Application Of Transcranial Ultrasonography In Diagnosis Of Neonatal Hypoxic-ischemic Encephalopathy

BackgroundNeonatal hypoxic-ischemic encephalopathy (HIE) is the most common injury in full term borns. Some of the survivors may be left severe neurological sequelae. Early diagnosis and timely intervention is the key to reduce the sequela and thus is concerned by pediatricians. Imaging modalities of CT andMRI have been widely used in clinical diagnosis of HIE, but both of these techniques have certain limitations especially in the critical patients. Transcranial ultrasound examination could display both the cerebral structure and blood flow changes, and has also been used in assessing neonatal HIE.ObjectiveTo evaluate the application of transcranial 2D and color Doppler in assessing neonatal hypoxic-ischemic encephalopathy (HIE). MethodsFourty-two full term newborn infants doubted with HIE were examined by SonoScape S8 ultrasonographic system within 24 hr and 72 hr post-natal. Blood flow parameters of middle cerebral artery including Vs, Vd, Vm, RI were measured and analyzed by transcranial color Doppler ultrasound. Forty healthy new-born infants were enrolled in the studies as the control group.Results1. Eighteen out of the 42 HIE new-borns showed periventricular hyperecho within 24hr. All cases presented diffused hyperecho in bilateral hemisphere post-asphyxia within 72hr.2. After the two days'treatment, thirty-four HIE new borns'intracranial echotexture were back to normal; Eight HIE new borns'white matter echotexture were not fully restored; Four showed subependymal hemorrhage, and 13 demonstrated intraventricular hemorrhage.3. Compared to the control group, the systolic peak flow velocity of the middle cerebral artery increased significantly , while the diastolic peak flow velocity decreased in 24hr in the HIE newborns(P<0.05), resulting in an increased resistance index.Both the systolic and diastolic peak flow velocities increased significantly within 72hr,ConclusionsTranscranial ultrasonography could be used to demonstrate the morphological, echotexture and cerebral blood flow changes in HIE patients, and it may provide valuable information in the diagnosis and real time assessment of the HIE therapeutic effects in clinic.