Study of Neurodevelopmental Outcomes at 10-14 Months of Age Using Bayley Scale of Infant and Toddler Development in Asphyxiated Newborns with Hypoxic Ischemic Encephalopathy Treated with and without Therapeutic Hypothermia

Document Type : Original Article

Authors

Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Abstract

Background: Therapeutic hypothermia has become an established protocol for all neonates with moderate to severe Hypoxic Ischaemic Encephalopathy (HIE). There are very few studies comparing the neurodevelopmental outcomes in asphyxiated neonates who received therapeutic hypothermia or did not. This study aimed to assess the neurodevelopmental outcomes of asphyxiated neonates with features of HIE at 10-14 months of age using Bayley Scale of Infant and Toddler Development III (BSID III) and to compare this outcome between neonates who received therapeutic hypothermia and those who did not.
Methods: Term infants with HIE admitted in neonatal intensive care unit (NICU) at a tertiary referral hospital were followed up at 10-14 months of age from December 2013 to August 2015. Neurodevelopmental outcomes were assessed using BSID III.
Results: A total of 76 neonates with birth asphyxia were admitted to NICU between December 2012 and August 2014. These neonates were followed up from December 2013 to August 2015, and 34 of them were included in the study. At10-14 months of age, 8 neonates (23.5%) had cognitive delay, 14 cases (41.17%) had motor delay, and 9 newborns (26.4%) had language delay using BSID III score of < 85 as cut off.
Twenty (58.82%) infants had normal development in all 3 domains. Higher percentage of infants (73.68%) who received therapeutic hypothermia had normal BSID Score  as compared to 40% of the neonates with normal BSID score (>85) who did not receive therapeutic hypothermia. Statistical analysis using Chi-square test showed P-value of 0.048 as statistically significant.
Conclusion: Neurodevelopment assessment at 10-14 months of age using BSID III of asphyxiated neonates with HIE showed significantly better outcome in infants who received therapeutic hypothermia than those who did not.
 

Keywords

References

1. World Health Organization. Perinatal mortality: a listing of available information. Geneva: World Health Organization; 1996.
2. National neonatal perinatal database India. Geneva: World Health Organization; 2003.
3. Haaland K, Loberg EM, Steen PA, Thoresen M. Posthypoxic hypothermia in newborn piglets. Pediatr Res. 1997; 41(4 Pt 1):505‑12.
4. Thoresen M, Penrice J, Lorek A, Cady EB, Wylezinska M, Kirkbride V, et al. Mild hypothermia after severe transient hypoxia‑ischemia ameliorates delayed cerebral energy failure in the newborn piglet. Pediatr Res. 1995; 37(5):667‑70.
 5. Edwards AD, Yue X, Squier MV, Thoresen M, Cady EB, Penrice J, et al. Specific inhibition of apoptosis after cerebral hypoxia-ischemia by moderate postinsult hypothermia. Biochem Biophys Res Commun. 1995; 217(3):1193-9.
 6. Thomas N, George KC, Sridhar S, Kumar M, Kuruvilla KA, Jana AK. Whole body cooling in newborn infants with perinatal asphyxial encephalopathy in a low resource setting: a feasibility trial. Indian Pediatr. 2011; 48(6):445-51.
7. Gluckman P, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005; 365(9460):663-70.
 8. Horn AR, Woods DL, Thompson C, Elis I, Kroon M. Selective cerebral hypothermia for post-hypoxic neuroprotection in neonates using a solid ice cap. S Afr Med J. 2006; 96(9 Pt 2):976-81.
 9. Purkayastha J, Lewis LE, Bhat R, Anusha KM. Feasibility and safety of therapeutic hypothermia and short term outcome in neonates with hypoxic Ischemic encephalopathy. Indian J Pediatr. 2016; 83(2):175-7.
10. Zhou WH, Cheng GQ, Shao XM, Liu XZ, Shan RB, Zhuang DY, et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxicischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr. 2010; 157(3): 367-72.
 11. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson EJ, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005; 353(15): 1574-84.
12. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis P. Cooling for newborns with hypoxicischaemic encephalopathy. Cochrane Database Syst Rev. 2007; 1:CD003311.
 13. Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009; 361(14):1349-58.
 14. American Academy of Paediatrics. Developmental surveillance and screening of infants and young children. Paediatrics. 2001; 108(1):192-6.
15. Sarnath HB, Sarnath MS. Neonatal encephalopathy following fetal distress. A clinical and Electroencephalographic study. Arch Neurol. 1976; 33(10): 696-705.
16. Jary S, Whitelaw A, Walløe L, Thoresen M. Comparison of Bayley-2 and Bayley-3 scores at 18 months in term infants following neonatal encephalopathy and therapeutic hypothermia. Dev Med Child Neurol. 2013; 55(11):1053-9.
 17. Chalak LF, DuPont TL, Sánchez PJ, Lucke A, Heyne RJ, Morriss MC, et al. Neurodevelopmental outcomes after hypothermia therapy in the era of Bayley-III. J Perinatol. 2014; 34(8):629-33.
 18. Rutherford MA, Counsell SJ, Couran FM, Azzopaddi D, Edwards D, Renowden S, et al. Magnetic resonance imaging patterns of brain injury following hypothermia in neonates with Hyoxic ischaemic Encephalopathy. Paediatr Res. 2004; 4(351):583.
 19. Rutherford M, Srinivasan L, Dyet L, Ward P, Allsop J, Counsell S, et al. Magnetic resonance imaging in perinatal brain injury: clinical presentation, lesions and outcome. Pediatr Radiol. 2006; 36(7):582-92.
20. Battin RM, Dezoete A, Gunn RT, Gluckmann DP, Gunn JA. Neurodevelopmental outcome of infants treated with head cooling and mild hypothermia after perinatal asphyxia. Pediatrics. 2001; 107(3): 480-4.
 21. Robertson CM, Finer NN. Long term follow up of term neonates with perinatal asphyxia. Clin Perinatol. 1993; 20(2):483-500.
Iranian Journal of Neonatology
Volume 9, Issue 4
December 2018
Pages 1-6

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