Assessing pupil reaction to light using ultrasound in a sick neonate with Hypoxic Ischemic Encephalopathy

Area of Science:

• Neonatal neurology
• Pediatric critical care
• Medical imaging technology

Background:

• Pupillary light response is crucial for neurological assessment in infants with hypoxic ischemic encephalopathy (HIE).
• Assessing pupil reactivity can be difficult in critically ill neonates due to generalized edema.
• Therapeutic hypothermia (TH) eligibility and prognostication rely on serial neurological evaluations.

Purpose of the Study:

• To introduce a simple, bedside point-of-care ultrasound (POCUS) technique for evaluating pupillary light response.
• To demonstrate the utility of POCUS in neonates with HIE undergoing TH.
• To address the challenges of traditional pupillary examination in edematous infants.

Main Methods:

• A case report detailing the application of bedside POCUS for pupil examination.
• Utilized POCUS to visualize and assess the pupillary light reflex in a neonate.
• Focused on a patient with moderate HIE receiving TH.

Main Results:

• Successfully demonstrated pupillary light response using POCUS in an infant with HIE and edema.
• The technique provided a feasible alternative to traditional methods.
• Facilitated ongoing neurological assessment during TH.

Conclusions:

• Bedside POCUS is a viable and simple method for assessing pupillary light response in infants with HIE.
• This technique can overcome challenges posed by edema in critically ill neonates.
• POCUS can aid in prognostication and management decisions for infants undergoing TH.