Neonatal Hypoxic Ischemic Encephalopathy Clinical Trial
Official title:
Neonatal Hypoxic Ischemic Encephalopathy:Targeting Early Diagnosis and Management of Associated Comorbidities
Perinatal asphyxia is common cause of acquired neonatal brain injury in neonates associated with hypoxic-ischemic encephalopathy, leading to long-term neurologic complication or death. In 2000, the neonatal mortality rate in Egypt was found to be 25 per 1000 live birth. In this survey, hypoxic ischemic encephalopathy accounts for 18% of neonatal mortality and is the second most common cause of neonatal death.
Cerebral palsy as complication of hypoxic ischemic encephalopathy is common problem in
Egypt.cerebral palsy is associated with many problems (cognitive disability-epilepsy-visual
and hearing problems) that make great economic burden on their family and health care system.
In 2010, the prevalence of cerebral palsy in El-Kharga District new valley described 2.04
cases of cerebral palsy every 1000 child.hypoxic ischemic encephalopathy was the second most
common cause of cerebral palsy with prematurity the most common. 70.5% of children with
cerebral palsy had severe mental retardation and 52% suffer from active epilepsy. An
observational study on 224 cerebral palsy case from Tanta University found that 80.8% of
patients with cerebral palsy had cognitive disorder, 36% had epilepsy, 25% loss of vision and
16% hearing problems. This health conditions provide a significant financial burden on the
health system in Egypt.
There are two problems regard dealing with cases of hypoxic ischemic encephalopathy in Egypt,
First one is early diagnosis and second is description of its severity. Assessment of the
severity of cerebral injury and neurological outcome in infants with hypoxic ischemic
encephalopathy is important for prognosis and stratifying the clinical management.
Neurophysiological tests, including amplitude-integrated electroencephalogram , biochemical
markers, and neuroimaging like (Trans cranial ultrasound - Magnetic resonance imaging) have
been used to assess prognosis and predict long-term outcome. In our neonatal unit
investigators perform routine cranial ultrasound to all cases of hypoxic ischemic
encephalopathy.Cranial ultrasound is cheap, available, and easily performed bedside
examination. However cranial ultrasound is limited in specificity and sensitivity in
diagnosis of Hypoxic ischemic encephalopathy and prediction of prognosis.
Magnetic resonant imaging might provide the best information on structural brain lesions
associated with long-term neurological impairment but is not available for immediate
diagnostics on neonatal unit. Amplitude integrated electroencephalography is unfortunately
not routinely performed in Egyptian neonatal units. It might improve early detection of
Hypoxic ischemic encephalopathy and risk stratification accordingly.
Cerebral bleeding and infection are commonly described comorbidities in Hypoxic ischemic
encephalopathy associated with the poor prognosis. Coagulopathy is common problem in
asphyxiated infants. It is associated with asphyxia and therapeutic hypothermia (standardized
treatment of hypoxia). Coagulopathy can cause bleeding in serious organs like brain that make
the prognosis of Hypoxia bad and control of seizure difficult.
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|---|---|---|---|
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Phase 3 | |
| Completed |
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N/A | |
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