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Outcome of non-cooled asphyxiated infants with under-recognised or delayed-onset encephalopathy
  1. Corline E J Parmentier1,
  2. Sylke J Steggerda2,
  3. Lauren C Weeke1,
  4. Monique Rijken2,
  5. Linda S De Vries1,2,
  6. Floris Groenendaal1
  1. 1 Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Floris Groenendaal, Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands; f.groenendaal{at}umcutrecht.nl

Abstract

Objective To describe the clinical characteristics, MRI findings and neurodevelopmental outcome of infants with documented perinatal asphyxia and seizure onset within 24 hours after birth who were not selected for therapeutic hypothermia (TH).

Design Retrospective cohort study.

Setting and patients (Near-)term infants with documented perinatal asphyxia referred to two Dutch level III neonatal units with neonatal encephalopathy (NE) and seizures <24 hours after birth not treated with TH. Infants with a diagnosis other than NE following perinatal asphyxia causing the seizures were excluded.

Main outcome measures Clinical characteristics, findings on cranial MRI performed within 8 days after birth and neurodevelopmental outcome assessed using the Griffiths Mental Development Scales at 18 months or Bayley Scales of Infant and Toddler Development–Third Edition at 2 years of age.

Results 39 infants were included. All had abnormalities on MRI. Predominant white matter/watershed injury was the most common pattern of injury, 23 (59%). 7 (18%) infants had predominant basal ganglia/thalamus injury, 3 (8%) near total brain injury, 5 (13%) arterial ischaemic stroke, 1 (3%) an intraventricular haemorrhage. Adverse outcome was seen in 51%: 6 died, 11 developed cerebral palsy (spastic n=8, dyskinetic n=3), 2 had neurodevelopmental delay, 1 had severe hearing impairment.

Conclusions All infants with documented perinatal asphyxia and seizure onset within 24 hours after birth who did not receive TH had abnormalities on MRI. 51% had an adverse outcome. Better methods for recognition of infants who might benefit from TH and careful neurodevelopmental follow-up are urgently needed.

  • neonatology
  • neurology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @fgroenendaal

  • Contributors Study conception and design: FG, LSDV, CEJP. Acquisition of data: CEJP, SJS, MR, LSDV, LCW, FG. Analysis and interpretation of data: CEJP, SJS, LSDV, FG. Drafting of manuscript: CEJP. Critical revision: all authors. Guarantor: FG

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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