A Study On Clinico- Neuro- radiological Correlation and Immediate Outcome of Perinatal Asphyxia in Neonates Admitted in Tertiary Care Hospital,Tirupati

Abstract

Background: Perinatal Asphyxia (PA) is the most common cause of neonatal mortality. Hypoxic-ischemic encephalopathy is the foremost concern in an asphyxiated neonate. Neuroimaging with cranial ultrasound, computed tomography (CT), and Magnetic resonance imaging (MRI) are valuable tools in the work-up of patients with birth asphyxia. This study was conducted to study the clinico-neuroradiological correlation in birth asphyxia and its immediate outcome.Materials and methods: This prospective, observational study was conducted among 110 newborns with birth asphyxia over a period of one year to study clinico-neuro radiological manifestations admitted to the Department of Pediatrics,  Sri Venkateswara Medical College, Tirupati. Neonates with major congenital malformations and meningitis were excluded from the study and after taking informed consent. All the admitted asphyxiated babies after clinically staging as Hypoxic Ischemic Encephalopathy I ,II,III as proposed by Sarnat and Sarnat staging were subjected to neuroimaging investigations  Neurosonogram, CT brain, and MRI brain. At the time of discharge, the outcome has been assessed by Seizure control, Feeding pattern, and clinical neurological evaluation.Results : In our study majority of babies were male newborns(61.8%) , and more than half of the cases (51.8%) were reported as HIE stage-II. Neurosonogram identified 38 cases (34.5%) as abnormal. Among these 40.6% of the cases showed focal echogenic lesions. MRI identified 48 cases (43.6%) as abnormal, among which 47.9% of the cases (n=23) showed T2 hyperintensities. Clinical outcome at discharge showed feeding abnormalities in 12 cases , 6 had paladi feeding, 3 had swallowing difficulty, and one had Ryle's tube feeding. Abnormalities in tone were observed in 16 cases, in which all are hypertonia. Fifty-eight cases required AEDs for seizures.Out of 110 cases, all the cases (100%) got discharged. 78.2% of cases had a good outcome, and 21.8% of cases had a poor outcome.

Conclusions: Radiological investigations such as Neurosonogram and MRI are good predictors of a poor outcome in perinatal asphyxia cases. Prompt treatment by the Paediatrician immediately after the birth will be helpful in preventing untoward events in these cases.