Basilar artery flow velocities and optic nerve sheath diameter as adjuvant tools for early diagnosis of hypoxic ischemic encephalopathy in neonates

Abstract

Abstract Objective We investigated potentiality ultrasonography measured optic nerve sheath diameter (ONSD) and basilar artery (BA) velocities to identify neonates with HIE-requiring-TH. Methods Study was of a case-control-design. Thirty- five neonates with mild-to-severe HIE admitted to NICU of Alexandria-University-Maternity-Hospital and were monitored by ultrasound-measured ONSD and BA velocities, in first-12-hours, during TH, and after rewarming. First scan measures of patients were compared to healthy-control-neonates. Comparative statistics, ROC-curves, and correlation of different clinical and imaging parameters were used in analysis. Results Mean value of left-and-right-ONSD measurements in control group (0.31 cm, 0.30 cm, respectively) were significantly higher than asphyxiated-group (0.35 cm), with p-value<0.001. ONSDs of > 0.32 cm in right-and-left eyes carry 91% and 88% sensitivity, respectively, and 100% specificity in identifying patients with mild-to-severe HIE. Resistive index (RI) of BA decreased and EDV of BA increased in HIE-patients than healthy-control-neonates, with p value<0.001. Left-and-right-ONSD diameters are negatively correlated with BA-RI, with r=-.432; p < .01and r=-.34; P.046, respectively. ONSDs in both eyes, BA-RI and BA-EDV showed significant changes throughout three time points in HIE-patients. Conclusion ONSD and BA-velocities can help in early identification of asphyxiated-neonates and therefore can be used to select patients candidate for TH. They also help in monitoring of asphyxiated-patient before, during and after TH.