Early Cranial Ultrasound Changes as Predictors of Outcome during First Year of Life in Infants with Perinatal Asphyxia- A Prospective Cohort Study

Abstract

Introduction: Perinatal Asphyxia (PA) causes impaired exchange of ventilatory gases, or ischemia that leads to persistent decrease in oxygen levels (hypoxemia) and increase in carbon dioxide levels (hypercarbia). It occurs during the peripartum period can contribute to early neonatal mortality and morbidity. Aim: To assess the role of early changes in cranial ultrasound a predictor of outcome in babes with PA. Materials and Methods: This prospective cohort study was conducted in a tertiary care neonatal unit in Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India, from July 2018 to October 2019. A total of 50 neonates with PA were studied. Cranial ultrasound was performed at or after seven days of life. Neurodevelopment assessment of the subjects were done at 3, 6, 9 and 12 months of life using Development Quotient (DQ). Variables were analysed by student’s t-test and categorical variables were analysed by Fisher’s-exact probability test using graph pad software. Results: Out of 50 infants of PA, 29 had an abnormal ultrasound scan and 21 had normal ultrasound scan. A 16/29 patients had abnormal outcome along with abnormal ultrasound scan while rest of the 13 had normal outcome. The mean DQ of the neonates having abnormal ultra sonographic examination was significantly lower as compared to those with normal examination. A 6 out of 21 neonates had abnormal outcome inspite of having normal ultrasound scan. Cranial ultrasound has a specificity=55%, sensitivity=73%, Positive Predictive Value (PPV)=58% and Negative Predictive Value (NPV)=71% in predicting neurodevelopment outcome of patients with birth asphyxia. Conclusion: Cranial Utrasonography (USG) findings in PA babies reveal a strong association with the development severity.

Keywords

• developmental quotient
• hypoxic ischaemic encephalopathy
• neurological outcome