Neonatal Hypoxic Ischemic Encephalopathy: Early Diagnosis and Outcome Prediction with Ultrasound

Background: Globally, neonatal hypoxia ischemic encephalopathy (HIE) is a leading cause of both long-term neurodevelopmental impairment and neonatal mortality. It results from perinatal asphyxia leading to impaired cerebral blood flow and oxygen deprivation. Early and accurate diagnosis is crucial for timely management and prognosis prediction. Although MRI is the gold standard for brain imaging, cranial ultrasonography offers a safe, portable, and cost-effective bedside tool that enables early detection of structural and hemodynamic brain abnormalities. Doppler parameters such as resistive and pulsatility indices provide valuable information about cerebral perfusion and correlate with HIE severity and outcomes.
Objective: To describe the ultrasound presentation of the brain and cerebral hemodynamics in neonates with HIE and to assess the outcome prediction.
Patients and Methods: A cross-sectional analytic study was conducted on 50 consecutive neonates admitted with a clinical diagnosis of perinatal asphyxia at the Radiology Department, Faculty of Medicine, Menoufia University and Sheikh Zayed Specialized Hospital during the period of the study from March 2023 till April 2024.
Results: There was statistically significant relation between mortality rate and the degree of HIE severity (p=0.039), severe HIE was more common (n=5, 55.56%) than moderate HIE (n=2, 12.5%). However, neurodevelopmental disability was significantly more common among neonates who had moderate HIE (n=14, 87.5%), followed by severe HIE (n=4, 44.4%) compared to neonates who had mild HIE which hadn't neurodevelopmental disability (p=0.017).
Conclusion: Ultrasound imaging of the brain in neonates with HIE is a crucial tool for assessing cerebral damage and predicting outcomes. The integration of advanced ultrasound techniques, such as Doppler imaging, enables detailed evaluation of cerebral hemodynamics, including blood flow patterns and vascular abnormalities. These imaging modalities provide critical information on the severity and extent of brain injury.