Clinical predictors of outcome following mild and moderate neonatal encephalopathy in term newborns in Kathmandu, Nepal

Abstract

We describe a clinical grading system for the assessment of neonatal encephalopathy developed for a large prospective study in Kathmandu. Inter‐observer variability testing of our system on 27 infants showed high agreement (kappa value 0.87). Validity for the prediction of major neuro‐developmental impairment at 1 y of age was tested using a cohort of 57 survivors of encephalopathy, all of whom were assessed using a combination of the Denver Developmental Screening Test and Bailey 2 at 1 y. We compared this with a modification of a scoring system previously validated in Cape Town. Both schemes converted a pretest probability of 31% (the prevalence of major impairment at 1 y of age in this cohort) to a post‐test probability of 55%. This showed only marginal improvement over the traditional risk marker of neurological abnormality at discharge (post‐test probability 51%). At 6 wk of age acquired microcephaly increased the probability of major impairment to 79%. Conclusions: It seems to make little difference both in practical or predictive terms whether one describes the neurological condition of the neonate using a descriptive or scoring system. The important thing is to perform repeated systematic neurological examinations on a daily basis during the neonatal period. Many clinicians will justifiably continue to use the discharge examination as the deciding factor for the need for continued neurodevelopmental surveillance.

Effects of Perinatal HIV Infection and Early Institutional Rearing on Physical and Cognitive Development of Children in Ukraine

“…In the group of uninfected institution‐reared children, 5 had perinatal hypoxic neurological conditions (PHNC), whereas there were no cases of PHNC in the three remaining groups. Because previous studies have demonstrated that PHNC are related to altered physical and cognitive development and stress regulation (Ellis et al., 2001; Van Handel, Swaab, De Vries, & Jongmans, 2007), we decided to exclude these children from further analysis. Moreover, one of the HIV‐infected family‐reared children was excluded because of clear signs of fetal alcohol syndrome not reported in the medical records, resulting in an effective sample of 58 children.…”

The effect of ladder approach on development of preterm low birth weight infants with HIE-2

“…During a perinatal hospitalization a study in Nepal found that 94% of infants diagnosed with HIE presented with tone abnormalities, sucking ability was poor in 32% and 19% presented with problems with consciousness. 5 The condition is associated with long term delayed developmental outcomes and is more prevalent in developing countries. 5 Infants that survive present with different severities and the condition often leads' to severe neurological impairment resulting in cerebral palsy.…”

“…5 The condition is associated with long term delayed developmental outcomes and is more prevalent in developing countries. 5 Infants that survive present with different severities and the condition often leads' to severe neurological impairment resulting in cerebral palsy. 4 Previous follow up studies have shown the children with mild encephalopathy or HIE I are likely to be free of disability but those with moderate encephalopathy HIE II have a disability rate up to 25% with both neurological and developmental dysfunction.…”

“…The majority of infants presenting with severe encephalopathy or HIE III usually have multiple disabilities.5Infants with HIE II and III are therefore referred for rehabilitation and occupational therapy which provide intervention for these children. 5,6 The wiring of the brain is occurring when the infant is in NICU it is the vital time to promote adaptive versus maladaptive wiring. Thus, it is important to create adaptive responses versus maladaptive responses to their environment as they grow and develop into children 6and adult.…”