Hypoxic Ischemic encephalopathy; Late Magnetic Resonance Imaging findings correlated with clinical findings, at Yehuleshet specialty clinic, December 2023, Addis Ababa, Ethiopia.
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Date
2023-12
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Addis Ababa University
Abstract
Introduction: Neonatal Hypoxic Ischemic Encephalopathy is a brain injury that occurs
when oxygen or blood flow to the brain is reduced or stopped before, during, or shortly after
birth. Birth asphyxia is the main contributor to both long-term neurodevelopmental problems and
infant mortality in low- and middle-income nations. MRI examination can assist in elucidating
the type of injury, the timing of injury, the pattern of pathological evolution, and changes in
brain metabolism over time.
Objectives: To explore the late Brain MRI patterns and associated clinical findings of children
who had clinical diagnosis of perinatal asphyxia in Addis Ababa, Ethiopia.
Methodology: The study is conducted in pediatric neurology clinic with MRI
facility in Addis Ababa, Ethiopia. A total of 797 pediatric patient’s charts were identified
who had Brain MRI imaging evaluation. Of these, 70 cases with clinical diagnosis of perinatal
asphyxia were included. Using a structured questioner, demographic data, pre and perinatal
history of patients was collected. The MRI reports were reviewed by the principal investigator in
a systematic pattern.
Result: The age at time of MRI evaluation ranges from 2 months to 14 years. Gestational age
was assessed of which 74.3% are term and 25.7% are preterm. 42.9% of our patients received
antenatal care (ANC) during gestation and 55.7% were delivered at a healthcare facility Global
Developmental Delay (GDD), observed in 61.4% of the cases followed by Seizures occurring in
21.4% of patients. 62.5% of preterm infants had periventricular leukomalacia on MRI as
compared with those full-term (10.8%) infants, (P-value<0.001). And, (64.9%) of term infants
had Subcortical/ deep watershed border zone hyperintensities on MRI as compared to with
preterm (12.5%) infants. MRI findings suggestive of chronic injury, thinning of corpus callosum
and cerebral cortical atrophy were seen 31.35 & 40% and 31.3% 37.3% respectively in preterm
and term infants.
Conclusion: The study reveals high magnitude of perinatal asphyxia (8.8%) among pediatric
Neurology clinic visits. Brain MRI imaging showed abnormality in majority of cases with
specific dominant patterns seen being periventricular leukomalacia and subcortical/deep
watershed hyperintensities for preterm and term infants respectively indicating that brain MRI
should be used as primary diagnostic work up for these patients.
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Keywords
MRI pattern, Prenatal asphyxia, Neonatal HIE, Global Developmental Delay, Addis Ababa, Ethiopia