Assessment Of Perinatal Factors, EEG And Neuro Imaging In The Prognosis Of Term Asphyxiated Newborns

Background:Hypoxic-ischemic encephalopathy(HIE)secondary to perinatal asphyxia remains a major cause of neonatal mortality and morbidity worldwide.Randomized control trials of therapeutic hypothermia(HT)for HIE have demonstrated a reduction in the death or severe disability at 18 months of age.However,death and disability continue to occur in 30% to 70% of infants with moderate-to-severe encephalopathy despite treatment with whole body/selective head cooling.1-8.The localization,distribution and severity of hypoxic-ischemic lesions detected by MRI can be graded and related to outcome.However,one issue that remains unanswered is whether early MRI,performed in the first few days of life,in newborns reflects brain hypoxic-ischemic damage in all its extension.This question is crucial since there is a need for an early and accurate identification of infants who will have very severe impairment if they survive.As reported in the recent therapeutic Hypothermia trials,two-thirds of deaths in HIE infants followed withdrawal of life sustaining treatment If decisions are delayed,there is a possibility that the infant will survive with very severe long-term disabilities,as end of life decisions are relying more and more on the results of MRI performed in the first days of life AND OBJECTIVES OF THE STUDYTo study the various perinatal risk factors which are contributing to HIE.To study the outcome of the term asphyxiated neonates at the time of discharge in relation to the perinatal risk factors.To correlate the neurological outcome of asphyxiated neonates with EEG and Neuroimaging findings.To evaluate the impact of Paediatrician attending delivery for the neonatal resuscitation on neurological outcome of the neonates with HIE.Materials & Methods:This prospective study was conducted on the term asphyxiated babies who were admitted in ASRAM hospital,Eluru.During the period july 2015 to july 2017 a thorough and systematic approach to the diagnosis was done.Clinical examination of all the admitted term asphyxiated babies were done.The evaluation was done including the general examination such as anthropometry,signs and stages of HIE as proposed by sarnat and sarnat staging were assessed.Routine investigations include blood sugar,serum electrolytes,coagulation profile,liver enzymes,renal parameters.Other investigations like EEG,Neurosonogram and MRI were advised depending on clinical presentation and the complications.Investigations were been performed in a serial fashion.The complete data has been kept in the form of a master sheet in the Microsoft word excel 2013 format and the statistical data tables were procceded using the SPSS 17.0 version software.Results:Totally 451 neonates were admitted in the ASRAM hospital during the study period in which 70 neonates were noted to be term asphyxiated newborns.Here,the study shows that 15.5% of the total population in NICU have been asphyxiated.The neonates included under stage 1 have 94.5% good prognosis and 5.5% poor prognosis.Neonates included in the stage 2 were having an equal percentages 47.4%good and poor prognosis and death percentage is 5.2%.On a overall view,stage 3has an higher death percentage of 33.3% and 66.7% poor prognosis.Neurosonogram is done as required clinically in neonates affected with HIE,in neonates with diffuse echogenic parenchymal pattern have 45% poor outcome and55% have good outcome.In the normal pattern of neurosonogram have 33.3% poor outcome and 66.7% good outcome.with frequency of MRI findings to prognosis of the neonates MRI is done in neonates affected with HIE,in neonates with BGT pattern have 68.5% poor outcome and 31.5% have good outcome.In the normal pattern of MRI 100% have good outcome.MRI have a significant p value.with frequency of EEG findings to prognosis of the neonates.EEG is done as required clinically in neonates affected with HIE,Discontinuous(or)burst suppression pattern have 64.8% poor outcome and 35.2% good outcome.In the normal pattern of EEG 20% poor outcome and 80% good outcome.EEG has a significant p value in relation to the outcome of the neonates.80% good outcome.EEG has a significant p value in relation to the outcome of the neonates.Conclusion:The present study concludes high correlation between early and late sequential MRI in HIE infants treated with hypothermia.There data suggest that MRI in the first days of life may be a useful prognostic tool for clinicians and can help in medical issues.Normal EEG patterns have shown 80% good prognosis and abnormal EEG patterns have shown 64.8% poor prognosis.