Tina Bregant

White matter and cortical injury in hypoxic-ischemic encephalopathy: antecedent factors and 2-year outcome.

OBJECTIVE To examine the spectrum of isolated white matter (WM)/cortical injury and its relation to outcomes in infants with hypoxic-ischemic encephalopathy (HIE) and normal appearing basal ganglia and thalami. STUDY DESIGN From 1992-2007, 84 term infants with HIE and normal basal ganglia and thalami on neonatal magnetic resonance imaging were studied; WM/cortical lesions were classified by site and severity. Neurodevelopmental outcomes and head growth were documented at a median age of 2 years. RESULTS The WM was normal or mildly abnormal in 33.5%, moderate in 40.5%, and severely abnormal in 26% of infants. Cortical involvement was not seen or was only mild in 75.5%, moderate in 13%, and severe in 12% of infants. WM and cortical injury severity were highly correlated (Spearman ρ = 0.74; P < .001). Infants with severe WM injury had more severe neonatal courses and a higher incidence of hypoglycemia. No infant died. Five infants (6%) developed cerebral palsy but all could walk independently. Cognitive, visual, language, behavioral, and seizure problems were highly prevalent and correlated significantly with the severity of WM injury and poor postnatal head growth. CONCLUSION Infants with HIE and selective WM/cortical injury have a low prevalence of cerebral palsy but have a wide range of other problems, which occur more often with severe WM/cortical lesions.

Region-specific reduction in brain volume in young adults with perinatal hypoxic-ischaemic encephalopathy

BACKGROUND A severe form of perinatal hypoxic-ischaemic encephalopathy (HIE) carries a high risk of perinatal death and severe neurological sequelae while in mild HIE only discrete cognitive disorders may occur. AIM To compare total brain volumes and region-specific cortical measurements between young adults with mild-moderate perinatal HIE and a healthy control group of the same age. METHODS MR imaging was performed in a cohort of 14 young adults (9 males, 5 females) with a history of mild or moderate perinatal HIE. The control group consisted of healthy participants, matched with HIE group by age and gender. Volumetric analysis was done after the processing of MR images using a fully automated CIVET pipeline. We measured gyrification indexes, total brain volume, volume of grey and white matter, and of cerebrospinal fluid. We also measured volume, thickness and area of the cerebral cortex in the parietal, occipital, frontal, and temporal lobe, and of the isthmus cinguli, parahippocampal and cingulated gyrus, and insula. RESULTS The HIE patient group showed smaller absolute volumetric data. Statistically significant (p < 0.05) reductions of gyrification index in the right hemisphere, of cortical areas in the right temporal lobe and parahippocampal gyrus, of cortical volumes in the right temporal lobe and of cortical thickness in the right isthmus of the cingulate gyrus were found. Comparison between the healthy group and the HIE group of the same gender showed statistically significant changes in the male HIE patients, where a significant reduction was found in whole brain volume; left parietal, bilateral temporal, and right parahippocampal gyrus cortical areas; and bilateral temporal lobe cortical volume. CONCLUSIONS Our analysis of total brain volumes and region-specific corticometric parameters suggests that mild-moderate forms of perinatal HIE lead to reductions in whole brain volumes. In the study reductions were most pronounced in temporal lobe and parahippocampal gyrus.

Lumbar punction: comparison between an atraumatic and a traumatic punction needle

Background: Lumbar puncture is a standardized, routine diagnostic procedure in the diagnosis of neurological diseases. Post-duarl puncture headache (PDPH) is a common complication which occurs in 10 to 30 % of patients. Although the incidence of PDPH is much lower with the use of small, non-cutting needles, neurologists in Slovenia routinely use the classical traumatic spinal needles. Methods: In the article we provide an overview of a research concerned with the use of traumatic and atraumatic needles in the procedure with the emphasis on complications of the lumbar puncture. We present American and European recommendations for lumbar puncture procedure. Conclusions: International recommendations for neurologists advise the use of atraumatic spinal needles for lumbar puncture. We recommend to Slovenian neurologists to start using the atraumatic needles for elective lumbar punctures and hence provide neurological patients with better quality and cheaper long-term care.

OP80 – 2596: Potential of spectral EEG analysis as academic performance predictor in young patients with hypoxic-ischaemic encephalopathy (HIE)

Objectives Currently there are no reliable assessment tools for academic performance prediction in HIE patients. We compared cortical electrical activity via spectral analysis of EEG of HIE subjects with that of the healthy control group. In previous studies we observed correlation between local maximum in the alpha spectrum and learning success in HIE adolescents. We expect that local maximum in the alpha spectrum is observed in the control group with learning success. Methods We studied two groups: 13 subjects (8 males) of mean age 21.7±0.9 years with mild (69.2%) to moderate HIE (30.8%), graded by Sarnat and Sarnat criteria, mean gestational age 36.3±3.4 weeks and body weight 2640±807 g. The group reached educational level of secondary school. Learning difficulties were reported in 6 (46.2%) subjects, 5 of them had problems with mathematics, one with additional ADHD problems. Young man with epilepsy needed global help due to psychomotor retardation. Second group was of 10 healthy subjects (5 males), mean age 23.2±1.1 years. EEG was performed after sleep deprivation with 30 electrodes, recorded at 256 Hz sampling rate. Data of 2 HIE subjects were not further analysed due to epileptiform changes. We decomposed EEG signals into brain rhythms. Gained high-dimensional data were further reduced with principal component analysis (PCA), which showed three significances, the rest we identified as background noise. Further spectral analysis was performed in Matlab with first PC further analysed because of its relation to the global alpha rhythm generator. Results The data from HIE individuals and control group with learning success showed local maximum of alpha rhythm at mean 7.0±1.0 Hz. Data of individuals within HIE group who reported learning difficulties showed absence of alphas local maximum. Conclusions If observed with statistical significance in a bigger population, the method could help predicting academic success in HIE patients.

Presentation and analysis of work at the emergency department - of the University Children's Hospital Ljubljana.

Background: In the article we present and analyse work at paediatric emergency department (ED) –of the University Children’s Hospital Ljubljana. Methods: Between 21 April 2012 and 21 May 2012, we analysed the data which were simultaneously obtained during hospitalization of children at the hospital ED of the University Children’s Hospital Ljubljana. Data were collected via software ISPEK (Think Med, Marand), according to the admission and discharge records. For statistical analysis we used descriptive statistics of programme SPSS 16.0 for Windows (SPSS Inc., 2007). Results: We collected the data of 121 children, 51 (42.1 %) girls and 70 (57.9 %) boys at the mean age of 5.3 years (SD = 5.6 years), median 2.4 years. They were hospitalized on average for 1.7 days (SD = 0.9 day), median 2.0 days. 47.9 % children were hospitalized for less than 24 hours. The majority of patients were treated for pulmonary problems (32.4 %), neurological issues (18.2 %), infections (11.6 %), immunological problems (10.8 %), intoxications (10.7 %), gastroenterological problems (9.1 %), and diseases of the urinary tract (5.8 %). The majority of children (84.3 %) were discharged home with medical and health care instructions, while some (15.7 %) were transferred to other departments. Three children (2.5 %) needed intensive care. Conclusions: Since 2010, the paediatric emergency department of the University Children’s Hospital Ljubljana has functioned in compliance wtih the guidelines used in similar international tertiary centres. However, there is still room for improvement in organization and staffing.

Quality of life in adolescents followed after neonatal hypoxic-ishaemic encephalopathy

Background: Hypoxic-ischaemic encephalopathy (HIE) during the perinatal period is a commonly recognized cause of severe, long-term neurological sequelae in children. Milder hypoxia- ischaemia can lead to minor disabilities, which can manifest only later with age-specific cognitive abilities and demands. Methods: We have used prospective, observational study of an inception cohort of 16 adolescents, who had neonatal HIE, compared to a gender- and age-matched control of 16 healthy medical students. Our cohort was selected from the Slovenian population of neonates, referred to the Pediatric Intensive Care Unit at the University Medical Centre Ljubljana, due to mild and moderate HIE, Sarnat stage 1 and 2. HIE was confirmed by generally accepted criteria. We estimated the self-assessed health-related quality of life by using SF-36v2 questionnaire, Rosenberg self-esteem inventory and Unwholesome behaviour questionnaire. Results: Our study included 16 adolescents with HIE, 7 girls (43.8 %) and 9 boys (56.3 %), who were born at a mean gestational age of 35.75 weeks (SD = 3.80) and mean birthweight of 2644g (SD = 815), which represents 50th percentile. Mean age was 21.69 years (SD = 0.87). Adolescents with a history of HIE reported a higher number of additional morbidity yet with a good quality of life. Health-related quality of life was rated high: for adolescents with HIE M = 81.9 (SD = 11.2) and for healthy adolescents M = 75.3 (SD = 11.,5); p = 0.112. The adolescents with HIE odsodid not differ from the healthy adolescents in self-esteem (p = 0.68) and unwholesome behaviours, except for over-eating (p = 0.01). Conclusions: Based on our data of higher morbidity, we propose that children with mild to moderate HIE, even when discharged as healthy, should be subject to a follow-up. They develop compensatory strategies, which enable them to have a good quality of life. We can hope that their compensatory strategies, rather than becoming insufficient when they reach adulthood, will enable them to have a high quality of life.