Clinical Profile and Short Term Outcome of Hypoxic Ischemic Encephalopathy Among Birth Asphxiated Babies in a Tertiary Care Hospital

Abstract

Objective: To determine the clinical profile, selected antepartum and intrapartum risk factor for adverse shortterm outcomes of hypoxic ischemic encephalopathy in babies with birth asphyxia.
 Study Design: Cross sectional study.
 Place and Duration of Study: Neonatal Intensive Care Unit of Pak Emirates Military Hospital, Rawalpindi, fromJan to Dec 2018.
 Methodology: This study including all birth asphyxiated babies born who fulfilled the inclusion criteria.Following data was collected prospectively regarding gender, gestational age, birth weight and mode of delivery, maternal age, antenatal follow up, history of premature rupture of membranes and meconium stained liquor. Babies were categorized into different stages of hypoxic ischemic encephalopathy according to Sarnat and Sarnat staging. Selected antepartum and intrapartum risk factors leading to hypoxic insult at birth were studied and short-term outcome was recorded in the form of need of mechanical ventilation, mortality and discharge from the hospital.Results: The frequency of birth asphyxia turned out to be 122/5986 (2.03%) at our center. Thirty four (27.87%)required mechanical ventilation, mortality was recorded at 20/122 (16.39%). While 61 (50%) babies suffered from stage I hypoxic ischemic encephalopathy, 13/20 (65%) of newborn who expired were suffering from grade III hypoxic ischemic encephalopathy.
 Conclusion: The severity of hypoxic ischemic encephalopathy affects the outcome of newborns having birthasphyxia with hypoxic ischemic encephalopathy grade III associated with maximum mortality. Early identifycation of pregnancies at risk for asphyxia, with appropriate intervention in selected cases is the key to prevent birth asphyxia and its ensuing neonatal complications.

Characteristics of Hypoxic Ischemic Encephalopathy among Neonates in Sanglah General Hospital

“…In this study, most neonates had mild HIE (65.4%). Hafza reported similar results with predominance of mild HIE [14]. This is similar to a study of 237 newborn in Ireland which showed 68,2% had mild stage of HIE.…”

“…This is similar to a study of 237 newborn in Ireland which showed 68,2% had mild stage of HIE. In addition, another study conducted in South India found the proportion of newborns with mild HIE was 56% [12,14] different with study from Pakistan which was dominated by moderate HIE [13] This study found that 71.2% neonates with HIE were males. Although other studies also show male predominance but the number of males in our study were much more as compared to other studies [15,16], with ratio male to female was 2.4:1.…”

“…Premature rupture of membranes is not only association with increased incidence of emergency caesarian section but also with birth asphyxia and HIE [41]. Hafza et al found that the frequency of HIE in PROM compared to other studies (24.9% vs 10%) [14].…”

Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis

“…The hospital-based studies on incidence came from India, 38 Pakistan 50 and Tanzania 39 all of which had high national NMR at the time of data collection.…”

“…Data on incidence of intrapartum-related NE are presented in table 2. Incidence of all grade NE ranged from 20.3/1000 live births50 to 1.5/1000 term live births48 depending on study setting and location (median 4.7/1000 live births, five studies). Only two population-based studies were included whereby no meta-analysis was conducted 47 48.…”