THE ROLE OF TRANSCRANIAL ULTRASOUND IN THE EVALUATION OF HYPOXIC ISCHEMIC ENCEPHALOPATHY

Introduction: Hypoxic ischemic encephalopathy is a clinical term used to describe an abnormal neurobehavioral state that consists of a decreased level of consciousness with abnormalities in neuromotor tone. Any neonate, regardless of birth weight, size, or gestational age, who has a greater than average chance of morbidity or mortality, due to fetal, maternal or placental anomalies or an otherwise compromised pregnancy especially within the first 28 days of life is categorized as high-risk neonate. Cranial ultrasonography plays an important role in the diagnosis of significant lesions in infants presenting with hypoxic ischemic encephalopathy (HIE) and seizures and assessing severity, neurodevelopment outcome and neurological prognosis of these high-risk infants. In the neonate, many sutures and fontanelles are still open and these can be used as acoustic windows to look into the brain. Methodology: This was a hospital based descriptive observational study of 100 preterm and term babies with suspected brain injuries who were referred for cranial USG examination to the Radiodiagnosis Department of R.N.T. Medical College, Udaipur with hypoxic ischemic encephalopathy over a period of 18 months from June 2020 to November 2021. Results:The most common affected age group was 32-37weeks (51%). The abnormalities found on neurosonogram were germinal matrix hemorrhage, periventricular leucomalacia, cystic PVL, cerebral edema and ventriculomegaly. The most common abnormality was germinal matrix hemorrhage (17%) and subependymal hemorrhage (41%) was most common type. Isolated ventriculomegaly (53.8%) was more common than ventriculomegaly with hemorrhage (46.2%). Conclusion: Neurosonogram remains the accurate, rapid imaging modality of choice for detecting brain injuries in preterm infant. This technique is both sensitive and specific for detecting germinal matrix hemorrhage and periventricular leucomalacia. It is a useful modality to perform frequent follow-up scans. The advantages of neurosonogram are that it is easy to operate, non invasive, accurate, has lack of ionizing radiation, bed side availability for unstable infants, rapid diagnosis, wide availability, cost effectiveness and repeatability.