# Impact of Hypoxic-Ischemic Encephalopathy on Visual Outcomes and Brain MRI Findings in Pediatric Patients: A Retrospective Observational Study From Northeast India

## TL;DR

This study from India shows that brain MRI findings in children with HIE are strongly linked to visual impairment, with cortical lesions being a key predictor.

## Contribution

The study identifies cortical MRI lesions as a novel and significant predictor of severe visual impairment in pediatric HIE patients.

## Key findings

- Cortical MRI lesions were found in 62.5% of patients and strongly correlated with severe visual impairment.
- Optic atrophy was the most common ocular abnormality and closely associated with cortical lesions.
- Preterm birth and neonatal hypoxia were significant risk factors for HIE-related visual impairment.

## Abstract

Objective: Hypoxic-ischemic encephalopathy (HIE) remains a significant cause of neonatal morbidity and mortality, often resulting in long-term neurological and visual impairment. This study aimed to identify the perinatal risk factors associated with HIE and evaluate the correlation between MRI abnormalities and visual outcomes in affected children.

Methodology: A retrospective observational study was conducted among 40 pediatric patients with MRI-confirmed HIE at Sri Sankaradeva Nethralaya, Guwahati, India. Demographic, perinatal, and neonatal variables were analyzed along with ophthalmic findings, including visual acuity and fundus evaluation. Statistical analysis was performed using SPSS v. 25 (IBM Corp., Armonk, NY). Chi-square, correlation, and logistic regression analyses were performed, with P < 0.05 considered statistically significant.

Results: The mean age was 2.9 ± 1.66 years, with a male predominance (30, 75%). Preterm birth (18, 45%) and low birth weight (20, 50%) were common and significantly associated with HIE (χ² = 6.27, P = 0.02; χ² = 5.18, P = 0.03). Neonatal hypoxia (15, 37.5%) strongly correlated with cortical MRI injury (χ² = 4.11, P = 0.04). MRI showed cortical lesions in 25 (62.5%), periventricular white matter changes in 10 (25%), and basal ganglia lesions in 5 (12.5% ). Visual impairment was observed in 21 (52.5%), predominantly Category IV blindness. Cortical involvement showed a significant correlation with the severity of visual impairment (Spearman’s ρ = 0.61, P = 0.001). Optic atrophy was the most common ocular abnormality (18, 45%) and demonstrated a strong association with cortical lesions (χ² = 8.09, P = 0.005). Multivariable logistic regression revealed that cortical MRI lesions (odds ratio (OR) = 5.74; 95% confidence interval (CI): 1.46-22.6; P = 0.01) and neonatal hypoxia (OR = 3.18; 95% CI: 1.02-9.87; P = 0.046) were independent predictors of severe visual impairment.

Conclusions: Preterm birth, low birth weight, and neonatal hypoxia were major contributors to HIE-related visual and neurological morbidity. Cortical MRI could serve as a key prognostic marker for visual outcomes. Early ophthalmologic screening and multidisciplinary management are critical for improving long-term outcomes.