PERINATAL ASPHYXIA: PREDICTING AND IMPROVING OUTCOME

Abstract

• Diffusion weighted imaging might underestimate cerebellar injury in neonates with hypoxic-ischemic encephalopathy (HIE), especially in the cerebellar hemispheres. If the apparent diffusion coefficient (ADC) values are measured in the cerebellum, the ADC values in the vermis are most representative for injury. • The newly developed cerebral ultrasound scoring system to assess brain injury in neonates with HIE was well associated with neurodevelopmental outcome at two years of age. It is an easy tool if MRI is not available or feasible and provides the opportunity for serial bedside monitoring of brain injury with cerebral ultrasound. • HIE can lead to smaller hippocampal volumes and atrophy of the mammillary bodies (MB) which are associated with memory problems and cognitive deficits at school-age, irrespective of therapeutic hypothermia. • Atrophy of the circuit of Papez, e.g. MB and hippocampal atrophy, could be an early biomarker to predict school-age memory and cognitive problems. • Allopurinol may be a beneficial add-on neuroprotective therapy, especially when it is administered early after birth. The effect of early allopurinol in HIE is currently investigated in the ALBINO trial. • The dosing regimen in the ALBINO trial is adequate with 20mg/kg intravenously started within 45 minutes after birth and in case of therapeutic hypothermia with a second dose of 10mg/kg intravenously. • Brain temperature can be measured using short and long echo time proton magnetic resonance spectroscopy without the need for calibration in infants with HIE. This offers an important tool for MRI safety studies in neonates. • 7.0T MRI is feasible in neonates and good quality images can be obtained. This might be an additional neuroimaging method for specific indications, such as stroke and metabolic disorders.