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Lavrentev SN, Petrova AS, Serova OF, Vishnyakova P, Kondratev MV, Gryzunova AS, Zakharova NI, Zubkov VV, Silachev DN. Ultrasound Diagnosis and Near-Infrared Spectroscopy in the Study of Encephalopathy in Neonates Born under Asphyxia: Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:591. [PMID: 38790586 PMCID: PMC11119551 DOI: 10.3390/children11050591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Brain injury resulting from adverse events during pregnancy and delivery is the leading cause of neonatal morbidity and disability. Surviving neonates often suffer long-term motor, sensory, and cognitive impairments. Birth asphyxia is among the most common causes of neonatal encephalopathy. The integration of ultrasound, including Doppler ultrasound, and near-infrared spectroscopy (NIRS) offers a promising approach to understanding the pathology and diagnosis of encephalopathy in this special patient population. Ultrasound diagnosis can be very helpful for the assessment of structural abnormalities associated with neonatal encephalopathy such as alterations in brain structures (intraventricular hemorrhage, infarcts, hydrocephalus, white matter injury) and evaluation of morphologic changes. Doppler sonography is the most valuable method as it provides information about blood flow patterns and outcome prediction. NIRS provides valuable insight into the functional aspects of brain activity by measuring tissue oxygenation and blood flow. The combination of ultrasonography and NIRS may produce complementary information on structural and functional aspects of the brain. This review summarizes the current state of research, discusses advantages and limitations, and explores future directions to improve applicability and efficacy.
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Affiliation(s)
- Simeon N. Lavrentev
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Anastasia S. Petrova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Olga F. Serova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
| | - Polina Vishnyakova
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Maxim V. Kondratev
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
| | - Anastasia S. Gryzunova
- The State Budgetary Institution, Moscow Regional Perinatal Center, 143912 Balashikha, Russia; (S.N.L.); (A.S.P.); (O.F.S.); (M.V.K.); (A.S.G.)
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Nina I. Zakharova
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
| | - Victor V. Zubkov
- Research Clinical Institute of Childhood of the Moscow Region, 115093 Moscow, Russia; (N.I.Z.); (V.V.Z.)
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
| | - Denis N. Silachev
- V.I. Kulakov National Medical Research Center for Obstetrics Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, 117997 Moscow, Russia;
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
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Laccetta G, Di Chiara M, De Nardo MC, Tagliabracci M, Travaglia E, De Santis B, Spiriti C, Dito L, Regoli D, Caravale B, Cellitti R, Parisi P, Terrin G. Quantitative ultrasonographic examination of cerebral white matter by pixel brightness intensity as marker of middle-term neurodevelopment: a prospective observational study. Sci Rep 2023; 13:16816. [PMID: 37798394 PMCID: PMC10556025 DOI: 10.1038/s41598-023-44083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023] Open
Abstract
Non-cystic white matter (WM) injury has become prevalent among preterm newborns and is associated with long-term neurodevelopmental impairment. Magnetic resonance is the gold-standard for diagnosis; however, cranial ultrasound (CUS) is more easily available but limited by subjective interpretation of images. To overcome this problem, we enrolled in a prospective observational study, patients with gestational age at birth < 32 weeks with normal CUS scans or grade 1 WM injury. Patients underwent CUS examinations at 0-7 days of life (T0), 14-35 days of life (T1), 370/7-416/7 weeks' postmenstrual age (T2), and 420/7-520/7 weeks' postmenstrual age (T3). The echogenicity of parieto-occipital periventricular WM relative to that of homolateral choroid plexus (RECP) was calculated on parasagittal scans by means of pixel brightness intensity and its relationship with Bayley-III assessment at 12 months' corrected age was evaluated. We demonstrated that: (1) Left RECP values at T1 negatively correlated with cognitive composite scores; (2) Right RECP values at T2 and T3 negatively correlated with language composite scores; (3) Left RECP values at T1 and T2 negatively correlated with motor composite scores. Thus, this technique may be used as screening method to early identify patients at risk of neurodevelopmental issues and promptly initiate preventive and therapeutic interventions.
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Affiliation(s)
- Gianluigi Laccetta
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Maria Di Chiara
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara De Nardo
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Monica Tagliabracci
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Elisa Travaglia
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Benedetta De Santis
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Caterina Spiriti
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Lucia Dito
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Regoli
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Barbara Caravale
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Raffaella Cellitti
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
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Gonçalves FG, Freeman C, Khrichenko D, Hwang M. Quantitative Evaluation of Brain Echogenicity in Hypoxic-Ischemic Encephalopathy in Term Neonates Compared with Controls. Ultrasound Int Open 2022; 8:E43-E52. [PMID: 36408372 PMCID: PMC9668510 DOI: 10.1055/a-1958-3985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Neurosonography evaluation of neonatal hypoxic-ischemic encephalopathy (HIE) is mainly qualitative. We aimed to quantitatively compare the echogenicity of several brain regions in patients with HIE to healthy controls. Materials and Methods 20 term neonates with clinical/MRI evidence of HIE and 20 term healthy neonates were evaluated. Seven brain regions were assessed [frontal, parietal, occipital, and perirolandic white matter (WM), caudate nucleus head, lentiform nucleus, and thalamus]. The echogenicity of the calvarial bones (bone) and the choroid plexus (CP) was used for ratio calculation. Differences in the ratios were determined between neonates with HIE and controls. Results Ratios were significantly higher for HIE neonates in each region (p<0.05). The differences were greatest for the perirolandic WM, with CP and bone ratios being 0.23 and 0.22 greater, respectively, for the HIE compared to the healthy neonates (p<0.001). The perirolandic WM had a high AUC, at 0.980 for both the CP and bone ratios. The intra-observer reliability for all ratios was high, with the caudate to bone ratio being the lowest at 0.832 and the anterior WM to CP ratio being the highest at 0.992. Conclusion When coupled with internal controls, quantitative neurosonography represents a potential tool to identify early neonatal HIE changes. Larger cohort studies could reveal whether a quantitative approach can discern between degrees of severity of HIE. Future neurosonography protocols should be tailored to evaluate the perirolandic region, which requires posterior coronal scanning.
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Affiliation(s)
| | - Colbey Freeman
- Radiology, University of Pennsylvania Perelman School of Medicine,
Philadelphia, United States
| | - Dmitry Khrichenko
- Radiology, The Children’s Hospital of Philadelphia,
Philadelphia, United States
| | - Misun Hwang
- Radiology, The Children’s Hospital of Philadelphia,
Philadelphia, United States
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Rath C, Rao S, Suryawanshi P, Desai S, Chetan C, Patil K, Patole S. Does abnormal Doppler on cranial ultrasound predict disability in infants with hypoxic-ischaemic encephalopathy? A systematic review. Dev Med Child Neurol 2022; 64:1202-1213. [PMID: 35390176 DOI: 10.1111/dmcn.15236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate whether abnormal resistive index or cerebral blood flow velocity (CBFV) on cranial ultrasound predicts disability (≥1 year) in infants with hypoxic-ischaemic encephalopathy (HIE). METHOD This was a systematic review and meta-analysis of studies comparing developmental outcomes of infants with HIE with normal versus abnormal resistive index or CBFV. RESULTS Twenty-six studies were included (pre-therapeutic hypothermia era, 20; therapeutic hypothermia era, six). Data from 15 studies (pre-therapeutic hypothermia, 10; therapeutic hypothermia, five) were available for meta-analysis. Pooled sensitivity and specificity, summary area under the receiver operating characteristic curve, and diagnostic odds ratio of resistive index or CBFV for predicting 'death or severe disability' were as follows. Pre-therapeutic hypothermia era: 0.83 (95% confidence interval [CI] 0.45-0.97) and 0.92 (95% CI 0.74-0.98), 0.94 (95% CI 0.92-0.96), 54 (95% CI 7-391). Therapeutic hypothermia era (measurements before therapeutic hypothermia): 0.62 (95% CI 0.41-0.80) and 0.96 (95% CI 0.88-0.99), 0.93 (95% CI 0.89-0.94), 23 (95% CI 6-91). Therapeutic hypothermia era (measurements during/after therapeutic hypothermia): 0.51 (95% CI 0.24-0.78) and 0.83 (95% CI 0.73-0.90), 0.81 (95% CI 0.78-0.85), 5 (95% CI 2-13). Overall Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating of evidence was 'low' or 'very low'. INTERPRETATION Low-level evidence suggests that abnormal resistive index or CBFV can predict death or disability with high sensitivity and specificity in infants with HIE who are not cooled. The specificity of these tests was high when performed before starting cooling in infants who received therapeutic hypothermia. WHAT THIS PAPER ADDS Cerebral doppler ultrasound may be useful in predicting death or disability in infants with hypoxic-ischaemic encephalopathy who are not cooled. Cerebral doppler ultrasound may also be useful in infants who are cooled, if done before starting cooling. Cerebral doppler ultrasound may not be useful when performed during or after completing cooling.
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Affiliation(s)
- Chandra Rath
- King Edward Memorial Hospital, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Shripada Rao
- King Edward Memorial Hospital, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Australia
| | | | - Saumil Desai
- King Edward Memorial Hospital, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Chinmay Chetan
- Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India
| | - Karamchand Patil
- Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India
| | - Sanjay Patole
- King Edward Memorial Hospital, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Australia
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Pishdad P, Yarmahmoodi F, Eghbali T, Arasteh P, Razavi SM. Using Doppler sonography resistive index for the diagnosis of perinatal asphyxia: a multi-centered study. BMC Neurol 2022; 22:104. [PMID: 35305562 PMCID: PMC8934006 DOI: 10.1186/s12883-022-02624-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background and objective Inhere we evaluated the diagnostic utility of Doppler sonography (DS) of the anterior cerebral artery (ACA), middle cerebral artery (MCA) and the basilar arteries (BA) based on resistive index (RI) for the diagnosis of asphyxia. Methods In this multi-centered cross-sectional study, neonates with clinical diagnosis of asphyxia, were considered for study. During the first 24 h, neonates underwent DS. MRI was done for each neonate during the first month, after discharge or during hospital admission, after obtaining clinical stability. Staging based on DS was compared with staging based on MRI. Results Overall, 34 patients entered the study. DS of the ACA, MCA, BA all had significant correlation with MRI findings (regarding severity of asphyxia) (r > 0.8 and p < 0.001). In the receiver-operating-characteristic analysis, ideal cut-off point for diagnoses of asphyxia based on ACA and BA was RI ≤ 0.62 [area under the curve (AUC) = 0.957 and 95% CI: 0.819–0.997; sensitivity = 95.65; specificity = 100; positive predictive value (PPV) = 100; negative predictive value (NPV) = 90.9 and negative likelihood ratio (NLR) = 0.043]. Regarding MCA, similarly, a RI ≤ 0.62 was ideal for differentiating between normal and asphyxiated neonates (AUC = 0.990 and 95% CI: 0.873–1; sensitivity = 91.30; specificity = 100; PPV = 91.2; NPV = 100 and NLR = 0.087). Conclusion For evaluating neonates clinically suspected of asphyxia, especially in centers with limited facilities such as MRI, DS can be used as a first line diagnostic modality and RI of ≤ 0.62 is an appropriate cut-off for the diagnosis of perinatal asphyxia.
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Early postnatal color Doppler changes in neonates receiving delivery room resuscitation with low 5 min Apgar score-a pilot study. J Perinatol 2021; 41:486-493. [PMID: 33299108 DOI: 10.1038/s41372-020-00882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/03/2020] [Accepted: 11/20/2020] [Indexed: 11/08/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the Doppler changes in the intracranial arteries of neonates exposed to perinatal hypoxic insult and compare it with normal neonates. MATERIALS AND METHODS Color Doppler of bilateral anterior and middle cerebral arteries was performed within 6 h of birth in 26 healthy neonates and 50 neonates who received delivery room resuscitation (DRR) for perinatal depression and had a 5 min Apgar score <7. Comparisons of resistive index (RI) and peak systolic velocity (PSV) were made between the (a) control group (b) patients with low 5 min Apgar score <7 who without clinical features of neonatal encephalopathy at 24 h (c) neonates with perinatal depression with a clinical evidence of disturbed neurological function at 24 h of birth and examination consistent with mild, moderate, or severe encephalopathy using modified Sarnat and Sarnat's classification. RESULTS Significantly higher RI was observed in the neonates with to perinatal depression compared to the normal neonates. Significantly higher RI was seen in the patients with clinical features of neonatal encephalopathy (Group C) compared to group B. RI <0.6 and >0.82 was associated with severe neonatal encephalopathy. Differences in PSV were not statistically significant in the various groups. CONCLUSION The study presents the changes in early cerebral Doppler parameters observed in neonates with low 5 min Apgar score following DRR compared to the normal neonates. We also present the relations of Doppler parameters with increasing severity of neonatal encephalopathy according to Sarnat classification.
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Spectral-domain OCT changes in retina and optic nerve in children with hypoxic-ischaemic encephalopathy. Graefes Arch Clin Exp Ophthalmol 2020; 259:1343-1355. [PMID: 33141256 PMCID: PMC8102460 DOI: 10.1007/s00417-020-04996-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate the effect of neonatal hypoxic–ischaemic injury on the retina and the optic nerve and to correlate ocular damage with systemic parameters, laboratory tests, neurological imaging and therapeutic hypothermia at birth. Methods Forty-one children with hypoxic–ischaemic encephalopathy (HIE) at birth (9.09 ± 3.78 years) and a control group of 38 healthy subjects (9.57 ± 3.47 years) were enrolled in a cohort study. The HIE population was divided into three subgroups, based on the degree of encephalopathy according to Sarnat score and the treatment with therapeutic hypothermia (TH): Sarnat score I not treated with hypothermia, Sarnat score II-III treated with TH and Sarnat score II-III not subjected to TH. Total macular thickness, individual retinal layers and peripapillary nerve fibre layer thickness were measured with spectral-domain optical coherence tomography. Clinical data of perinatal period of HIE children were collected: APGAR score, pH and base excess of funiculus blood at birth, apnoea duration, brain ultrasound, cerebral MRI ischaemic lesions and blood chemistry tests. Results Children with Sarnat score I did not show a reduction of peripapillary nerve fibres and ganglion cell layer compared to the control group (p = 0.387, p = 0.316). Peripapillary nerve fibre layer was 109.06 ± 7.79 μm in children with Sarnat score II-III treated with TH, 108.31 ± 7.83 μm in subjects with Sarnat score II-III not subjected to TH and 114.27 ± 6.81 μm in the control group (p = 0.028, p = 0.007). Ganglion cell layer was thinner in children with Sarnat score II-III treated with TH (50.31 ± 5.13 μm) compared to the control group (54.04 ± 2.81 μm) (p = 0.01). Inner retinal layers damage correlated with C-reactive protein and lactate dehydrogenase increase, while higher levels of total bilirubin were protective against retinal impairment (p < 0.05). Cerebral oedema was related to peripapillary nerve fibre layer damage (p = 0.046). Conclusions Thickness reduction of inner retinal layer and peripapillary nerve fibre impairment was related to encephalopathy severity. Ocular damage was associated with inflammation and cerebral oedema following hypoxic–ischaemic damage.
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Head Ultrasound Resistive Indices Are Associated With Brain Injury on Diffusion Tensor Imaging Magnetic Resonance Imaging in Neonates With Hypoxic-Ischemic Encephalopathy. J Comput Assist Tomogr 2020; 44:687-691. [PMID: 32842070 DOI: 10.1097/rct.0000000000001069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neonatal hypoxic-ischemic encephalopathy (HIE) is associated with dysfunctional cerebral autoregulation. Resistive index (RI) measured in the anterior cerebral artery on transfontanellar head ultrasound is a noninvasive measure of blood flow and may indicate autoregulation dysfunction. We tested whether RI was associated with brain injury on diffusion tensor imaging magnetic resonance imaging (MRI). MATERIALS AND METHODS Seventy-five neonates who underwent therapeutic hypothermia for HIE were enrolled. Resistive index values were obtained from head ultrasound performed at the end of therapeutic hypothermia. Apparent diffusion coefficient scalars were measured on MRIs performed before day of life 10. RESULTS Lower RI was associated with lower apparent diffusion coefficient in the centrum semiovale, basal ganglia, thalamus, and posterior limb of the internal capsule. Combining RI and Apgar scores improved the ability to distinguish injury severity on MRI relative to either metric alone. CONCLUSIONS Low RI correlated with worse brain injury on diffusion tensor imaging and may serve as an early marker of brain injury in cooled HIE neonates.
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The development and validation of a cerebral ultrasound scoring system for infants with hypoxic-ischaemic encephalopathy. Pediatr Res 2020; 87:59-66. [PMID: 32218538 PMCID: PMC7098882 DOI: 10.1038/s41390-020-0782-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypoxic-ischaemic encephalopathy (HIE) is an important cause of morbidity and mortality in neonates. When the gold standard MRI is not feasible, cerebral ultrasound (CUS) might offer an alternative. In this study, the association between a novel CUS scoring system and neurodevelopmental outcome in neonates with HIE was assessed. METHODS (Near-)term infants with HIE and therapeutic hypothermia, a CUS on day 1 and day 3-7 after birth and available outcome data were retrospectively included in cohort I. CUS findings on day 1 and day 3-7 were related to adverse outcome in univariate and the CUS of day 3-7 also in multivariable logistic regression analyses. The resistance index, the sum of deep grey matter and of white matter involvement were included in multivariable logistic regression analyses. A comparable cohort from another hospital was used for validation (cohort II). RESULTS Eighty-three infants were included in cohort I and 35 in cohort II. The final CUS scoring system contained the sum of white matter (OR = 2.6, 95% CI 1.5-4.7) and deep grey matter involvement (OR = 2.7, 95% CI 1.7-4.4). The CUS scoring system performed well in cohort I (AUC = 0.90) and II (AUC = 0.89). CONCLUSION This validated CUS scoring system is associated with neurodevelopmental outcome in neonates with HIE.
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Salas J, Reddy N, Carson KA, Northington FJ, Huisman TA. Ultrasound Predicts White Matter Integrity after Hypothermia Therapy in Neonatal Hypoxic-Ischemic Injury. J Neuroimaging 2019; 29:743-749. [PMID: 31206969 PMCID: PMC6814495 DOI: 10.1111/jon.12644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypoxic-ischemic injury (HII) is a major cause of neonatal death and neurodevelopmental disability. Head ultrasounds (HUS) in neonates with HII often show enhanced gray/white matter differentiation. We assessed the significance of this finding in predicting white matter structural integrity measured by diffusion tensor imaging (DTI) in neonates with HII. METHODS We performed a quantitative region of interest-based analysis of white and gray matter echogenicity within the cingulate gyrus on pre- and posthypothermia HUS. We also completed a quantitative analysis of fractional anisotropy (FA) and mean (MD), axial (AD), and radial (RD) diffusivity within the bilateral anterior and posterior centrum semiovale (CSO) on posthypothermia brain magnetic resonance imaging. For HUS studies, we calculated a white-to-gray matter echogenicity ratio (WGR) and subsequently correlated it to DTI measurements. RESULTS Forty-two term neonates with HII who underwent hypothermia therapy were included. Significant correlation was found between prehypothermia WGR and MD, AD, and RD values in the left anterior CSO (r = .38-.40, P = .02). Prehypothermia WGR also correlated with the following: MD and RD in the right anterior CSO (r = .35-.36, P = .04), MD and AD in the right posterior CSO (r = .32-.45, P = .008-.03), and AD in the left posterior CSO (r = .47, P = .005). No significant correlation was found either between prehypothermia WGR and FA values in the bilateral anterior and posterior CSO or between posthypothermia WGR and all DTI scalars in the bilateral anterior and posterior CSO. CONCLUSIONS Prehypothermia HUS WGR may predict posthypothermia white matter structural integrity and is potentially an early and easily obtainable biomarker of severity in neonatal HII.
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Affiliation(s)
- Jacqueline Salas
- Division of Neonatology, Department of Pediatrics, New-York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA,Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine
| | - Nihaal Reddy
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn A. Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frances J. Northington
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine
| | - Thierry A.G.M. Huisman
- Neurosciences Intensive Care Nursery Group and Division of Neonatology, Johns Hopkins University School of Medicine,Division of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Normal values of the resistivity index of the pericallosal artery with and without compression of the anterior fontanelle. Pediatr Radiol 2019; 49:646-651. [PMID: 30712160 DOI: 10.1007/s00247-019-04347-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/07/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Resistivity index (RI) of the pericallosal artery as is commonly measured during head ultrasound (US) examination in neonates. Some studies have shown that RI measured with gentle compression of the fontanelle provides additional information in cases of neonatal brain anomalies. OBJECTIVE The purpose of this study was to establish normal RI values with and without compression in a large population of neonates with normal cranial ultrasound as a function of gestational age. MATERIALS AND METHODS The authors of this retrospective study reviewed the RI of 323 infants with normal gray-scale cranial US and with a gestational age ranging 26-42 weeks. We conducted the exams both with and without compression of the anterior fontanelle and we studied changes in RI depending on gestational age, gender and type of delivery. RESULTS Infants with a gestational age of more than 35 weeks tended to have a lower RI (P=0.011). The compression of the anterior fontanelle emphasized the change in RI with increasing gestational age, with higher gestational ages having a lower RI (P<0.001). The results concerning the percentage change between baseline RI and RI with compression showed that infants with higher gestational ages have a smaller percentage change in RI (P=0.002). CONCLUSION We established the normal values for RI from 26 weeks to 42 weeks of gestation. The results of the study show the importance of taking the gestational age into consideration when evaluating the RI.
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Peeples ES, Ezeokeke CK, Juul SE, Mourad PD. Evaluating a Targeted Bedside Measure of Cerebral Perfusion in a Nonhuman Primate Model of Neonatal Hypoxic-Ischemic Encephalopathy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:913-920. [PMID: 28960438 PMCID: PMC5867225 DOI: 10.1002/jum.14426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/01/2017] [Accepted: 07/12/2017] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To compare ultrasound-derived resistive indices (RIs) obtained at the level of the thalamus via fast Doppler ultrasound with traditional anterior cerebral artery measures in a model of neonatal hypoxic-ischemic encephalopathy and to correlate each with clinical outcomes. METHODS Nine nonhuman primate neonates underwent no umbilical cord occlusion (n = 3), umbilical cord occlusion without hypothermia (n = 3), or umbilical cord occlusion with hypothermia (n = 3). The RI was measured in the anterior cerebral artery and thalamus on days 0, 1, and 4 of life. Magnetic resonance imaging with spectroscopy was performed on day 4. RESULTS Mean thalamus and anterior cerebral artery RI values in the first 36 hours of life were statistically different in neonates who died (+0.13; P = .019) or developed cerebral palsy (-0.08; P = .003). Thalamic RI values showed stronger associations with serum and spectroscopic lactate values than those in the anterior cerebral artery. The umbilical cord occlusion-with-hypothermia group showed a significant increase in the RI in the thalamus but not the anterior cerebral artery. CONCLUSIONS Resistive index measurements in the thalamus may eventually supplement other bedside measures for predicting outcomes in the HIE population, but further studies need to differentiate the effect of hypothermia from illness severity on thalamic perfusion.
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Affiliation(s)
- Eric S. Peeples
- Department of Pediatrics, University of Washington, Seattle, WA, U.S.A
- Correspondence: Eric Peeples, M.D., Division of Neonatology, Children’s Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114-4113, P: (402) 955-6140, F: (402) 955-3398,
| | | | - Sandra E. Juul
- Department of Pediatrics, University of Washington, Seattle, WA, U.S.A
| | - Pierre D. Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA, U.S.A
- Division of Engineering and Mathematics, University of Washington, Seattle, WA, U.S.A
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Noninvasive monitoring of brain edema after hypoxia in newborn piglets. Pediatr Res 2018; 83:484-490. [PMID: 29069074 DOI: 10.1038/pr.2017.264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/25/2017] [Indexed: 01/09/2023]
Abstract
BackgroundDevelopment of cerebral edema after brain injury carries a high risk for brain damage and death. The present study tests the ability of a noninvasive cerebral edema monitoring system that uses near-infrared spectroscopy (NIRS) with water as the chromophore of interest to detect brain edema following hypoxia.MethodsVentilated piglets were exposed to hypoxia for 1 h, and then returned to normal oxygen levels for 4 h. An NIRS sensor was placed on the animal's head at baseline, and changes in light attenuation were converted to changes in H2O. Cerebral water content and aquaporin-4 protein (AQP4) expression were measured.ResultsThe system detected changes in NIRS-derived water signal as early as 2 h after hypoxia, and provided fivefold signal amplification, representing a 10% increase in brain water content and a sixfold increase in AQP4, 4 h after hypoxia. Changes in water signal correlated well with changes in cerebral water content (R=0.74) and AQP4 expression (R=0.97) in the piglet brain.ConclusionThe data show that NIRS can detect cerebral edema early in the injury process, thus providing an opportunity to initiate therapy at an earlier and more effective time-point after an insult than is available with current technology.
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The value of midbrain morphology in predicting prognosis in chronic disorders of consciousness: A preliminary ultrasound study. J Neurol Sci 2017; 380:46-50. [PMID: 28870587 DOI: 10.1016/j.jns.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022]
Abstract
Transcranial sonography (TCS) of the brainstem is currently used to support the clinical diagnosis of movement disorders. The aim of the study was to assess the usefulness of midbrain TCS in assessing outcome in patients with Chronic Disorders of Consciousness (DOC). Eleven patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) were included in the study. We measured the area and echogenicity of the midbrain by encoding and digitally analyzing the corresponding images from the orbitomeatal plane, the morphology of brain parenchyma from the thalamic and cella media plane, and the intracranial circulation. All the patients showed an increase of pulsatility index and numerous morphological alterations on all the scan planes. In particular, we found a loss of the characteristic butterfly-shape of the midbrain, which appeared hypoechoic in the UWS but not in the MCS patients. After six months, the patients were clinically assessed by using Glasgow Outcome Scale Extended (GOSE). We found that a higher increase in GOSE scoring at follow-up was correlated with larger area and higher echogenicity of the midbrain at baseline. The present study suggests that TCS data of the midbrain may support clinical assessment of patients with chronic DOC to estimate their outcome.
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Browning Carmo K, Lutz T, Berry A, Kluckow M, Evans N. Feasibility and utility of portable ultrasound during retrieval of sick term and late preterm infants. Acta Paediatr 2016; 105:e549-e554. [PMID: 27628296 DOI: 10.1111/apa.13589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/21/2016] [Accepted: 09/12/2016] [Indexed: 12/01/2022]
Abstract
AIM To determine the role of clinician performed ultrasound (CPU) during the retrieval and transport of critically ill term and near term newborns. METHODS A neonatologist with portable ultrasound accompanied a sample of newborn retrievals to perform cardiac and cerebral ultrasound before and after transportation. RESULTS A total of fifty-five babies were studied. Median birthweight: 3350 g (2220-5030 g). CPU led to a change in the planned receiving hospital in ten babies. Eleven babies were suspected congenital heart disease (CHD) prior to retrieval: eight confirmed CHD by CPU and three normal structure. One transported to a children's hospital for cardiology review was confirmed as having normal structure; one to a perinatal hospital where normal structure was confirmed and one baby died at the referring hospital and postmortem confirmed normal structure. In five babies with clinical pulmonary hypertension, CPU revealed unsuspected CHD. The destination was changed to a paediatric cardiology centre, avoiding a second retrieval. Eleven babies had evidence of haemodynamic compromise allowing targeting of inotropes. CONCLUSION This is the first study of CPU during retrieval of high-risk infants. Ultrasound in retrieval is feasible, allows accurate triage of babies to cardiac centres and may allow more accurate targeting of fluid and inotrope support.
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Affiliation(s)
- Kathryn Browning Carmo
- Neonatal and Paediatric Emergency Transport Service (NETS); Westmead NSW Australia
- Grace Centre for Newborn Intensive Care CHW; Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
| | - Tracey Lutz
- Neonatal and Paediatric Emergency Transport Service (NETS); Westmead NSW Australia
- University of Sydney; Sydney NSW Australia
- Department of Newborn Care; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Andrew Berry
- Neonatal and Paediatric Emergency Transport Service (NETS); Westmead NSW Australia
| | - Martin Kluckow
- University of Sydney; Sydney NSW Australia
- Department of Neonatology; Royal North Shore Hospital; Sydney NSW Australia
| | - Nick Evans
- University of Sydney; Sydney NSW Australia
- Department of Newborn Care; Royal Prince Alfred Hospital; Sydney NSW Australia
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Beller T, Peylan T, Ben Sira L, Shiran SI, Levi L, Bassan H. Quantitative analysis of cranial ultrasonographic periventricular echogenicity in relation to early neuromotor development in preterm infants. Arch Dis Child Fetal Neonatal Ed 2016; 101:F217-22. [PMID: 26307066 DOI: 10.1136/archdischild-2015-308216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 08/03/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Periventricular white matter (WM) hyperechoic flares that do not evolve into cystic lesion(s) are frequently encountered on cranial ultrasonography (CUS) of preterm infants. Subjective interpretation of its presence, however, is challenging and its association with maturation and neurodevelopment remains undefined. OBJECTIVES To determine the relationship between quantitative WM echogenicity and postnatal and postmenstrual ages and the relationship between quantitative WM echogenicity and neuromotor development at term equivalent. METHODS We measured the mean pixel brightness intensity at the frontoparietal and parieto-occipital WM, choroid plexus and calvarium bone on sequential neonatal CUS scans of preterm infants born at <34 weeks gestation. The relative echogenicity (RE) was derived by dividing the mean WM echogenicity to that of the choroid plexus (RE(CP)) or bone (RE(BN)). The Lacey Assessment of the Preterm Infant was administered before discharge. RESULTS 58 preterm infants (the mean gestational age 30.6±2.3 weeks and the mean birth weight 1211.9±224.7 g) were included. The RE(CP) of the frontoparietal WM decreased significantly with advancing postnatal and postmenstrual ages (r=-0.4, p<0.0001). The RE(BN) values of the frontoparietal and parieto-occipital WM during intermediate and late predischarge CUS studies, respectively, were significantly associated with neuromotor status at term (p<0.05). The RE(CP) and RE(BN) measured during the first week of life were not associated with neuromotor status at term. CONCLUSIONS Quantitative measurements of the periventricular WM echogenicity are feasible in neonatal CUSs of premature infants and may reflect microstructural developmental changes. An optimal echogenicity quantification technique and its correlation with long-term outcome remain to be determined.
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Affiliation(s)
- Tammy Beller
- Child Neurology and Development Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tali Peylan
- Child Neurology and Development Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liat Ben Sira
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shelly Irene Shiran
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Loren Levi
- Child Neurology and Development Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Haim Bassan
- Child Neurology and Development Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Dinan D, Daneman A, Guimaraes CV, Chauvin NA, Victoria T, Epelman M. Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging. Semin Ultrasound CT MR 2014; 35:627-51. [DOI: 10.1053/j.sult.2014.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Variability of resistive indices in the anterior cerebral artery during fontanel compression in preterm and term neonates measured by transcranial duplex sonography. J Perinatol 2014; 34:306-10. [PMID: 24526007 DOI: 10.1038/jp.2014.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/31/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the normal range of resistive index (RI) variability in clinically/neurologically unremarkable preterm and term infants and to compare the hemodynamic response to transient elevation of intracranial pressure. STUDY DESIGN We measured RIs at baseline and following brief fontanel compression, assessing for differences in mean baseline and compression values and percent change. RESULT One hundred and twenty-nine subjects were included in the study. Mean baseline RI and normal range were 0.7 in preterm (0.54 to 0.86) and 0.66 in term infants (0.52 to 0.8; P=0.001). Mean RI during compression was 0.71 in preterm and 0.68 in term infants (P=0.015). Mean percent change between baseline and compression was 5.86% in preterm and 7.45% in term infants (P=0.092). CONCLUSION No difference in the hemodynamic response to transient elevation of intracranial pressure between different gestational groups, suggesting no significant differences in autoregulatory response.
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Kudrevičienė A, Basevičius A, Lukoševičius S, Laurynaitienė J, Marmienė V, Nedzelskienė I, Buinauskienė J, Stonienė D, Tamelienė R. The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia. Medicina (B Aires) 2014; 50:100-10. [DOI: 10.1016/j.medici.2014.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/09/2014] [Indexed: 10/25/2022] Open
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