title: Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study.
abstract: In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury.
  
  
  
  Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36 h reported blind to NE status.
  
  
  
  Scans were performed at median age 11.5 (interquartile range (IQR): 5.2-20.2) and 8.4 (IQR: 3.6-13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of the cases vs. 1.0% controls (P < 0.001). White matter injury was not significantly associated with bacteremia in encephalopathic infants (odds ratios (OR): 3.06 (95% confidence interval (CI): 0.98-9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs. 25.9% without; OR: 3.34 (95% CI: 1.61-6.95)).
  
  
  
  In this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia-ischemia (HI). Early abnormalities were a significant predictor of death.
authors.affiliation: Institute for Women's Health, University College London, London, UK.|London School of Hygiene & Tropical Medicine, London, UK.|MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Cally J
authors.identifier: 0000-0003-0131-4952
authors.initials: CJ
authors.lastname: Tann
authors.affiliation: Uganda Women's Health Initiative, Kampala, Uganda.
authors.forename: Margaret
authors.initials: M
authors.lastname: Nakakeeto
authors.affiliation: Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Hagmann
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Webb
authors.affiliation: Department of Paediatrics, Mulago Hospital, Kampala, Uganda.
authors.forename: Natasha
authors.initials: N
authors.lastname: Nyombi
authors.affiliation: Department of Paediatrics, Mulago Hospital, Kampala, Uganda.
authors.forename: Flaviah
authors.initials: F
authors.lastname: Namiiro
authors.affiliation: Institute for Women's Health, University College London, London, UK.
authors.forename: Kelly
authors.initials: K
authors.lastname: Harvey-Jones
authors.affiliation: Department of Paediatrics, Mulago Hospital, Kampala, Uganda.
authors.forename: Anita
authors.initials: A
authors.lastname: Muhumuza
authors.affiliation: Institute for Women's Health, University College London, London, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Burgoine
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.|MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Elliott
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.affiliation: Institute for Women's Health, University College London, London, UK.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Robertson
authors.affiliation: Department of Paediatrics, Imperial College London, London, UK.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D001927:Brain Diseases / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D004453:Echoencephalography; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology; D007231:Infant, Newborn; D007511:Ischemia / Q000503:physiopathology; D008297:Male; D012017:Referral and Consultation; D012306:Risk; D014454:Uganda; D014463:Ultrasonography