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The diagnostic and prognostic implications of brain hyperechogenicity in hypoxic-ischaemic encephalopathy grade II
1Department of Pediatrics, Plovdiv Medical University, 15a Vassil Aprilov St., Plovdiv 4000, Bulgaria. ivanov@hms-plovdiv.acad.bg
Objective:
To study from a practical viewpoint the type, intensity and spread of brain hyperechogenicities (BHE) and their diagnostic and prognostic implications in patients with the most common, and most variable in presentation and prognosis, second grade of hypoxic-ischaemic encephalopathy (HIE).
Methods:
Full-term newborns (75) with HIE gr.II were examined and divided into subgrades IIa and IIb, depending on the evidence of neurological improvement on day 7 after birth. Ultrasound examination was performed with a 5-MHz transducer. All patients were evaluated for intensity of BHE by a score system and those with focal lesions had also the number of affected loci with BHE counted. In 27 of these infants the BHE data were analyzed according to the outcome after the 11th month. A control group of 31 healthy neonates was also studied.
Results:
We obtained 84% sensitivity and 77% specificity of BHE in HIE gr.II. Of the patients, 96% demonstrated different combinations of focal BHE, and only four demonstrated diffuse BHE. A significant correlation was found between the BHE variables (intensity score and number of loci) and clinical severity. The difference in intensity scores between HIE IIa and IIb was significant in the first 2 weeks after birth. The combination of clinical severity with the BHE variables could predict the outcome with 70.4% accuracy.
Conclusion:
BHE (focal or diffuse) could serve as additional diagnostic, grading and prognostic criterion in HIE gr.II.