Neurodevelopmental assessment in HIE II and HIE III

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Neurodevelopmental assessment in HIE II and HIE
III

• Dr Jaimin M Patel
• Dr K M Mehariya, Dr B B Javdekar, Dr B R Vyas.
• M P Shah Medical college, Jamnagar.

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Case scenario

• FT (Forcep), 3.5 kg,
• Meconium, hopotonic, depressed
• Apgar 4 at 3min,
• HIE II, convulsing on 2nd day, loaded with 2
  anticonvulsants
• Improved on 5th day.
• Taking BF by 7th day.

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The important issues related to the
Neurodevelopmental assessment in HIE are

• At what age is the assessment most predictive?
• Which signs or clusters are most specific for
  predication and early identification of CP?
• Which screening or assessment methods/tools are
  specific and accurate?
• Is routine developmental screening useful?

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Study design

• Aim 1. To Evaluate TDSC againt Amiel-Tison
  Method. 2. To compare D3 and D7 neurological
  examination with 1 yr outcome.
• Study place NICU and High Risk Clinic, Guru
  Gobind Singh Hospital, Jamnagar.
• Sample The infants from the G. G. Hospital with
  the diagnosis of HIE 2 or 3 during the period 1st
  Jan 2001 to 31st Jan 2002 were included in the
  study.
• Exclusion Criteria Infants whose examination was
  not possible during follow up for at least 2
  different examinations were excluded from the
  study.

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Study designExamination Shedule

• In NICU for Apgar Score, HIE stage, Neurological
  examination at Day 3, Day 7.
• Growth Chart (NCHS) plotting throughout each
  examination.
• TDSC chart plotting and Amiel-Tison examination
  at each follow up visit at 3 monthly examinations
  till 1 yr.
• Who didnt turn up where repeatedly contacted and
  if 2 or more examination was missed excluded from
  study.

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What was abnormal neurological examination at
D3 or D7??

• child had inability to take breast-feeding
• Irritability, lethargy, Impaired consciousness or
  coma
• Abnormal tone either hypertonia or hypotonia
• Exaggerated or depressed reflexes or clonus
• Convulsion within last 24 hrs
• Signs suggestive of raised ICT

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Trivendrum Developmental Screening Chart.
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Amiel-Tison Method.

• Major emphasis on tone, extrapyramidal and
  pyramidal waves of development of tone.
• Scoring system
• Score wise classification in to Minor, Moderate,
  Major deficit.
• Cluster of signs more important.

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Sign clusters

• Cortical thumb, which was present in 7 patients
  at birth,
• High- arched palate in 8 patients, and
• Overlapping cranial sutures present in 7 patients
  serve as strong indicators

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TDSC Vs Neurological outcome at 1 yr using
Amiel-Tison Method.
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D7 examination Vs Neurological Outcome at 1 yr
using Amiel-Tison Method

• P 0.000457
• (P lt 0.01)

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Message to take home.

• TDSC is a valuable screening tool to screen out
  major and moderate deficit as per Amiel-tison
  method during first yr of life in High Risk HIE
  patients.
• Day 7 Neurological Assessment has statistically
  significant association with Neurological outcome
  at 1 yr.

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Thank You