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Neurodevelopmental assessment in HIE II and HIE III

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. Case scenario……. FT (Forcep), 3.5 kg, Meconium, hopotonic, depressed Apgar 4 at 3min,

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Neurodevelopmental assessment in HIE II and HIE III

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  1. 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.

  2. 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.

  3. 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?

  4. 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.

  5. Study design…Examination 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 didn’t turn up where repeatedly contacted and if 2 or more examination was missed excluded from study.

  6. 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

  7. Trivendrum Developmental Screening Chart.

  8. 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.

  9. 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

  10. TDSC Vs Neurological outcome at 1 yr using Amiel-Tison Method.

  11. D7 examination Vs Neurological Outcome at 1 yr using Amiel-Tison Method • P = 0.000457 • (P < 0.01)

  12. 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.

  13. Thank You

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