Early Neurological Assessment in Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia

Abstract

Early neurological assessment in infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia has not been systematically explored. The aims of the present study were to assess whether the Hammersmith Infant Neurological Examination (HINE) is a good tool to predict later neurodevelopmental outcomes at 2 year from birth in this population of infants. A total of 41 term born infants with HIE treated with hypothermia performed the HINE at 12 months and a neurodevelopmental assessment at 24 months. All the infants who had a global HINE score between 67 and 78 were able to walk independently at 2 years and reported a normal developmental quotient; language disorders were observed in a limited number of infants. HINE scores <67 were always associated with motor impairment. In conclusion, the HINE confirms its role as one of the early neurological examination tools for the diagnosis of high risk infants, even in infants with HIE treated with hypothermia. These results can be useful for clinicians involved in the follow up of these infants for early identification of motor disabilities and in planning appropriate intervention.

Hammersmith Infant Neurological Examination in low‐risk infants born very preterm: a longitudinal prospective study

“…different aspects of neurological function and it is easy to administer in a clinical setting with a simple, scorable system. The HINE has reliable inter-and intraoperator reliability and is a good predictor of outcome [7][8][9][10][11][12][13][14][15][16][17] in both infants born preterm and at term. The use of the HINE in low-risk infants has been reported less widely.…”

“…The neurological development of infants born preterm during the first months of life has been widely studied in infants with brain lesions or, more generally, at higher risk of developing an atypical outcome 4–7 . The Hammersmith Infant Neurological Examination (HINE) is one of the simplest neurological examinations for the early diagnosis of neurological impairment in both low‐ and high‐risk infants during the first 2 years of life 7–17 . The tool explores different aspects of neurological function and it is easy to administer in a clinical setting with a simple, scorable system.…”

Hipotermia terapéutica como neuroprotección en neonatos con encefalopatía hipóxica-isquémica

“…La encefalopatía hipóxica isquémica tiene gran relevancia en la discapacidad a nivel mundial, el uso de la tecnología ha favorecido el uso de métodos diagnósticos como la resonancia magnética que confirma que los neonatos no presentan una atrofia cerebral concreta lo que se presume que estas lesiones son causadas en la labor de parto (Ovali, 2022) en el avance clínico demuestran la relevancia del uso de la hipotermia terapéutica como un factor que disminuye la discapacidad grave (parálisis cerebral)(Chin Journal Scientific MQRInvestigar 1379 tasa de discapacidad grave varía entre 42-100 % por lo que el uso de este plan terapéutico podría ayudar a reducir los picos de prevalencia de la discapacidad (Garfinkle et al, 2013). Se ha determinado que la secretoneurina un polipéptido es la encargada del proceso de la angiogénesis así como otros procesos como una citoquina quimiotáctica, angiogénica y en el sistema nervioso; por ejemplo en el caso del sistema nervioso la secretoneurina ayuda a la liberación de la dopamina, en la isquémica existen concentraciones altas en el tejido cerebral y en el suero produciendo un colapso de sangre en el cerebro teniendo un aumento de secreción sérica de secretoneurina en muchos de los casos estos niveles altos han sido encontrados en pacientes que han sufrido una reanimación cardiopulmonar siendo un biomarcador para pronosticar un daño neurológico, en el caso de los recién nacidos este neuropéptido puede ser de gran utilidad utilizado como un biomarcador en la identificación de una encefalopatía hipóxico isquémico después de una asfixia perinatal ya que estos niveles se encuentran en concentraciones más altas en comparación con los recién nacidos a término y sanos, sin embargo se considera necesario realizar estudios más avanzados permitan demostrar si este puede ser un biomarcador completo para un diagnóstico eficaz de la EHI (21)(22)(23)(24).…”

Dexmedetomidine Use in Infants Undergoing Cooling Due to Neonatal Encephalopathy (DICE Trial): A Randomized Controlled Trial: Background, Aims and Study Protocol

“…To determine the extent to which dexmedetomidine is associated with improved short-term clinical outcomes during initial hospitalization the following data will be collected: (63)(64)(65). In the present proposal, these tools will be used as markers of neurodevelopmental safety following the use of dexmedetomidine.…”

“…The following well established tests will be used: (1) Generalized Movement Assessment (GMA) (cerebral palsy assessment) performed 1 week after sedation is weaned off and at 3–4 months of life; (2) Hammersmith Infant Neurological Exam (HINE) test performed at 3–4 and at 6–9 months of life; (3) Test of Infant Motor Performance (TIMP) performed at 3–4 months of life; and (4) Peabody Developmental Motor Skills (PDMS-2) test performed at 6–9 months of life. These validated tests are core components of the neurodevelopmental assessment for early diagnosis of cerebral palsy ( 63 – 65 ). In the present proposal, these tools will be used as markers of neurodevelopmental safety following the use of dexmedetomidine.…”