Feriha Catibusic

Neurodevelopmental Follow Up After Therapeutic Hypothermia for Perinatal Asphyxia

Introduction: Neuroprotective benefit of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy (HIE) was assessed by analyzing survival and neurodevelopmental outcome of neonates subjected to this procedure. Material and methods: Newborns with gestational age > 36 weeks and < 6 hours of age with moderate to severe asphyxial encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. Outcome measures assessed were death and neurodevelopmental characteristics, which were compared at the different age using ASQ-3. Twenty-five children were assessed at age 3-6, 12-18 and 24-36 months. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died. Results: At the first assessment developmental categories of communication were normal in 78.9%, problem solving in 63.2%, personal-social in 68.4%, gross motor in 68.4%, and fine motor in 42.1% with a high need of retesting in this area. Second assessment was done in 17 patients: developmental categories of communication normal in 58.8%, problem solving in 70.6%, personal-social in 64.7%, gross motor in 64.7%, and fine motor in 35.3%. Third evaluation was done in 14 patients: developmental categories of communication were normal in 64.3%, problem solving in 71.4%, personal-social in 57.1%, gross motor in 64.3%, and fine motor in 42.9%. Conclusion: There was no correlation between baseline parameters and outcome. Results of the study are showing that therapeutic hypothermia in term newborns can provide better survival and less neurologic sequels in HIE patients.

Diagnostics of common microdeletion syndromes using fluorescence in situ hybridization: single center experience in a developing country

Microdeletion syndromes are caused by chromosomal deletions of less than 5 megabases which can be detected by fluorescence in situ hybridization (FISH). We evaluated the most commonly detected microdeletions for the period from June 01, 2008 to June 01, 2015 in the Federation of Bosnia and Herzegovina, including DiGeorge, Prader-Willi/Angelman, Wolf-Hirschhorn, and Williams syndromes. We report 4 patients with DiGeorge syndromes, 4 patients with Prader-Willi/Angelman, 4 patients with Wolf-Hirschhorn syndrome, and 3 patients with Williams syndrome in the analyzed 7 year period. Based on the positive FISH results for each syndrome, the incidence was calculated for the Federation of Bosnia and Herzegovina. These are the first reported frequencies of the microdeletion syndromes in the Federation of Bosnia and Herzegovina.

Interictal Electroencephalography (EEG) Findings in Children with Epilepsy and Bilateral Brain Lesions on Magnetic Resonance Imaging (MRI).

Introduction: Neuroimaging procedures and electroencephalography (EEG) are basic parts of investigation of patients with epilepsies. Aim: The aim is to try to assess relationship between bilaterally localized brain lesions found in routine management of children with newly diagnosed epilepsy and their interictal EEG findings. Patients and methods: Total amount of 68 patients filled criteria for inclusion in the study that was performed at Neuropediatrics Department, Pediatric Hospital, University Clinical Center Sarajevo, or its outpatient clinic. There were 33 girls (48,5%) and 35 boys (51,5%). Average age at diagnosis of epilepsy was 3,5 years. Results: Both neurological and neuropsychological examination in the moment of making diagnosis of epilepsy was normal in 27 (39,7%) patients, and showed some kind of delay or other neurological finding in 41 (60,3%). Brain MRI showed lesions that can be related to antenatal or perinatal events in most of the patients (ventricular dilation in 30,9%, delayed myelination and post-hypoxic changes in 27,9%). More than half of patients (55,9%) showed bilateral interictal epileptiform discharges on their EEGs, and further 14,7% had other kinds of bilateral abnormalities. Frequency of bilateral epileptic discharges showed statistically significant predominance on level of p<0,05. Cross tabulation between specific types of bilateral brain MRI lesions and EEG finding did not reveal significant type of EEG for assessed brain lesions. Conclusion: We conclude that there exists relationship between bilaterally localized brain MRI lesions and interictal bilateral epileptiform or nonspecific EEG findings in children with newly diagnosed epilepsies. These data are suggesting that in cases when they do not correlate there is a need for further investigation of seizure etiology.

Predictors of Mortality in Neonates with Seizures; a Prospective Cohort Study.

Objective: The aim of this study was to analyze prognostic indicators for mortality in neonates with seizures in a level III Neonatal Intensive Care Unit (NICU). Patients and methods: A cohort of 100 neonates with clinically manifested seizures hospitalized in the NICU during 4 years period was prospectively monitored for the first year of life. The cohort consisted of 33 preterm and 67 full-term babies with 60 male and 40 female infants. Results: The mortality rate in the first year of life of infants with seizures in the neonatal period was 23%. The most common cause of seizures was birth asphyxia for full-term infants and intra-periventricular hemorrhage for preterm infants. Death was more common in pre-term than term infants (p <0,005). Simple regression demonstrated statistically significant associations between death in the first year of life and a cluster of highly associated variables: resuscitation (p<0, 01), mechanical ventilation (p<0,01) and asphyxia (p<0,05). This cluster of variables significantly correlates with: gestational age (p<0, 05), birth weight (p<0, 05) and intracranial hemorrhage (p<0, 05). Conclusion: In this cohort of neonates with seizures asphyxia requiring neonatal resuscitation was the primary risk factor for death.

PP10.9 – 2483: Neurodevelopmental outcome of infants with neonatal seizures

Objective Prospective study was performed on a cohort of 100 patients: term and preterm newborns, who had clinically manifested seizures during the neonatal period. Methods Initial assessment was performed during their hospitalisation, while furder follow-up was done through regular visits to outpatient facilities of Deparment of Child Neurology. Patients were divided into two groups – preterm and term newborns (67/33). During early and late neonatal period, 23 children died (12 terms/11 preterms). Use of medications and drugs during pregnancy (38%), underlaying disease in mothers (22%), type of labour (vaginaly 61%), intrauterine growth restriction (28%), necessity for resustitation mesures (54%), perinatal aspyxia (52%) and mechanical ventilation (54%) were considered as risk factor. Neurodevelopmental assessment was performed at the age of one year with Alberta Infant Motor scale (AIMS) and Developmental scale. Results According to AIMS 68.83% patients had scores below 10 th percentile which corresponded to motoric developmental delay. According to Developmental scale, 62.33% of children showed developmental discordance with the results expected for chronological age. 28.57% of patients with diagnosis of epilepsy at the age of one year had also low scores at AIMS ( Conclusion Neonatal seizures have strong prediction for short and long term morbidity and mortality.

P123 – 2671: Follow up of neurodevelopmental outcome after therapeutic hypothermia for perinatal asphyxia

Objective Neuroprotective benefit of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy was assessed by analyzing survival and neurodevelopmental outcome of neonates subjected to this procedure. Methods Newborns with gestational age of more than 36 weeks and less than 6 hours of age with moderate to severe asphyxial encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. The outcome measures assessed were death and neurodevelopmental characteristics, which we compared at the different age using ASQ-3, at least 3 times during follow-up. Results Twenty-five children were assessed during the period from October 2010 to October 2013. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died and two were lost for follow up. At the first assessment developmental categories of communication were normal in 68.4%, problem solving in 73.7%, personal-social in 68.4%, gross motor in 57.9%, and fine motor in 36.8% but with a high need of retesting in this area. Seven of 19 patients (36.8%) had completely normal results for all five categories, while three (15.8%) had abnormal results for all categories. Second assesment was done in 17 patients with developmental categories of communication normal in 70.5%, problem solving in 76.5%, personal-social in 70.5%, gross motor in 58.8%, and fine motor in 41.1%. Third evaluation was done in 13 patients: developmental categories of communication were normal in 69.2%, problem solving in 76.9%, personal-social in 69.2%, gross motor in 61.5%, and fine motor in 46.2%. Conclusion Relatively small number of patients and limitations of this study design precluded any far-reaching conclusions, but we think that therapeutic hypothermia in term newborns can provide better survival and less neurologic sequels in hypoxic-ischemic encephalopathy patients.