Abstract
Purpose :
Neonatal hypoxic ischemic encephalopathy (HIE) is one of the most common causes of neonatal death and long-term disability. The effect of HIE on visual outcomes, especially the effect of seizure and the correlation of brain MRI finding with visual function abnormalities is not well studied. We aim to study the visual outcomes in infants with HIE.
Methods :
We did a retrospective chart review of neonates admitted to University of Illinois, Chicago, with a diagnosis of HIE. We analyzed the visual outcomes of these neonates in their subsequent follow up visits. Univariate and multivariate analysis were performed to determine the predictors of abnormal visual outcomes with a P value less than 0.05, considered significant.
Results :
We had 57 neonates (34 Male/23 Female) with a diagnosis of HIE during the study period 2009-2019, which were divided into mild (27) moderate (23) and severe (7) HIE based on SARNAT scoring. Mean birth weight (BW) was 3265± 618 grams. 12% had severe HIE, and 11(13%) required inotropic support. 34(59.6%) underwent therapeutic hypothermia (TH), 13 (22.8%) had seizures. 14 of the 48 (29.2%) neonates who underwent MRI of the brain had abnormal imaging findings. 4/14 had lesions of occipital cortex, 7 had optic radiation abnormalities, 10 had DW restrictions, and 4 had geniculate body lesions.16 (28%) patients had visual assessment on follow up exam, out of which only 2 had visual abnormalities. One of them had reduced visual acuity, and other one had refractory amblyopia. One patient with visual abnormality had a full-term gestation, with an APGAR of 0,0, 2, 4, 7 and a BW of 3420 g, had severe HIE with seizures, had use of inotropes, TH, and seizure medications. Another patient was also a full-term, with an APGAR of 1, 4, 7, BW of 3040 had mild HIE, with no seizures, and no use of TH or inotropes. We didn’t find any significant predictors of abnormal visual outcomes. In our cohort, severe HIE was associated with imaging abnormalities (p=0.003), inotrope use (p=0.01), seizures (p<0.001) and use of TH (p<0.001).
Conclusions :
Severe HIE was found to be associated with imaging abnormalities of visual pathways on brain MRI. However, the sample size was small and had limited follow up to show any significant association between HIE and abnormal visual outcomes. Future research may focus on obtaining larger sample size and better follow up of neonates with HIE, especially with severe HIE.
This is a 2021 ARVO Annual Meeting abstract.