Correlation of Thompson Score in Predicting Early Outcome of Newborn with Birth Asphyxia

Abstract

Background: Birth asphyxia is one of the important causes of neonatal morbidity and mortality, accounting up to 30% of neonatal death in Nepal. It is also an important cause of long term neurological disability and impairment. Thompson encephalopathy score is a clinical score which can be used to assess the newborn with hypoxic ischemic encephalopathy for the prognosis and their neurodevelopmental outcome. The aim of the study was to assess the role of Thompson score in predicting the early outcome of neonates with birth asphyxia.
 Methods: A prospective study was conducted from May 2019 to April 2020 in Nepal Medical College. All the term babies during the period with Apgar score of less than seven at five minutes were considered to have birth asphyxia and included in the study. Neurological examination was done on first, second and third day using HIE score proposed by Thompson and severity of hypoxic ischemic encephalopathy was classified accordingly. Outcome was measured as normal, morbidity with encephalopathy, seizure, organ dysfunction and death.
 Results: Out of 391 newborn admitted to neonatal unit, 84 (21.4%) had birth asphyxia. Mild Thompson score on day 1,2,3 were 49(58.3%), 49 (58.3%), 51(60.7%); moderate Thompson score on day 1,2,3 were 21 (25%), 21 (25%), 18(21.4%) and severe Thompson score on day 1, 2, 3 were 14 (16.7%), 14 (16.7%), 15(17.9%) respectively. Out of 14 babies who had severe Thompson score on day 1, 11(91.7%) expired and 3 (16.7%) developed encephalopathy.
 Conclusions: There was strong correlation of severity of Thompson score with the outcome.
 Keywords: Birth asphyxia; hypoxic ischemic encephalopathy; thompson score

Birth Asphyxia among Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital

“…6 In other studies done in Nepal, the rate of primigravida varied between 37.60-55.00%. 7,9,10 In our study meconium-stained liquor was reported only in 28 (23.33%) neonates which is comparable to other studies of Nepal (28.00-34.10%). 8,11 However this finding was lower than other studies reported from Nepal (36.70-69.96%).…”

“…The prevalence of birth asphyxia seen in our study is comparable to the prevalence seen in similar studies conducted in Nepal (14-15.9%). 6,7 However, other studies from Nepal have reported the prevalence varying from 3.6% to 19.3%. [8][9][10][11] The variations in prevalence seen might be due to different definitions used to define birth asphyxia including different populations studied as well as different levels of maternal and perinatal care provided across various centres.…”

“… 8 , 11 However this finding was lower than other studies reported from Nepal (36.70-69.96%). 6 , 7 , 9 This is important since neonates with meconium-stained liquor have a 7.9 times higher risk of developing birth asphyxia. 12 …”

“…This finding is in contrast to other studies from Nepal which reported a significantly higher number of of neonates with HIE I (65.00-75.49%). 6 , 7 , 9 This difference may be due to most neonates being outborn, thereby having referral bias. Relatively simpler HIE I cases might have been observed and managed at the delivery places.…”

High incidence of poor in‐hospital outcomes of term newborns with hypoxic–ischaemic encephalopathy admitted at a regional referral hospital in Dodoma, Tanzania

“…Of The in-hospital mortality of 27.1% in our study was similar to the rates of 26% and 27% reported in other neighbouring countries such as Uganda and Kenya, respectively, 5,20 whereas it was slightly lower compared with the mortality of 30% reported in Nepal and 34% in Ethiopia. 21,22 The observed high mortality associated with neonatal HIE in these countries may reflect the shared challenges in the provision of quality neonatal care due to socioeconomic, structural and human resources limitations in low-and middle-income countries.…”