Kim Annink

73 Cerebral ultrasound scoring system for neonates with HIE INTRODUCTION Hypoxic-ischemic encephalopathy (HIE) following presumed perinatal asphyxia is an important cause of morbidity and mortality in neonates and can result in long-term neurological sequelae (1,2). Perinatal asphyxia can be caused by acute or subacute perinatal hypoxia-ischemia that both correspond with different patterns of brain injury (3,4). Acute perinatal asphyxia often results in injury of the deep grey nuclei, such as the basal ganglia and thalamus, or even in near-total brain injury (5). Injury to the deep grey nuclei can lead to dyskinetic cerebral palsy, impaired cognitive outcome and epilepsy (5). Subacute (‘chronic’) perinatal asphyxia is most often associated with watershed injury with involvement of the cortex and subcortical white matter (5). This usually does not result in motor impairment, but cognitive impairment and language problems occur more frequently and disabilities become apparent in childhood (6-8). In daily practice, the neurological prognosis is predicted based on the triad of neuroimaging, (amplitude-integrated) electro-encephalography ((a)EEG) and clinical features (9). Currently, the gold standard in neuroimaging is magnetic resonance imaging (MRI) (5, 10, 11). MRI predicts neurological outcome in HIE based on conventional imaging i.e. with an MR scoring system (12,13) and quantitatively with apparent diffusion coefficients, arterial spin labelling or magnetic resonance spectroscopy (14-16). MRI is the gold standard, but an alternative neuroimaging technique is necessary because there are circumstances when the infant is not stable enough to be transported to the MRI unit or MRI is not available, for example in developing countries (17,18). In these situations, cerebral ultrasound (CUS) might offer a bedside and cheaper alternative (18). Currently, CUS is not routinely used to predict outcome in HIE; CUS is not as sensitive as MRI in diagnosing brain injury and may take several days to become apparent (11,19). However, based on the available literature CUS might not only be complementary to MRI but in some cases the only available neuroimaging method in HIE (19-21). A validated composite CUS scoring system is needed to assess brain injury and to predict outcome with CUS in HIE. To the best of our knowledge, such an ultrasound scoring system is not yet available. The CUS scoring systems that have previously been developed have not been validated (17,22-28). The aim of this study is to assess the association between a novel CUS scoring system and neurodevelopmental outcome in neonates with HIE at the age of two years. 4