Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study

Ezenwa, Beatrice Nkolika; Olorunfemi, Gbenga; Fajolu, Iretiola; Adeniyi, Toyin; Oleolo-Ayodeji, Khadijah; Kene-Udemezue, Blessing; Olamijulo, Joseph Ayodeji; Ezeaka, Chinyere

doi:10.1371/journal.pone.0250633

Cited by 14 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings confirm findings from previous studies [4,29]. However, unlike the findings of Ezenwa et al's study in Nigeria, outborn neonates did not appear to be at higher risk of neonatal death compared to their inborn counterparts [30]. This could be explained by the differences in referral pathways in Nigeria and Zimbabwe to their tertiary neonatal units, but further research into this field is required.…”

Section: Plos Global Public Health Neonatal Outcomes In Hospitalsupporting

confidence: 84%

Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period

Gannon

Chimhini

Cortina‐Borja

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with neonatal encephalopathy from a tertiary neonatal unit in Zimbabwe. A retrospective review of risk factors of short-term neonatal encephalopathy mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 –October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of neonatal encephalopathy, incorporating maternal, intrapartum, and neonatal risk predictors of the primary outcome: mortality. 494/2894 neonates had neonatal encephalopathy on admission and were included. Of these, 94 died giving a neonatal encephalopathy-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence interval (CI) 1.39–6.25), convulsions (OR 7.13 (1.41–36.1)), lethargy (OR 3.13 (1.24–7.91)), Thompson score “11–14” (OR 2.98 (1.08–8.22)) or “15–22” (OR 17.61 (1.74–178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Nearly 1 in 5 neonates diagnosed with neonatal encephalopathy died before discharge, similar to other low-resource settings but more than in typical high-resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with neonatal encephalopathy was an appropriate predictive clinical scoring system to identify at risk neonates in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on neonatal encephalopathy mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions.

show abstract

Section: Plos Global Public Health Neonatal Outcomes In Hospitalsupporting

confidence: 84%

Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period

Gannon

Chimhini

Cortina‐Borja

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…It is not possible to compare this with prevalence estimates per 1000 live births. These estimates are lower than a recent study in Nigeria (Ezenwa et al, 2021) reporting prevalence of 71 per 1000 admissions with 25.3% respectively where NE was defined in a term infant as the presence of encephalopathy or altered consciousness and multi-organ failure with a positive history of delayed cry at birth or required prolonged resuscitation at birth in addition to the presence of any of the neurological features as contained in the Sarnat and Sarnat classification.…”

Section: Discussioncontrasting

confidence: 55%

Predictors of abnormal Thompson score in term neonates in a tertiary hospital in Zimbabwe

Khan,

Mugwagwa,

Cortina-Borja

et al. 2023

Preprint

View full text Add to dashboard Cite

BackgroundNeonatal encephalopathy, abnormal neurological function in a baby born at term is a key cause of neonatal death. In the absence of adequate training and brain imaging or monitoring in low-resource settings, clinical risk scores, such as Thompson score, have been useful to predict risk of neonatal encephalopathy. A clearer understanding of the clinical and maternal predictors of abnormal values of Thompson score would be beneficial to identify term neonates with suspected neonatal encephalopathy.MethodsA scoping review of the literature identified a set ofa priorineonatal and maternal variables associated with neonatal encephalopathy in low-resource settings. Next, a prospective study of all neonates born at term admitted to Sally Mugabe Central Hospital in Zimbabwe between October 2020 and December 2022 (n=6,054) was conducted. A predictive statistical model for abnormal (>10) Thompson score (range 0-22) was developed.ResultsIn total 45 articles were identified from three databases and 10 articles were selected. 45 candidate predictors were identified −36 from the available literature and 9 from clinical data and experience. 4.06% (n=246) of neonates had an abnormal Thompson score of 10 or more on admission and 90.65% (n=223) of these neonates had an Apgar score less than 7 at 5 mins (p<0.001). 24 possible predictors were selected as the most important of which nine factors were identified as the most useful in predicting which neonates are at risk of abnormal Thompson score. These predictors and their adjusted odds ratios are: low Apgar score at 5min (OR= 0.46, 95%CI=(0.42, 0.51)), low neonatal heart rate at admission (OR=0.977, 95%CI=(0.97, 0.985)), temperature lower than 36.5°C (OR=1.64, 95%CI=(1.18, 2.28)), abnormal head shape (OR=2.12, 95%CI=(1.51, 2.97)), resuscitation received (OR=3.95, 95%CI=(1.69, 11.01)), neonatal encephalopathy as an admission reason (OR= 2.47, 95%CI=(1.37, 4.32)), risk factors of sepsis other than premature rupture of membrane and offensive liquor (OR=2.04, 95%CI=(1.1, 3.67)), respiratory distress as an admission reason (OR=2.48, 95%CI=(1.59, 3.96)), and other admission reasons (OR=1.81, 95% CI=(1.12, 2.97)). The main admission reasons in ‘Other’ category include low birthweight, meconium aspiration and hypoxic ischaemic encephalopathy and congenital abnormality.ConclusionIn resource-poor settings where it may be not possible to clinically assess all admitted neonates, those with the identified risk factors should be prioritised for a Thompson score assessment. Local clinical guidelines should incorporate these factors into the clinical management of at-risk neonates and assess their impact on clinical care and neonatal outcomes.

show abstract

“…Suboptimal care is an important factor for encephalopathy and mortality. 39,40 A study in Nigeria found that the majority of neonates with asphyxia had poor quality care and had a delay in deciding to present at the appropriate health facility. 41 The findings from our study provide further evidence of an urgent need to implement root cause analysis of an adverse obstetric event at all three tiers of the health care system.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, case fatality rate and risk factors for mortality among neonates admitted with perinatal asphyxia at a tertiary hospital in northern Nigeria

et al. 2022

View full text Add to dashboard Cite

Documenting the burden and the risk factors for perinatal asphyxia-related mortality is key to its prevention. The goal was to document the factors associated with mortality in perinatal asphyxia in a tertiary health facility in Nigeria. Records of consecutive neonatal admissions (between January 2016 and January 2017) underwent a retrospective analysis. Data were analyzed using Stata statistical software version 16 (Statacorp® Texas, USA). 102 (12.1%) of 841 admitted neonates had perinatal asphyxia; the median age (inter quartile range [IQR]) was 6 (0-168) hours. The mean admission weight ±(SD) was 2.96kg±(0.66) kg. Among inborn neonates, the incidence was 9.7 per 1000 live births. In 49% (50/102) pregnancies the amniotic fluid was clear; in 42% (43/102) it was meconium-stained; and 9 staining was unreported. Case fatality rate was 20.6% (21 of 102). 77(75%) neonates had no HIE, while 24 (24.5%) did. When compared to neonates without HIE, those with HIE II had about 7000 times higher odds of mortality (aOR = 68132.19, P0.01, 95% CI 3 to 1.4X 109). The adjusted odds of mortality for neonate with meconium-stained liquor were about 1900 times higher compared to clear meconium (aOR =1895, P = 0.02, 95%CI = 2.7 to 13072). Neonates with higher mean admission lengths (49.4cm [range = 48.8 to 50]) had 88 times lower odds of death compared to shorter neonates (aOR of 0.12 (95% CI: 0.17 to 0.85; p = 0.03).

show abstract

Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study

Cited by 14 publications

References 39 publications

Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period

Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period

Predictors of abnormal Thompson score in term neonates in a tertiary hospital in Zimbabwe

Prevalence, case fatality rate and risk factors for mortality among neonates admitted with perinatal asphyxia at a tertiary hospital in northern Nigeria

Contact Info

Product

Resources

About