Prediction of hypoxic-ischemic brain damage in full-term neonates with acute encephalopathy, using two different brain proteins electroencephalogram and magnetic resonance imaging

ABSTRACT

The Objective of this study was to compare the usefulness of serum levels of two different brain proteins; Neuron specific enolase [NSE] and Creatinine brain specific kinase [CK-BB], electroencephalography [EEG], Conventional MRI imaging and diffusion-weighted MR imaging [DWMRI] for the early diagnosis of ischemic brain injury and prediction of hypoxic brain damage. The study was performed at Tanta University Hospitals, Neonatology Unit. The study design was a cross sectional one. A total of 30 term newborns, 20 with neonatal encephalopathy and 10 normal cases were included in the study. Clinical evaluation of neonatal condition and neurological outcomes was done. Serum estimation of NSE, CK-BB was done at 0, 12 and 24 hours after admission. Electroencephalography [EEG] was done at a median date of 1.17 days. Magnetic resonance imaging [MRI] both conventional and diffusion weighted were also done. EEG and MRI were done for the study group cases. The results showed that the Apgar score at 2 minutes has highest specificity with a good negative predictive value of severe brain injury. Arterial blood base deficit have the highest sensitivity and highest negative predictive values. The highest significance was evident at 12 hours values of both NSE and CK-BB. A combination of NSE at 12 h with arterial blood pH [cutoff value, <6.9] or arterial blood base deficit [cutoff value, >17 mM/L] increased the positive predictive value and specificity. Bad outcomes as severe degree or death are usually associated with the moderate to severe findings of both MRI and background trace of EEG. Bad outcomes as severe degree or death are usually associated with severe findings of both diffusion weighted MRI and background trace of EEG. The early EEG changes distinguish between those infants with a normal or abnormal outcome. MRI gives more specific information about the type of brain lesion. The 12 hour values of NSE and CK-BB have a good predictive power either alone or combined with other clinical tests or investigations. Combined biochemical testing and EEG may give very good indicators about neonatal outcomes. This early determination is becoming increasingly important with the advent of hypothermia and other potential neuroprotective therapies for the treatment of HI brain injury in the asphyxiated newborn