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[Prognostic factors in cerebral hypoxic-ischemias in infants less than a year old]
M Tardieu1, D Devictor, C Wood
1Département de Pédiatrie, Hôpital de Bicêtre, Le Kremlin.
Insights
Coma duration over 8 hours after acute cerebral hypoxic ischemic insult indicates poor prognosis in infants. Seizures and specific CT scan findings also predict adverse outcomes, aiding early intervention strategies.
Area of Science:
- Neurology
- Pediatrics
- Neonatology
Context:
- Acute cerebral hypoxic ischemic insult in infants presents significant prognostic challenges.
- Establishing reliable early prognostic criteria is crucial for timely intervention and management.
Purpose:
- To identify early clinical and neuroimaging markers for predicting cerebral outcomes in infants following hypoxic ischemic insult.
- To differentiate between favorable and unfavorable neurological evolution.
Summary:
- A study of 31 infants with hypoxic ischemic insult revealed that coma duration exceeding 8 hours strongly correlated with unfavorable outcomes (death or sequelae).
- Poor prognosis was associated with hyperproteinorachia within 24 hours and cortico-subcortical hypodensity on CT scans.
- While early EEG and echography showed limited prognostic value, seizure activity and status epilepticus were observed in most survivors with poor outcomes.
Impact:
- Findings provide critical insights for clinicians managing infants with hypoxic ischemic insult, enabling more accurate early prognostication.
- Highlights the importance of coma duration and specific neuroimaging findings in guiding clinical decisions and parental counseling.
- Suggests a need for further research into more sensitive biomarkers for predicting long-term neurological deficits.
Abstract:
In order to establish criteria for early cerebral prognosis after acute cerebral hypoxic ischemic insult, we studied 31 cases of patients presenting, during their first year of life, cardio-respiratory arrests due to SIDS (21 cases), anesthesia (4 cases), other causes (6 cases). A favourable evolution was observed in 5 cases where coma lasted less than 8 hours. Conversely unfavorable evolution was seen in the 26 patients (21 deaths, 5 sequellae) where coma lasted more than 8 hours. Among 12 patients of this group surviving after the 4th day, 9 expressed seizures or status epilepticus. The poor evolution was correlated with hyperproteinorachia during the first 24 hours and with cortico-subcortical hypodensity on CT scan. Early EEG and transfontanellar echography seemed less useful to establish a prognosis, specifically to discriminate children surviving with and without sequelae.