Cranial ultrasound as a predictor of outcome in term newborn encephalopathy

Jongeling, Brad R.; Badawi, Nadia; Kurinczuk, Jennifer J.; Thonell, Sven; Watson, Linda; Dixon, Glenys; Stanley, Fiona J.

« Previous Next »Pediatric Neurology
Volume 26, Issue 1 , Pages 37-42, January 2002

Cranial ultrasound as a predictor of outcome in term newborn encephalopathy

Brad R. Jongeling, MBBS
- Joondalup Child Development Centre, North Metropolitan Health Service, Perth, Western Australia
Nadia Badawi, PhD
- Communications should be addressed to: Dr. Badawi; Department of Neonatology; The Children’s Hospital at Westmead; Locked Bag 4001; Westmead, NSW 2145, Australia
- Department of Neonatology, The Children’s Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
- Division of Population Sciences, TVW Telethon Institute for Child Health Research, and Centre for Child Health Research, The University of Western Australia, Perth, Western Australia
Jennifer J. Kurinczuk, MD
- Division of Population Sciences, TVW Telethon Institute for Child Health Research, and Centre for Child Health Research, The University of Western Australia, Perth, Western Australia
- Department of Epidemiology and Public Health, University of Leicester, Leicester, United Kingdom
Sven Thonell, MBBS
- Department of Radiology, Princess Margaret Hospital for Children, Perth, Western Australia
Linda Watson
- Division of Population Sciences, TVW Telethon Institute for Child Health Research, and Centre for Child Health Research, The University of Western Australia, Perth, Western Australia
Glenys Dixon, BA, Bpsych
- Division of Population Sciences, TVW Telethon Institute for Child Health Research, and Centre for Child Health Research, The University of Western Australia, Perth, Western Australia
Fiona J. Stanley, MD
- Division of Population Sciences, TVW Telethon Institute for Child Health Research, and Centre for Child Health Research, The University of Western Australia, Perth, Western Australia

Received 23 March 2001; accepted 20 July 2001.

Abstract

As part of a patient-based case-control study of newborn encephalopathy, we examine the cranial ultrasound results of 212 patients to determine the validity of ultrasound in predicting an adverse outcome. Forty-six (22%) patients died or developed cerebral palsy (adverse outcome) by 2 years of age. On the basis of clinical decision, 125 (60%) patients had an ultrasound before 72 hours of age; of these, 29% had an adverse outcome. The resistive index is the primary measure of interest, with a value of 0.55 or less considered abnormal. Infants with an abnormal resistive index are 8.8 times (P < 0.001) more likely to have an adverse outcome than those with a normal result. The positive predictive value of an abnormal resistive index was 71%. The results are similar for the subgroup with intrapartum hypoxia and the subgroup that had ultrasound performed before 24 hours of age. It is clear that resistive index results cannot be used in isolation, although they may have a place, in combination with other factors, in the counseling of parents and, cautiously, in the clinical management of patients.