Clinical Profile of Term Neonates admitted with Hypoxic-Ischemic Encephalopathy at Mayo Hospital Lahore

Abstract

ABSTRACT

Objective: To determine the clinical profile, associated factors, and outcome of term newborns admitted to the Neonatal Unit with Hypoxic-Ischemic Encephalopathy (HIE).

Study Design: Cross-Sectional Observational Study

Place And Duration Of Study: Neonatal Unit Of Pediatric Medicine Department, King Edward Medical University (Mayo Hospital) Lahore, From January 2020 To December 2021.

Material And Methods: All term newborns admitted to the Neonatal Unit during this period with the clinical diagnosis of Hypoxic-Ischemic Encephalopathy (HIE) were included by consecutive sampling. The baseline characteristics, antenatal and perinatal associated factors, the severity of HIE, and the outcome of each case were noted. The Chi-Square test was applied to compare the severity of HIE among the stratified data, and a p-value <0.05 was regarded as significant.

Results:  During the study period, the total number of newborns admitted to the Neonatal Intensive Care Unit (NICU) was 2330, out of which 302 newborns (12.96%) were admitted with the diagnosis of HIE.   The majority of the 302 newborns with HIE were male (63.2%), with a mean presentation age of 14.10 ±39.82 hours (median of 2.75 hours). Most neonates had mild HIE (55.6%), followed by moderate in 12.3%, and severe in 32.1%. Mortality was seen in 113 (37.4%) neonates, highest in severe HIE (93.8%), followed by moderate (43.2%) and mild HIE (3.6%). Antecedent factors like the presence of a skilled birth attendant, the place and the mode of delivery, and regular antenatal visits were associated significantly with the severity of HIE. Similarly, the need for respiratory support, need for inotropic drugs, fits, multi-organ damage, and abnormal cranial ultrasound scan were also significantly associated with severe HIE (p-value <0.05).

Conclusion :

Hypoxic-Ischemic Encephalopathy is a common admitting diagnosis in the neonatal unit that carries high case fatality owing to severity at presentation and higher complication rates in severe cases. The severity of HIE is found to be associated with several modifiable antenatal and perinatal factors. If such factors are addressed timely, the outcome of these neonates may improve.

Keywords: Birth Asphyxia, Hypoxic Ischemic Encephalopathy, Clinical Profile, Term Neonates, Thompson Score.