[PCL] Pre-congress Lectures

[PCL-5] Neuoimagings of neonatal hypoxic-ischemic encephalopathy and current state of cerebral palsy in Japan

^○Akira Oka (Department of Pediatrics, The University of Tokyo, Japan)

Neonatal hypoxic ischemic encephalopathy (HIE) remains an important cause of neurological sequelae. Due to the wide variety of preceding hypoxia and ischemia in utrero and during delivery, it has been difficult to predict the neurological outcomes. Recently, magnetic resonance imaging of brains(MRI) has been established as a standard modality of in clinical settings of neonatal intensive care, and the findings of neonatal MRI have been categorized and proved to have predictive values of neurological outcomes. The distribution of findings on MRI encompasses basal ganglia and thalamus, white matter, brainstem, and cerebral cortex. Earlier studies have revealed basal ganglia/thalamus(BT) pattern corresponds to severer clinical events, and white matter-dominant watershed(WS) pattern is mainly observed in less severe conditions. Accordingly, neurodevelopmental outcomes are shown to be more favorable in the latter. Based on these, the categorization and scoring of findings of MRI have been proposed, and the significance of predictive values have been verified in large case series in infants with HIE and hypothermia. High grades of abnormality, such as BT pattern, have indicated grave outcomes with high sensitivity and specificity, and normal MRI indicated favorable outcomes with high specificity.
In Japan, Obstetric Compensation System for Cerebral Palsy has been commenced as a public system, and infants with severe CP, which is related to neonatal events, are eligible for the compensation. While infants born as preterm before 28 gestational weeks are excluded, annual number of infants who received it is approximately 4 hundreds. The current trend of CP in Japan will be discussed.