Diffusion-weighted MRI and urinary Activin-A are potential predictors of severity in neonates with hypoxic ischemic encephalopathy

الملخص EN

Background : Early diagnosis and treatment are important to reduce neonatal morbidity and mortality occurring from hypoxic ischemic encephalopathy (HIE).

Objective : We aimed to correlate between urinary Activin-A and MRI (conventional and diffusionweighted) and the degree of HIE according to Sarnat and Sarnat staging.

Methods : Sixty full term neonates (37–42 weeks) selected from Minia University hospital for children from May 2014 to July 2016 were enrolled into the study.

We measured urinary Activin-A using enzyme immunoassay and MRI using MRI scanner (Philips Achieva) and correlations between urinary Activin-A and MRI with the degree of HIE were done.

Results : Neonates with HIE had higher levels of urinary Activin-A than controls (P < .001) and it was positively correlated with the clinical grading of HIE at cutoff value of 0.08 mg/l on day-1 after birth with a sensitivity 98.2% and specificity 97.1% for prediction of HIE.

DW-MRI detected HIE with a high sensitivity (85%) compared to the low sensitivity of conventional MRI (35%).

Apparent diffusion coefficient (ADC) value of 0.8 was the best sensitivity-specificity cutoff point for detecting severe ischemic injury.

DW-MRI imaging was positively correlated with the urinary Activin-A and both of them were positively correlated with the degree of HIE (P < .001).

Conclusions: DW-MRI imaging is correlated well with urinary Activin-A in full-term neonates with HIE and both of them are correlated with the degree of HIE.

Early determination of urinary Activin-A combined with DW-MRI imaging can early detect HIE and its degree of severity in full-term neonates with HIE.