J, Shah P, Perlman M. Do hyperoxemia and
• hypocapnia add to the risk of brain injury after intrapartum asphyxia? Arch Dis Child Fetal Neonatal Ed 2005; 90: 49-52.
• Türk Neonatoloji Derneği Hipoksik İskemik Ensefalopati Çalışma
• Grubu. Türkiye'de yenidoğan yoğun bakım ünitelerinde izlenen hipoksik iskemik ensefalopatili olgular, risk faktörleri, insidans ve kısa dönem prognozları. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 123-9.
• Ment LR, Bada HS, Barnes P, et al. Practice parameter: neuroimaging of the neonate-report of the Quality Standards Subcommittee of the American Academy of Neurology. and the Practice Committee of the Child Neurology Society. Neurology 2002; 58: 1726-38.
• Lequin MH, Dudink J, Tong KA, Obenaus A. Magnetic resonance imaging in neonatal stroke. Semin Fetal Neonatal Med 2009; 14: 299-310.
• Thayyil S, Chandrasekaran M, Taylor A, et al. Cerebral magnetic resonance biomarkers in neonatal encephalopathy: a meta-analysis. Pediatrics 2010; 125: 382-95.
• Rutherford MA, Pennock JM, Counsell SJ, et al. Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy. Pediatrics 1998; 102: 323-8.
• El-Ayouty M, Abdel-Hady H, El-Mogy S, Zaghlol H, El-Beltagy M, Aly H. Relationship between electroencephalography and magnetic resonance imaging findings after hypoxic ischemic encephalopathy at term. Am J Perinatol 2007; 24: 467-73.
• Leijser LM, Vein AA, Liauw L, Strauss T, Veen S, Wezel-Meijler G. Prediction of short-term neurological outcome in full-term neonates with hypoxic-ischaemic encephalopathy based on combined use of electroencephalogram and neuro-imaging. Neuropediatrics 2007; 38: 219-27.
• Steinman KJ, Gorno-Tempini ML, Glidden DV, et al. Neonatal watershed brain injury on magnetic resonance imaging correlates with verbal IQ at 4 years. Pediatrics 2009; 123: 1025-30.
• van Schie PE, Becher JG, Dallmeijer AJ, Barkhof F, Weissenbruch MM, Vermeulen RJ. Motor outcome at the age of one after perinatal hypoxic-ischemic encephalopathy. Neuropediatrics 2007; 38: 71-7.
• Liauw L, van der Grond J, van den Berg-Huysmans AA, Laan LA, van Buchem MA, van Wezel-Meijler G. Is there a way to predict outcome in (near) term neonates with hypoxic-ischemic encephalopathy based on MR imaging? Am J Neuroradiol 2008; 29: 1789-94.
• Cowan F, Rutherford M, Groenendaal F, et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet 2003; 361: 736-42.
• Barkovich AJ. Brain and spine injuries in infancy and childhood. In: Barkovich AJ, (ed). Pediatri neuroimaging. Philadelphia: Lippincott Williams & Wilkins, 2005: 190-290.
• Boichot C, Walker PM, Durand C, et al. Term neonate prognoses after perinatal asphyxia: contributions of MR imaging, MR spectroscopy, relaxation times, and apparent diffusion coefficients. Radiology 2006; 239: 839-48.
• Twomey E, Twomey A, Ryan S, Murphy J, Donoghue VB. MR imaging of term infants with hypoxic-ischaemic encephalopathy as a predictor of neurodevelopmental outcome and late MRI appearances. Pediatr Radiol 2010; 40: 1526-35.
• Chau V, Poskitt KJ, Miller SP. Advanced neuroimaging techniques for the term newborn with encephalopathy. Pediatr Neurol 2009; 40: 181-8.
• Vermeulen RJ, van Schie PE, Hendrik L, et al. Diffusion-weighted and conventional MR imaging in neonatal hypoxic ischemia: two-year follow-up study. Radiology 2008; 249: 631-9.
• Hunt RW, Neil JJ, Coleman LT, Kean MJ, Inder TE. Apparent diffusion coefficient in the posterior limb of the internal capsule predicts outcome after perinatal asphyxia. Pediatrics 2004; 114: 999-1003.
• Rutherford M, Counsell S, Allsop J, et al. Diffusion-weighted magnetic resonance imaging in term perinatal brain injury: a comparison with site of lesion and time from birth. Pediatrics 2004: 114: 1004-14.