HYPOXIC ISCHEMIC ENCEPHALOPATHY IN NEONATES
AbstractBackground: Birth anoxia remains an important cause of mortality and morbidity in neonates.Hypoxia/ischemia can lead to permanent brain damage and also affects other tissues of the body. Itresults from lack of oxygen before, during or after birth. The study was designed to assess the riskfactors of birth asphyxia, common presentations and association of Apgar score with grades ofhypoxic-ischemic encephalopathy. Methods: the study is descriptive, prospective and carried out inthe Paediatric Department of Ayub Teaching Hospital, Abbottabad from September 2007 tillSeptember 2008. A total number of 181 neonates (144 males and 37 females) who showed theneurological signs of hypoxic-ischemic encephalopathy were included in the study. Maternal historywas taken, Apgar scoring was done and neurological grading was done for the assessment of braindamage. Results: out of 181 neonates 77.9% were full term, 8.8% were premature, 5.2% were havingintra uterine growth retardation and 6.1% were post mature. 38.7% were diagnosed as having grade-3,38.7% as grade-2 and 22.6% as grade-1 encephalopathy. Mortality due to hypoxic ischemicencephalopathy in our unit was 16%. 52.5% of the mothers were primigravida, 50% of the multigravidmothers had history of perinatal deaths, and 6.1% had ante-natal examination. Antenatal factors likelack of antenatal examinations, toxaemia of pregnancy and prolonged labour were major contributorsto the mortality of neonates. Conclusion: Primigravid mothers, maternal anaemia, lack of antenatalexamination, toxaemia of pregnancy and prolonged labour were the major contributors to the hypoxicischemic encephalopathy. Early recognition of the risk factors and public health awareness needs to beaddressed. Improvements in maternal health and regular antenatal checkups should be emphasised.Key words: Hypoxic ischemic encephalopathy, risk factors, birth asphyxia.
Ferriero DM. Neonatal brain injury. N Engl J Med
Perlman JM. Brain injury in the term infant. Semin
Grow J, Barks JD. Pathogenesis of hypoxic-ischemic cerebral
injury in the term infant: current concepts. Clin
Cowan F, Rutherford M, Groenendaal F, Eken P, Mercuri E,
Bydder GM, et al. Origin and timing of brain lesion in term
infants with neonatal encephalopathy. Lancet 2003;361:736–42.
Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal
distress: A clinical and electroencephalographic study. Arch
Lawn JE, Cousens S, Zupan J. Four Million Neonatal Deaths:
Where? When? Why? Neonatal Survival Series Paper 1. Lancet
Save the Children. WHO estimates published in Saving Newborn
Lives. State of the world’s newborns. Washington DC: Save the
Children; 2001. p.1–44.
World Health Organization. Global burden of disease, 2000.
version 2. Geneva: World Health Organization; 2003.
Wu YW, Backstrand KH, Zhao S, Heather J, Fullerton HJ,
Johnston SC. Declining Diagnosis of Birth Asphyxia in
California: 1991–2000. Pediatrics 2004;114;1584–90.
Maqbool S. Birth asphyxia. Hand book of neonatal care. 1996.
Stewart JH, Andrews J, Cartlidge PH. Numbers of deaths related
to intrapartum asphyxia and timing of birth in all Wales perinatal
survey, 1993–1995. BMJ 1998;316:657–60.
Vannucci RC, Perlman JM. Interventions for perinatal hypoxicischemic encephalopathy. Pediatrics 1997;100:1004–14.
Guyer B, Martin JA, Mac Dorman MF, Anderson RN, Strobino
DM. Annual summary of vital statistics-1996. Pediatrics
Perlman JM. Intrapartum hypoxic-ischemic cerebral injury and
subsequent cerebral palsy: medicolegal issues. Pediatrics
Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia:
incidence, clinical course and outcome in a Swedish population.
Acta Paediatr 1995;84:927–32.
Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD,
Ferriero DM, et al. Selective head cooling with mild systemic
hypothermia after neonatal encephalopathy: multicenter
randomised trial. Lancet 2005;365:663–70.
Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald
SA, Donovan EF, et al. Whole-body hypothermia for neonates
with hypoxic-ischemic encephalopathy. N Engl J Med
Zanelli SA, Stanley DP, Kaufman DA. Hypoxic-Ischemic
Encephalopathy. Available at: http://emedicine.medscape.com/
article/973501-overview. Updated: Nov 19, 2009
Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O'Sullivan
F, Burton PR, et al. Antepartum risk factors for newborn
encephalopathy: the Western Australian case-control study. BMJ
Bukowski R, Burgett AD, Gei A, Saade GR, Hankins GD.
Impairment of fetal growth potential and neonatal
encephalopathy. Am J Obstet Gynecol 2003;188:1011–5.