Early cranial ultrasound changes as predictors of outcome during first year of life in term infants with perinatal asphyxia

Objectives: To identify the types of early cranial ultrasound changes that were significant predictors of adverse outcome during the first year of lif e in asphyxiated term infants. Methodology: This was a prospective cohort study. Shortly after birth, cran ial ultrasonography was carried out via the anterior fontanelles of 70 norm al control infants and 104 asphyxiated infants with a history of fetal dist ress and Ap,oar scores of less than 6 at 1 and 5 min of life, or requiring endotracheal intubation and manual intermittent positive pressure ventilati on for at least 5 min after birth. Neurodevelopmental assessment was carrie d out on the survivors at 1 year of age. Results: Abnormal cranial ultrasound changes were detected in a significant ly higher proportion (79.8%, or n = 83) of asphyxiated infants than control s (39.5%, or n = 30) (P < 0.0001). However, logistic regression analysis sh owed that only three factors were significantly associated with adverse out come at 1 year of life among the asphyxiated infants. These were: (i) decre asing birthweight (for every additional gram of increase in birthweight, ad justed odds ratio (OR)= 0.999, 95% confidence interval (CI) 0.998, 1.000; P = 0.047); (ii) a history of receiving ventilatory support during the neona tal period (adjusted OR = 8.3; 95%CI 2.4, 28.9; P = 0.0009); and (iii) hypo xic-ischaemic encephalopathy stage 2 or 3 (adjusted OR = 5.8; 95%CI 1.8, 18 .6; P = 0.003). None of the early cranial ultrasound changes was a signific ant predictor. Conclusions: Early cranial ultrasound findings, although common in asphyxia ted infants, were not significant predictors of adverse outcome during the first year of life in asphyxiated term infants.