Hypoxic-ischaemic cerebral injury in the term newborn: correlation of CT findings with neurological outcome

Abstract

For asphyxiated term infants, prediction of neurological outcome based on clinical criteria alone is not always reliable. We have used changes in tissue density on CT scan (known to represent hypoxic-ischaemic injury) as an adjunct to clinical examination to assess the severity of cerebral injury. The study population comprised 56 term newborns with hypoxic-ischaemic encephalopathy. Scans were performed with a General Electric 8800 scanner and classified as Normal, Patchy, Diffuse or Global according to the extent of areas of decreased density (DD). These were correlated with neurological outcome (i.e. Normal, Minor handicap, Major handicap, Indefinite or Death). Death or major handicap occurred in only two of 14 infants in the combined Normal or Patchy DD groups but in 26 of 29 in the combined Diffuse or Global groups. This correlation was highly significant (p less than 0.0005). 13 classified as Indefinite were normal at age three to 10 months but were excluded from analysis because of the short follow-up. The data demonstrate that CT scanning is a valuable adjunct to neurological examination for assessment of cerebral injury in the asphyxiated term infant.