Abstract Objective To investigate the clinical and imaging characteristics of acute hypoxic-ischemic brain injury (HIBI) due to perinatal sentinel events in neonates. Methods Forty-six neonates with acute HIBI who were admitted between January 2004 and May 2013, and who had a history of major cardiopulmonary resuscitation, were enrolled in the study. They were classified into full-term and preterm infants to analyze the clinical and imaging characteristics. Results Among full-term infants, the incidence rates of white matter injury, cortical injury, basal ganglia /thalamic injury, and brain stem injury were 95%, 90%, 75%, and 65%, respectively; among preterm infants, the incidence rates of white matter injury, cortical injury, basal ganglia/thalamic injury, and brain stem injury were 73%, 23%, 19%, and 15%, respectively. Compared with full-term infants, preterm infants had a significantly lower incidence of gray matter injury in the cortex, basal ganglia/thalamus, and brain stem (P<0.05). About 46% of all subjects had multiple organ dysfunction. The 20 full-term infants with HIBI had typical clinical manifestations; 19 (95%) of them had moderate or severe neonatal encephalopathy, with mixed lesions on magnetic resonance imaging (MRI), and moderate or severe basal ganglia/thalamic injury was found in 68% of these patients. Multiple organ dysfunction, various abnormal neurological manifestations, and arterial blood pH less than 7.1 were closely related to moderate or severe brain injury. Conclusions White matter injury is the most common type of HIBI. Gray matter injury can be found in preterm infants, but the incidence is lower than that in full-term infants. Moderate or severe neonatal encephalopathy is mainly manifested as basal ganglia/thalamic injury on MRI. Evaluation of multiple organ dysfunction and abnormal neurological manifestations and early blood gas analysis are very important for the diagnosis of neonatal HIBI.
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Cite this article:
WANG Ying-Jie,MAO Jian. Types of acute hypoxic-ischemic brain injury due to perinatal sentinel events in neonates[J]. CJCP, 2014, 16(6): 589-595.
WANG Ying-Jie,MAO Jian. Types of acute hypoxic-ischemic brain injury due to perinatal sentinel events in neonates[J]. CJCP, 2014, 16(6): 589-595.
Trotman H, Garbutt A. Outcome of neonates with hypoxic ischaemic encephalopathy admitted to the neonatal unit of the University Hospital of the West Indies[J].Ann Trop Paediatr, 2009, 29(4): 263-269.
[2]
Martinez-Biarge M, Bregant T, Wusthoff CJ, et al. White matter and cortical-ischemic encephalopathy: Antecedent factors and 2-year outcome[J].Pediatrics, 2012, 161(15): 799-801.
[3]
Amuchou SS, Abhay KL, Nalini S, et al. Neonatal outcomes following extensive cardiopulmonary resuscitation in the delivery room for infants born at less than 33 weeks gestational age[J].Resuscitation, 2014, 85(2): 238-243.
[4]
Okereafor A, Allsop J, Counsell SJ, et al. Patterns of brain injury in neonates exposed to perinatal sentinel events[J].Pediatrics, 2008, 121(5): 906-914.
[5]
Martinez-Biarge M, Diez-Sebastian J, Rutherford MA, et al. Outcomes after central grey matter injury in term perinatal hypoxic-ischaemic encephalopathy[J].Early Hum Dev, 2010, 86(11): 678-682.
Miller SP, Ramaswamy V, Michelson D, et al. Patterns of brain injury in term neonatal encephalopathy[J].J Pediatr, 2005, 146(4):453-460.
[8]
Toet MC, van Rooij LGM, de Vires LS. The use of amplitude integrated EEG for assessing neonatal neurological injury[J].Clin Perinatol, 2008, 35(4): 665-678.
[9]
Volpe JJ. Neurology of the newborn[J].Major Probl Clin Pediatr, 1981,22:1-648.
[10]
Scafidi J, Gallo V. New concepts in perinatal hypoxia ischemia encephalopathy[J].Curr Neurol Neurosci Rep, 2008, 8(2): 130-138.
[11]
Alvarez-Diaz A, Hilario E, de Cerio FG, et al. Hypoxic-ischemic injury in the immature brain - Key vascular and cellular players[J].Neonatology, 2007, 92(4): 227-235.
[12]
Malamitsi-Puchner A, Economous E, Rigopoulou O, et al. Perinatal changes of brain-derived neurotrophic factor in pre- and full term neonates[J].Early Hum Dev, 2004, 76(1): 17-22.
[13]
Rutherford M, Srinivasan L, Dyet L, et al. Magnetic resonance imaging in perinatal brain injury: clinical presentation, lesions and outcome[J].Pediatr Radiol, 2006, 36(7): 582-592.
[14]
Li AM, Chau V, Poskitt KJ, et al. White matter injury in term newborns with neonatal encephalopathy[J].Pediatr Res, 2009, 65(1): 85-89.
[15]
Harteman JC, Nikkels PG, Benders MJ, et al. Placental pathology in full-term infants with hypoxic-ischemic neonatal encephalopathy and association with magnetic resonance imaging pattern of brain injury[J].Pediatrics, 2013, 163(4): 968-975.
[16]
Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of the newborn infants[J].N Engl J Med, 2001, 344(7): 467-471.
[17]
Barberccvv CA, Wyckoff MH. Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room[J].Pediatrics, 2006, 118(3): 1028-1034.
