PERINATAL ASPHYXIA: PREDICTING AND IMPROVING OUTCOME

• Diffusion weighted imaging might underestimate cerebellar injury in neonates
with hypoxic-ischemic encephalopathy (HIE), especially in the cerebellar
hemispheres. If the apparent diffusion coefficient (ADC) values are measured in
the cerebellum, the ADC values in the vermis are most representative for injury.
• The newly developed cerebral ultrasound scoring system to assess brain injury in
neonates with HIE was well associated with neurodevelopmental outcome at two
years of age. It is an easy tool if MRI is not available or feasible and provides the
opportunity for serial bedside monitoring of brain injury with cerebral ultrasound.
• HIE can lead to smaller hippocampal volumes and atrophy of the mammillary
bodies (MB) which are associated with memory problems and cognitive deficits
at school-age, irrespective of therapeutic hypothermia.
• Atrophy of the circuit of Papez, e.g. MB and hippocampal atrophy, could be an
early biomarker to predict school-age memory and cognitive problems.
• Allopurinol may be a beneficial add-on neuroprotective therapy, especially
when it is administered early after birth. The effect of early allopurinol in HIE is
currently investigated in the ALBINO trial.
• The dosing regimen in the ALBINO trial is adequate with 20mg/kg intravenously
started within 45 minutes after birth and in case of therapeutic hypothermia
with a second dose of 10mg/kg intravenously.
• Brain temperature can be measured using short and long echo time proton
magnetic resonance spectroscopy without the need for calibration in infants
with HIE. This offers an important tool for MRI safety studies in neonates.
• 7.0T MRI is feasible in neonates and good quality images can be obtained. This
might be an additional neuroimaging method for specific indications, such as
stroke and metabolic disorders.