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Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study

Title: Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study
Author(s): Tann, CJ
Nakakeeto, M
Hagmann, C
Webb, EL
Nyombi, N
Namiiro, F
Harvey-Jones, K
Muhumuza, A
Burgoine, K
Elliott, AM
Kurinczuk, JJ
Robertson, NJ
Cowan, FM
Item Type: Journal Article
Abstract: BACKGROUND: In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury. METHODS: Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36 h reported blind to NE status. RESULTS: Scans were performed at median age 11.5 (interquartile range (IQR): 5.2-20.2) and 8.4 (IQR: 3.6-13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of the cases vs. 1.0% controls (P < 0.001). White matter injury was not significantly associated with bacteremia in encephalopathic infants (odds ratios (OR): 3.06 (95% confidence interval (CI): 0.98-9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs. 25.9% without; OR: 3.34 (95% CI: 1.61-6.95)). CONCLUSION: In this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia-ischemia (HI). Early abnormalities were a significant predictor of death.
Publication Date: 25-May-2016
Date of Acceptance: 2-Feb-2016
URI: http://hdl.handle.net/10044/1/40244
DOI: http://dx.doi.org/10.1038/pr.2016.77
ISSN: 1530-0447
Publisher: Nature Publishing Group
Start Page: 190
End Page: 196
Journal / Book Title: Pediatric Research
Volume: 80
Issue: 2
Copyright Statement: This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Pediatrics
1114 Paediatrics And Reproductive Medicine
Publication Status: Published
Appears in Collections:Clinical Sciences
Imaging Sciences
Faculty of Medicine



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