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Updated: May 10, 2025
A Piglet Model of Neonatal Hypoxic-Ischemic Encephalopathy
Published on: May 16, 2015
The pattern of visual impairment in the spectrum of hypoxic ischemic encephalopathy
Swati Phuljhele1, Niranjana Balasubramaniam1, Gunjan Saluja1
1Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Insights
Visual impairment in children with hypoxic-ischemic encephalopathy (HIE) is linked to HIE severity and negatively affects social maturity. Early detection and management of visual issues in HIE are crucial for development.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Developmental Pediatrics
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Visual impairment is a common sequela of HIE, impacting child development.
- Understanding the interplay between HIE severity, visual function, and social development is critical.
Purpose of the Study:
- To investigate the relationship between visual impairment, social maturity, and clinical severity of HIE in Indian children.
- To assess visual acuity, refractive errors, and ocular findings in HIE patients.
- To correlate these findings with social maturity using the Vineland Social Maturity Scale.
Main Methods:
- An observational study included 60 children (6 months to 5 years) with HIE sequelae, categorized by Sarnat clinical grades.
- Comprehensive ophthalmological evaluations included cycloplegic refraction, visual acuity (VA) testing, fundus examination, and visual evoked response (VER).
- Social maturity was assessed using the Vineland Social Maturity Scale (VSMS).
Main Results:
- A significant association was found between visual acuity and HIE clinical severity (p < 0.0001).
- Visual acuity was also significantly related to social maturity.
- Optic disc pallor was prevalent in severe HIE (grade 3), and convergent strabismus was common.
Conclusions:
- Visual impairment is significantly correlated with the clinical severity of hypoxic-ischemic encephalopathy.
- Visual impairment negatively impacts the social maturity of children with HIE.
- Ocular assessment and intervention are vital for improving developmental outcomes in HIE survivors.
Purpose:
This study aimed to evaluate the relationship between visual impairment, social maturity, and clinical severity of hypoxic-ischemic encephalopathy (HIE) in the Indian population.
Methods:
An observational study was conducted in children with HIE sequelae aged between 6 months and 5 years. Sixty diagnosed cases of perinatal HIE were recruited, with twenty children in each of clinical grades 1, 2, and 3 according to the Sarnat clinical staging. All children underwent cycloplegic refraction using atropine 1% eye ointment, visual Acuity (VA) testing by teller acuity cards (TAC), anterior and posterior segment examination, FLASH visual evoked response (VER), strabismus workup, and social maturity assessment using the vineland social maturity scale (VSMS).
Results:
Sixty children, including 14 preterm and 46 term infants, with a mean age of 26.11 ± 16.06 months were studied. Normal birth weight was observed in 54% of the cases, whereas 42% had low birth weight and 4% had very low birth weight. There was no statistically significant difference between birth weight and the clinical severity of HIE (P = 0.970). A significant relationship between VA and clinical severity (TAC- p < 0.0001) and between VA and social maturity was observed. Optic disc pallor was present in 85% of grade 3 HIE cases. Among the 37 children with strabismus, the convergent type was predominant (86.4%). Refractive error was comparable across all grades of HIE.
Conclusion:
Visual impairment was significantly related to the clinical severity of HIE and had a negative impact on the social maturity of these children.
