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Observational Study
. 2016 Aug;80(2):190-6.
doi: 10.1038/pr.2016.77. Epub 2016 Apr 11.

Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study

Cally J Tann  1   2   3 , Margaret Nakakeeto  4 , Cornelia Hagmann  5 , Emily L Webb  2 , Natasha Nyombi  6 , Flaviah Namiiro  6 , Kelly Harvey-Jones  1 , Anita Muhumuza  6 , Kathy Burgoine  1 , Alison M Elliott  2   3 , Jennifer J Kurinczuk  7 , Nicola J Robertson  1 , Frances M Cowan  8
Affiliations
Observational Study

Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study

Cally J Tann et al. Pediatr Res. 2016 Aug.

Abstract

Background: In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury.

Methods: Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36 h reported blind to NE status.

Results: Scans were performed at median age 11.5 (interquartile range (IQR): 5.2-20.2) and 8.4 (IQR: 3.6-13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of the cases vs. 1.0% controls (P < 0.001). White matter injury was not significantly associated with bacteremia in encephalopathic infants (odds ratios (OR): 3.06 (95% confidence interval (CI): 0.98-9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs. 25.9% without; OR: 3.34 (95% CI: 1.61-6.95)).

Conclusion: In this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia-ischemia (HI). Early abnormalities were a significant predictor of death.

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Figures

Figure 1
Figure 1
Flow diagram of study participants.
Figure 2
Figure 2
Normal basal ganglia and white matter seen on coronal (a, b) and parasagittal (c) images consistent with a score of 0.
Figure 3
Figure 3
Bilateral basal ganglia and thalamic echogenicity seen on coronal (a) and parasagittal (b) images consistent with a score of 2.
Figure 4
Figure 4
Diffuse, moderate/severe echogenicity in the white matter seen on coronal (a) and parasagittal (b) images consistent with a score of 2.
Figure 5
Figure 5
Severe dense echogenicity in the basal ganglia and thalami on parasagittal view (a) and global echogenicity and swelling in the white matter and cortex on coronal images (b) consistent with a score of 3.
See this image and copyright information in PMC

References

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