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OUTCOME OF TERM NEWBORNS WITH HYPOXIC ISCHEMIC ENCEPHALOPATHY.

Byline: Shazia Mahar, Jai Parkash, Chetan Das and Muhammad Saeed

Abstract

Background: Hypoxic ischemic encephalopathy is main complication of the birth asphyxia. The objective of the study was to determine the frequency of outcome of term newborns with hypoxic ischemic encephalopathy(HIE).

Material and Methods: This cross sectional study was done at Neonatology Unit of National Institute of Child Health, Karachi, from July, 2014 to January, 2015. Sample size was 162 cases selected through consecutive sampling technique. Mean age was 7.74 3.87 days. Males were 100 (61.7%) and females were 62 (38.3%). All neonates of either gender from birth to 14 days of life presented with gestational age >37 weeks and37 weeks and7 days of age. Male preponderance was found as100 (61.7%) as compared to females 62 (38.3%). Majority of the patients 138 (85.20%) were presented with [?]40 weeks of gestational age.Table 1.

There were 64 (39.50%) patients with HIE stage I, 62 (38.30%) with HIE stage II and 36 (22.2%) patients with HIE stage III. Figure 1

Improved outcome was observed in 137 (84.6%) while death was observed in 25 (15.40%) patients. Figure 2

No significant differences were found in the outcome according to age, gestational, age and gender, p-value 0.66, 0.78 and 0.79 respectively. Table 2

A significant difference was found in the outcome according to the severity of HIE, as well as majority of patient 16 out of 25 died with HIE stage III. Table 3

Table 1: Demographic characteristics of term new borns with hypoxic ischemic encephalopathy (n=162)

Basic characteristics###Frequency###Percentage

Neonatal age

7days###90###55.60%

Gestational age

40 weeks###24###14.80%

Gender

Male###100###61.70%

Female###62###38.30%

Table 2: Comparison of outcome according to age, gestational age and gender (n=162).

###Outcome

Age (in days)###Total###p-value

###Improved###Death

Age

7###62(45.3)###10(40)###72(44.4)###0.668

>7###75(54.7)###15(60)###90(55.6)

Total###137(100%)###25(100%)###162(100%)

Gestational age

40###117(85.4)###21(84)###138(85.2)

###0.786

>40###20 (14.6)###4(16)###24(14.8)

Total###137(100%)###25(100%)###162(100%)

Gender

Male###84(61.3)###16(64)###100(61.7%)

###0.799

Female###53(38.7)###9(36)###62(38.3%)

Total###137(100%)###25(100%)###162(100%)

Table 3: Comparison of outcome with HIE stage (n=162).

###Outcome

HIE Stage###Total###p-value

###Improved###Death

I###61 (44.5)###3 (12)###64 (39.5)

II###56 (40.9)###6 (24)###62 (38.3)

###0.001

III###20 (14.6)###16 (64)###36 (22.2)

Total###137 (100%)###25 (100%)###162 (100%)

DISCUSSION

Perinatal asphyxia is the major and serious cause of morbidity and mortality in neonates globally.10 WHO reported in 2000 that out of 130 million neonates born globally per year, estimately 4 million neonates die under one month of the age, and it has been shown that 99% of these deaths of neonates occur in developing nations, perinatal asphyxia contributes to almost 23% of these deaths.10 Padayachee N et al11 reported that out of 450 infants 41.1% were females and mean of the gestational age was 39.12.2 weeks, these finding are comparable with our results as male were in higher number i.e. 100 (61.7%) than females 62 (38.3%).

In our study, majority of the cases 64 (39.50%) were found with HIE stage I, followed by 62 (38.30%) with HIE stage II and 36 (22.2%) patients with HIE stage III. Similarly Thakkar PA et al12 demonstrated that out of 45 babies, 35 developed HIE, of which 13 (28.8%) were in HIE stage II and 13 (28.8%) were in HIE stage III. Memon S et al8 showed that 15% newborns were normal while clinical signs of HIE were in 85% neonates, out of them 30% were in stage I, 35% neonates in Stage II and 20% neonates were in stage III of HIE.

In this study improved outcome was observed in 137 (84.6%) while mortality was observed in 25 (15.40%) patients. Similarly mortality in other studies range from 10% to 45%.13-15Thakkar PA et al 12 reported 20% mortality. The varying rates of mortality may be due to type of patients based on high risk pregnancy, late referral in case of obstructed labour, type and level of Neonatal ICU care. Studies of developing nations demonstrated that 18% of survivors with mild to moderate birth asphyxia had newborn encephalopathy and long lasting severe neurological impairment.16,17

In our findings, a significant difference was found in the outcome according to the severity of HIE, as majority of patients 16 out of 25 died with HIE stage III. Similarly other studies also reported that mortality rate was high in HIE stage III.13-15 We found no significant difference in mortality in the different age groups, gestational age groups and gender, p-value 0.66, 0.78 and 0.79 respectively. A Nigerian study also reported comparable findings.10

CONCLUSION

Severity of HIE (stage III) was found significantly associated with mortality.

REFERENCES

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Publication:Gomal Journal of Medical Sciences
Article Type:Report
Date:Mar 31, 2017
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