Ophthalmic outcomes following neonatal hypoxic ischaemic encephalopathy; oculomotor, biometric and refractive data in early childhood

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

To investigate the functional and structural impact of neonatal hypoxic ischaemic encephalopathy (HIE) on childhood visual development. In a prospective study, the neurocognitive outcomes of 42 children with a history of neonatal HIE were assessed serially up to 5 years. For the ophthalmic component of the study, visual, refractive, orthoptic and ocular biometry measurements were obtained in 32 children, with axial length measurements estimated using the IOLMaster. For the 32 children who completed the ophthalmic component of the study, severity of HIE grade was determined to be mild, moderate, or severe in 18 (56.3%), 13 (40.6%), and 1 (3.1%) cases, respectively. One (3.1%) child was classed as visually impaired. Twelve (37.5%) were found to have ametropia. Mean (±SD) axial length was 22.09 (±0.81) mm, within the normal range for the age of this cohort. Seven of the 42 (16.7%) children who were involved in the larger neurodevelopmental arm of the study had clinical evidence of a squint. There was no correlation between the severity of HIE grade at birth and axial length or occurrence of squint. Neonatal HIE is associated with a higher incidence of squint compared with the general paediatric population. This occurred irrespective of severity of HIE grade. The ocular biometry measurements were consistent with published normative data, and no significant difference in ocular biometry was demonstrated between HIE severity groups.

Related collections

Most cited references 27

Record: found
Abstract: found
Article: not found

Cooling for newborns with hypoxic ischaemic encephalopathy.

Susan Jacobs, Marie Berg, Rod Hunt … (2013)

Newborn animal studies and pilot studies in humans suggest that mild hypothermia following peripartum hypoxia-ischaemia in newborn infants may reduce neurological sequelae without adverse effects. To determine the effect of therapeutic hypothermia in encephalopathic asphyxiated newborn infants on mortality, long-term neurodevelopmental disability and clinically important side effects. We used the standard search strategy of the Cochrane Neonatal Review Group as outlined in The Cochrane Library (Issue 2, 2007). Randomised controlled trials evaluating therapeutic hypothermia in term and late preterm newborns with hypoxic ischaemic encephalopathy were identified by searching the Oxford Database of Perinatal Trials, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2007, Issue 2), MEDLINE (1966 to June 2007), previous reviews including cross-references, abstracts, conferences, symposia proceedings, expert informants and journal handsearching. We updated this search in May 2012. We included randomised controlled trials comparing the use of therapeutic hypothermia with standard care in encephalopathic term or late preterm infants with evidence of peripartum asphyxia and without recognisable major congenital anomalies. The primary outcome measure was death or long-term major neurodevelopmental disability. Other outcomes included adverse effects of cooling and 'early' indicators of neurodevelopmental outcome. Four review authors independently selected, assessed the quality of and extracted data from the included studies. Study authors were contacted for further information. Meta-analyses were performed using risk ratios (RR) and risk differences (RD) for dichotomous data, and weighted mean difference for continuous data with 95% confidence intervals (CI). We included 11 randomised controlled trials in this updated review, comprising 1505 term and late preterm infants with moderate/severe encephalopathy and evidence of intrapartum asphyxia. Therapeutic hypothermia resulted in a statistically significant and clinically important reduction in the combined outcome of mortality or major neurodevelopmental disability to 18 months of age (typical RR 0.75 (95% CI 0.68 to 0.83); typical RD -0.15, 95% CI -0.20 to -0.10); number needed to treat for an additional beneficial outcome (NNTB) 7 (95% CI 5 to 10) (8 studies, 1344 infants). Cooling also resulted in statistically significant reductions in mortality (typical RR 0.75 (95% CI 0.64 to 0.88), typical RD -0.09 (95% CI -0.13 to -0.04); NNTB 11 (95% CI 8 to 25) (11 studies, 1468 infants) and in neurodevelopmental disability in survivors (typical RR 0.77 (95% CI 0.63 to 0.94), typical RD -0.13 (95% CI -0.19 to -0.07); NNTB 8 (95% CI 5 to 14) (8 studies, 917 infants). Some adverse effects of hypothermia included an increase sinus bradycardia and a significant increase in thrombocytopenia. There is evidence from the 11 randomised controlled trials included in this systematic review (N = 1505 infants) that therapeutic hypothermia is beneficial in term and late preterm newborns with hypoxic ischaemic encephalopathy. Cooling reduces mortality without increasing major disability in survivors. The benefits of cooling on survival and neurodevelopment outweigh the short-term adverse effects. Hypothermia should be instituted in term and late preterm infants with moderate-to-severe hypoxic ischaemic encephalopathy if identified before six hours of age. Further trials to determine the appropriate techniques of cooling, including refinement of patient selection, duration of cooling and method of providing therapeutic hypothermia, will refine our understanding of this intervention.

0 comments Cited 418 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Neonatal Encephalopathy Following Fetal Distress

Harvey B. Sarnat (1976)

0 comments Cited 193 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Early EEG findings in hypoxic-ischemic encephalopathy predict outcomes at 2 years.

G. Boylan, Sean Connolly, Brendan D. Murray … (2009)

We examined the evolution of electroencephalographic (EEG) changes after hypoxic injury. Continuous, multichannel, video-EEG was recorded for term infants with hypoxic-ischemic encephalopathy, from 30 seconds, electrographic seizures, and absence of sleep-wake cycling at 48 hours. Early EEG is a reliable predictor of outcome in HIE. A normal or mildly abnormal EEG results within 6 hours after birth were associated with normal neurodevelopmental outcomes at 24 months.