Treatment and outcome of neonates with hypoxic ischaemic encephalopathy at B.P. Koirala Institute of Health Sciences (original) (raw)
Related papers
Indian Journal of Child Health, 2017
erinatal asphyxia is the third major cause of neonatal mortality in India [1]. It is also the fifth largest cause of underfive mortality and exerts a great pressure on the health system [2]. According to the World Health Organization (WHO), around 4 million babies develop birth asphyxia, and asphyxiated newborn may develop severe consequences such as epilepsy, cerebral palsy, developmental delay, and mental retardation. Furthermore, of 1.2 million neonatal deaths in India, 300,000-350,000 babies die due to perinatal asphyxia mostly within first 3 days of life [3]. Asphyxial injury may involve virtually every organ system of the body, but hypoxic ischemic encephalopathy (HIE) is the most studied and serious sequelae. The severity of HIE symptoms reflects the timing and duration of insult. The majority (90%) of the insults occur in the antenatal and intrapartum period. The remainder is in the immediate postnatal period due to cardio respiratory or neurological abnormalities [4]. The means of assessment include Apgar scores, blood pH, fetal heart rate abnormalities, need for resuscitation, neurological changes, and evidence of multiorgan dysfunction [5]. Umbilical cord blood gas analysis is now recommended in all high risk deliveries by both the British and American college of obstetricians and gynecologists. Low cord pH in neonates without cardiopulmonary compromise does not indicate an increased risk of adverse outcome. Babies, with pH <7 at birth and nonvigorous, have high risk of adverse outcome. In a study by Yeh et al., the ideal cord arterial blood pH was 7.26-7.30. The risk of adverse neurological outcome starts to rise at a pH <7.10, with the risk being highest at a pH <7 [6]. A systematic review in 2010 concluded that low arterial pH in umbilical cord strongly correlated with adverse outcomes such as HIE, periventricular leukomalacia (PVL), intracranial hemorrhage, cerebral palsy, and death [7]. An umbilical cord pH <7.2 immediately after birth is used as a prognostic factor for unfavorable short-term outcome in newborn [8]. In an asphyxiated newborn, an artery cord sample may underestimate the acidosis in fetus or newborn since lactic acid produced by hypoxia at tissue level will not be cleared to central circulation. As the baby is resuscitated, circulation improves and tissue lactic acid reaches the central circulation. The postnatal base deficit obtained from an asphyxiated newborn within 1 st h after delivery is found to be worse than cord levels, and hence, this blood gas parameter is one of the most accurate predictors of neurological outcome [9]. In spite of improvements in obstetric and neonatal care, the incidence of birth asphyxia in India is high. The neonatal mortality has slightly decreased but morbidity in the form of neurological damage is same or increased due to survival of asphyxiated ABSTRACT Introduction: In India, in spite of improvement in perinatal-neonatal care, perinatal asphyxia accounts for 23% of the neonatal deaths. Objective: The objective of the study was to study the clinical profile and short-term outcome of perinatally asphyxiated term neonates. Materials and Methods: This prospective study conducted at a tertiary care teaching hospital in Southern Kerala from June 2011 to June 2015. 120 term asphyxiated neonates fulfilling the inclusion criteria admitted in the NICU were followed up till death or survival. Results: 49.2% babies were inborn and 50.8% babies were outborn. Of the total, 53 (44.2%) were delivered vaginally, 54 (45%) by cesarean section, and 13 (10.8%) by instrumental delivery. Antenatal complications were seen in 58 (48.3%) and intrapartum complications in 93 (77.5%). Hypoxic ischemic encephalopathy (HIE) was diagnosed in 78.3%, with HIE 1 in 19.3%, HIE 2 in 27.5%, and HIE 3 in 31.6%. The mortality was 31 (25.8%) and it was more in out born babies compared to inborn. Factors associated with development of severe HIE (HIE 3) were male gender (p=0.0057), need for endotracheal intubation (p=0.0114), instrumental delivery and pH <7.2 (p=0.0013). Factors associated with mortality were instrumental delivery (p=0.0032), place of birth (p=0.0012), pH ≤ 7 (p=0.0006), HIE 3 (p<0.0001), and 5 min Apgar ≤3 (p=0.0372). Conclusion: HIE was seen in 78.3% perinatally asphyxiated babies with HIE 3 contributing to 31.6%. The mortality rate in HIE 3 was 81.6% which was significantly associated with place of birth, instrumental delivery, pH <7, and 5 min Apgar ≤3.
Introduction: Perinatal asphyxia is a major cause of neonatal mortality and morbidity in developing nations. The study aims to evaluate the clinical profile and outcome at discharge of term asphyxiated newborns in an Indian tertiary care center. Material and methods: This is a prospective observational study of 120 term asphyxiated neonates admitted in NICU of an Indian tertiary care center. Maternal risk factors associated with birth asphyxia were recorded. Babies were treated as per the standard treatment protocol for birth asphyxia. Neurological assessment at discharge was done by clinical examination, Amiel-Teison tone assessment and neuroimaging. Results: Of 120 asphyxiated infants, 82 infants were delivered via normal vaginal delivery while 22 were extracted by LSCS and 16 babies by forceps/vaccum delivery. The most common associated maternal risk factor was meconium stained amniotic fluid. 51 infants developed mild HIE, 66 moderate HIE and 3 severe HIE. Acute Kidney Injury was diagnosed in 19 infants with moderate to severe HIE. Among 69 infants with moderate to severe HIE, 52 developed seizures which were controlled in 42 infants within 2 days. Among infants with moderate to severe HIE, 53 infants were on direct breast feeds, 54 infants had normal neurobehavior and 48 infants had normal neuroimaging at discharge. The mean duration of hospital stay was 8 days. The overall mortality rate was 1.6%. Conclusions: Early identification of maternal risk factor, timely obstetric intervention and optimum neonatal care will improve the outcome of perinatal asphyxia. Even majority of infants with moderate to severe HIE had normal neurobehavior and were on oral feeds at discharge.
Pediatric Review: International Journal of Pediatric Research, 2016
Hypoxic-ischemic encephalopathy (HIE) secondary to perinatal asphyxia remains a major cause of neonatal mortality and morbidity worldwide. Perinatal asphyxia was responsible for 20% of all neonatal deaths. Manifestations of HIE were seen in approximately 1.5% of all babies. Aims and Objectives of the study: 1.To study the various perinatal risk factors which are contributing to HIE. 2. To study the outcome of the term asphyxiated neonates at the time of discharge in relation to the perinatal risk factors. Materials and method: This prospective study was conducted on the term asphyxiated babies who were admitted in ASRAM medical college, Eluru during the period of January 2013 to August 2014. Result: The incidence of the HIE in neonates in the present study is 15.5%. Males neonates were more in number 40 (61.5%) than female neonates 25 (38.5%). Cord entangled twice around the neck was having very poor prognosis 83.4%. Conclusion: In the present study cord around the neck, the neonates having Apgar score <3 at 5min have shown poor prognosis and deaths. Pediatrician presence at the time of delivery is associated with good prognosis in the neonates.
BMC Pediatrics, 2017
Background: Hypoxic Ischemic Encephalopathy (HIE) remains a problem of great concern worldwide especially in developing countries. The occurrence of a neurological syndrome can be an indicator of insult to the brain. We aimed to determine the prevalence, HIE proportions, neurological signs and early outcomes of newborns that developed birth asphyxia at KCMC Tanzania. Methods: A prospective study was conducted at KCMC from November 2014 to April 2015 among newborns with birth asphyxia. Sarnat and Sarnat score was used to assess newborns immediately after birth to classify HIE and were later followed daily for 7 days or until discharge. Results: Of the 1752 deliveries during the study period, 11.5% (n = 201) had birth asphyxia. Of the 201 newborns, 187 had HIE. Of these 187 with HIE; 39.0% had moderate HIE and 10.2% had severe HIE according to the Sarnat and Sarnat classification. Neurological signs that were observed during the study period were; weak/absent reflexes (46.0%), hypotonia (43.3%) and lethargy (42.2%). Mortality was 9.1% among the 187 newborns with HIE. Mortality was higher among newborns with severe HIE 84.2% (16/19) compared to those with moderate HIE 1.4% (1/73). On the 7th day after delivery, 17.1% (32/187) of the newborns did not show any change from the initial score at delivery. Conclusion: Prevalence of birth asphyxia is high in our setting and most of the newborns (49%) end up with moderate/severe HIE. Good obstetric care and immediate resuscitation of newborns are vital in reducing the occurrence of HIE and improving the general outcome of newborns.
Pediatric Review: International Journal of Pediatric Research, 2019
Introduction: Perinatal asphyxia is an important contributor of neonatal morbidity, mortality and adverse outcome in India. Due to any reason, if blood supplied through placenta is hampered, it leads to asphyxial injury. Renal involvement is frequent in perinatal asphyxia. The severity of renal involvement and adverse outcome are correlated with severity of asphyxia and HIE stage. We performed this study to determine the incidence of renal failure in birth asphyxia by estimating urine output, serum creatinine and blood urea. Aim and Objective: To study incidence of Acute Kidney Injury (AKI) in Hypoxic Ischemic Encephalopathy (HIE) and its association with severity of HIE in Newborns. Material Methods: Cross-sectional observational hospital based study was conducted over a period of six months from March 2018 to August 2018 in Special Newborn Care Unit (SNCU) of Dr. BRAM hospital, Raipur. Sarnat and Sarnat staging was used to classify HIE. Statistical analyses were performed by using SPSS21.0 software. Chi square test, P-value and likelihood ratio were calculated using appropriate tests. Result: Total 1318 newborns were admitted in SNCU during study period. 415 newborns were admitted with HIE following perinatal asphyxia. Out of these 52 (12.5%) were HIE-I cases, 242(58.3%) were HIE-II and 121(29.1%) were HIE-III. Total 70(16.9%) newborns developed AKI. None of newborn in HIE I developed AKI. 20(8.2%) newborns with HIE II developed AKI while in HIE III 50 (41.3%) newborns had AKI. There was significant correlation between HIE III and AKI (P value-0.157).Conclusion: There is significant correlation of HIE with AKI. As severity of HIE progresses from stage-I to stage-III, there is increased risk of developing AKI.
Perinatal asphyxia in the term newborn
Despite the important advances in perinatal care in the past decades, asphyxia remains a severe condition leading to significant mortality and morbidity. Perinatal asphyxia has an incidence of 1 to 6 per 1,000 live full-term births, and represents the third most common cause of neonatal death (23%) after preterm birth (28%) and severe infections (26%). Many preconceptional, antepartum and intrapartum risk factors have been shown to be associated with perinatal asphyxia. The standard for defining an intrapartum hypoxic-ischemic event as sufficient to produce moderate to severe neonatal encephalopathy which subsequently leads to cerebral palsy has been established in 3 Consensus statements. The cornerstone of all three statements is the presence of severe metabolic acidosis (pH < 7 and base deficit ≥ 12 mmol/L) at birth in a newborn exhibiting early signs of moderate or severe encephalopathy. Perinatal asphyxia may affect virtually any organ, but hypoxic-ischemic encephalopathy (HIE) is the most studied clinical condition and that is burdened with the most severe sequelae. The feasibility of providing neuroprotection after HIE has been proven by hypothermia therapy, which is able to reduce the risk of death or major neurodevelopmental disability. Many promising neuroprotective agents might contribute to reduce hypoxic-ischemic brain injury through different mechanisms of action, but further studies are required to confirm their efficacy. The prognosis is dependent on the severity of the perinatal asphyxia. Only a minority of infants with severe HIE survive without handicap.
Introduction: Perinatal asphyxia (also known as neonatal asphyxia orPerinatal Asphyxia in children) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain.Perinatal Asphyxia in children is defined by the World Health Organization "the failure to initiate and sustain breathing at birth Aim of the Study:The aim of this study was to assess the outcome of perinatal asphyxia in childrenand neonatal risk factors, and study the cause of death. Material & Methods: There were 127 live births asphyxiated neonates who were clinically diagnosed and admitted in the department of Pediatrics, Natore District Hospital, Natore, Bangladesh during the period from January 2018 to December 2018.Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The Hospital records provided additional information about new born infant (birth asphyxia, stages of Perinatal Asphyxia in children, birth weight, sex and subsequent mortality). Results:The outcome of treatment in babies with birth asphyxia showing the recovery rate in group one (HIE I) was 18(14.17%) , in group two (HIE II) was 90(70.87%) and in group three (HIE III) was 7(5.51%) and Death ratio was in group one (HIE I) was 2(1.57%) , in group two (HIE II) was 3(2.36%) and in group three (HIE III) was 7(5.51%). In Table-4 the morbidity and mortality in cases of birth asphyxia the highest causes of death in stage 3(HIE III) was 7(58.53%) Preterm with Hyaline membrane disease was 3(25%) and then the higher causes of death in stage II were Neonatal sepsis 2(16.67%). Conclusion: Birth asphyxia was one of the commonest causes of admission and mortality in the department of Pediatrics, Natore District Hospital, Natore, Bangladesh l. Babies with HIE Stage III had a very poor prognosis. Birth asphyxia combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of birth asphyxia. Maternal gravida, pregnancy complication with PROM,Thick meconium stain, APH, emergency caesarean section, term and male sex were the risk factors for birth asphyxia.
Annals of Tropical Paediatrics, 2009
Aim: To describe the outcome of neonates with hypoxic ischaemic encephalopathy (HIE) admitted to the University Hospital of the West Indies. Method: A retrospective review of all cases of HIE admitted to the neonatal unit of the University Hospital of the West Indies during the 6-year period 1998 to 2003 was conducted. Descriptive analyses were performed; differences in neonates by Sarnat staging were determined using analysis of variance. Results: Ninety-five term neonates fulfilled criteria for recruitment to the study, 55 (58%) of whom were males. Eighty-six were inborn, giving an incidence of 6/1000 live births with HIE during the study period. There was a 12% mortality rate and all non-survivors had stage 3 encephalopathy. Infants with stage 3 encephalopathy had increased neurological deficits and more severe end organ damage than infants with stage 2 or stage 1 encephalopathy (p,0.05). Only 34 (40%) of the survivors were still attending follow-up clinic at 1 year of age. At this age, all infants with stage 2 and stage 3 encephalopathy had significantly smaller head circumferences than those with stage 1 encephalopathy (p,0.05). A significantly higher proportion (78%) of infants with stage 3 encephalopathy did not achieve milestones appropriately compared with infants with stage 2 (35%) and stage 1 encephalopathy amongst whom none had delayed milestones (p50.004). Conclusion: The incidence of HIE was 6/1000 live births and HIE was associated with significant morbidity and mortality in infants with severe encephalopathy.