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

• Main Authors: Sheren E. Maher, Abdel-Azeem M. El-Mazary, Mohamed G. Eissawy, Mahmoud M. Higazi, Nagwa I. Okaily
• Format: Article
• Language: English
• Published: SpringerOpen 2017-11-01
• Series: Egyptian Pediatric Association Gazette
• Subjects: Activin-A; HIE; MRI; Apparent diffusion coefficient; Neonates
• Online Access: http://www.sciencedirect.com/science/article/pii/S1110663817300307
• ISSN: 1110-6638

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 diffusion-weighted) 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 µg/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.