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Original Research

Open Access

The value of ultrasonography in predicting outcomes at an early school age among individuals with perinatal hypoxic-ischemic encephalopathy

  • Renata Dzikiene1,*,
  • Saulius Lukosevicius2
  • Jurate Laurynaitiene3
  • Vitalija Marmiene4
  • Irena Nedzelskiene5
  • Rasa Tameliene1
  • Ausrele Kudreviciene1

1Department of Neonatology, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania

2Department of Radiology, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania

3Department of Neurology, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania

4Department of Psychiatry, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania

5Department of Dental and Oral Disease, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania

DOI: 10.22514/sv.2022.010 Vol.18,Issue 4,July 2022 pp.81-90

Submitted: 21 September 2021 Accepted: 09 December 2021

Published: 08 July 2022

*Corresponding Author(s): Renata Dzikiene E-mail:


Neurosonography (NSG) is a readily available non-invasive radiological examination technique that assesses brain damage in neonates who experienced perinatal hypoxia. The aim of the study was to determine the relationship between hypoxic-ischemic (HI) brain injuries in full-term neonates detected during ultrasonography and mental and neuromotor development outcomes at an early school age. We evaluated 8–9-year-old children (n = 32) who had experienced hypoxia at birth with mild to moderate hypoxic-ischemic encephalopathy (HIE) and hadn’t undergone therapeutic hypothermia. The control group consisted of 8–9-year-old children (n = 16) who were born healthy. During the first five days of life, the newborns underwent cerebral ultrasonography. The HIE stage was evaluated according to the Sarnat and Sarnat scale. Neuromotor and neurological outcomes were assessed using the Gross Motor Function Classification System, the Health Utilities Index (HUI) questionnaire, the Wechsler Intelligence Scale for Children WISC-III, and structured neurological examination. In the case of moderate brain edema and/or thalamus and/or basal ganglion injuries along with cerebellum and brainstem (E/T/BG/C/B) injuries compared to other injuries, the following abnormalities were statistically significantly more common: hearing disorders (100%, p = 0.03), cerebellar dysfunction (60%, p = 0.02), epilepsy (60%, p = 0.01), a lower Working Memory Index (median, 82.0, p = 0.015). In case of moderate brain swelling (edema) and thalamus and/or basal ganglion (E/T/BG) injuries, the sensitivity and specificity of the ultrasound examination when predicting epilepsy, hearing disorders, lower full IQ, and the Perceptual Organization Index were 100%. Neurosonography helps predict the outcomes of mental and neuromotor development at an early school age in full-term neonates who experienced perinatal asphyxia/hypoxia. Moderate hypoxic-ischemic brain changes detected during ultrasonography were statistically significantly associated with hearing disorders, cerebellar dysfunction, epilepsy, and a lower Working Memory Index in children at an early school age.


Neurosonography; Hypoxic ischemic encephalopathy; Long-term outcomes; Early school age

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Renata Dzikiene,Saulius Lukosevicius,Jurate Laurynaitiene,Vitalija Marmiene,Irena Nedzelskiene,Rasa Tameliene,Ausrele Kudreviciene. The value of ultrasonography in predicting outcomes at an early school age among individuals with perinatal hypoxic-ischemic encephalopathy. Signa Vitae. 2022. 18(4);81-90.


[1] Liu W, Yang Q, Wei H, Dong W, Fan Y, Hua Z. Prognostic value of clinical tests in neonates with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia: a systematic review and meta-analysis. Frontiers in Neurology. 2020; 11:133.

[2] Nanavati T, Seemaladinne N, Regier M, Yossuck P, Pergami P. Can we predict functional outcome in neonates with hypoxic ischemic encephalopathy by the combination of neuroimaging and electroen-cephalography? Pediatrics and Neonatology. 2015; 56: 307–316.

[3] Ouwehand S, Smidt LA, Dudink J, Benders MNL, de Vries L, Groenendaal F, et al. Predictors of outcomes in hypoxic-ischemic encephalopathy following hypothermia: a meta-analysis. Neonatology. 2020; 117: 411–427.

[4] Sánchez Fernández I, Morales-Quezada JL, Law S, Kim P. Prognostic value of brain magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy: a meta-analysis. Journal of Child Neurology. 2017; 32: 1065–1073.

[5] Narayan S, k Singh P, Choudhury N, Bhatia R, Agarwal D, Ahluwalia VV. Value of cranial ultrasonography and resistive index of cerebral arteries in predicting neuromotor outcomes in newborns with hypoxic ischaemic encephalopathy. Indian Journal of Neonatal Medicine and Research. 2018; 6: PO17–PO22.

[6] Kudrevičienė A, Basevičius A, Lukoševičius S, Laurynaitienė J, Marmienė V, Nedzelskienė I, et al. The value of ultrasonography and doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia. Medicina (Kaunas). 2014; 50: 100–110.

[7] Annink KV, de Vries LS, Groenendaal F, Vijlbrief DC, Weeke LC, Roehr CC, et al. The development and validation of a cerebral ultrasound scoring system for infants with hypoxic-ischaemic encephalopathy. Pediatric Research. 2020; 87: 59–66.

[8] de Vries LS, Jongmans MJ. Long-term outcome after neonatal hypoxic-ischaemic encephalopathy. Archives of Disease in Childhood. Fetal and Neonatal Edition. 2010; 95: F220–F224.

[9] Leijser LM, Vein AA, Liauw L, Strauss T, Veen S, Wezel-Meijler Gv. Prediction of short-term neurological outcome in full-term neonates with hypoxic-ischaemic encephalopathy based on combined use of electroencephalogram and neuro-imaging. Neuropediatrics. 2007; 38: 219–227.

[10] Mercuri E, Ricci D, Cowan FM, Lessing D, Frisone MF, Haataja L, et al. Head growth in infants with hypoxic-ischemic encephalopathy: correlation with neonatal magnetic resonance imaging. Pediatrics. 2000; 106: 235–243.

[11] Woolger C. Wechsler intelligence scale for children. In Dorfman W.I., Hersen M. (eds.) Understanding psychological assessment (pp. 219–233). 3rd edn. Springer: Boston, MA. 2001.

[12] Rosenbaum PL, Palisano RJ, Bartlett DJ, Galuppi BE, Russell DJ. Development of the gross motor function classification system for cerebral palsy. Developmental Medicine and Child Neurology. 2008; 50: 249–253.

[13] Horsman J, Furlong W, Feeny D, Torrance G. The Health Utilities Index (HUI): concepts, measurement properties and applications. Health and Quality of Life Outcomes. 2003; 1: 54.

[14] Guan B, Dai C, Zhang Y, Zhu L, He X, Wang N, et al. Early diagnosis and outcome prediction of neonatal hypoxic-ischemic encephalopathy with color Doppler ultrasound. Diagnostic and Interventional Imaging. 2017; 98: 469–475.

[15] Tann CJ, Nakakeeto M, Hagmann C, Webb EL, Nyombi N, Namiiro F, et al. Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study. Pediatric Research. 2016; 80: 190–196.

[16] Alloway TP, Gathercole SE, Kirkwood H, Elliott J. The working memory rating scale: a classroom-based behavioral assessment of working memory. Learning and Individual Differences. 2009; 19: 242–245.

[17] Himpens E, Oostra A, Franki I, Van Maele G, Vanhaesebrouck P, Van den Broeck C. Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population. European Journal of Pediatrics. 2010; 169: 1213–1219.

[18] Himpens E, Oostra A, Franki I, Vansteelandt S, Vanhaesebrouck P, den Broeck CV. Predictability of cerebral palsy in a high-risk NICU population. Early Human Development. 2010; 86: 413–417.

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