Defining hypoxic ischemic encephalopathy in newborn infants: benchmarking in a South African population

Horn, A; Swingler, George; Myer, Landon; Harrison, Michael; Linley, L L; Nelson, Candice J.; Tooke, Lloyd; Rhoda, Natasha; Robertson, Nicola J.

doi:10.1515/jpm-2012-0107

Cited by 22 publications

(29 citation statements)

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“…In-hospital mortality was low (60/450, 13.3%), with the burden anticipated to be in the disabled survivors. Our rates of perinatal asphyxia and HIE were similar to those found by Horn et al [12] The 5-minute Apgar score is a poor indication of cerebral injury. In this study, 103 babies (22.9%) had no evidence of HIE, although 347 (77.1%) had signs of neurological compromise recorded.…”

Section: Discussionsupporting

confidence: 90%

“…Horn et al [12] discuss the difficulties in consensus definitions and criteria of HIE. The data show that there is a wide variation in the incidence and grade of HIE, depending on which criteria are used.…”

Section: Discussionmentioning

confidence: 99%

“…Horn et al showed that there is wide variation in the incidence and grade of HIE, depending on which criteria are used. [12] Until recently, solving the problem of perinatal asphyxia lay mainly in the obstetric realm. Prompt, effective neonatal resuscitation can improve outcome.…”

Section: Researchmentioning

confidence: 99%

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Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa

Padayachee

Ballot

2013

S Afr J CH

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Background. Perinatal asphyxia is a signi cant cause of death and disability. Objective. To determine the outcomes (survival to discharge and morbidity a er discharge) of neonates with perinatal asphyxia at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods. is was a descriptive retrospective study. We reviewed information obtained from the computerised neonatal database on neonates born at CMJAH or admitted there within 24 hours of birth between 1 January 2006 and 31 December 2011, with a birth weight of >1 800 g and a 5-minute Apgar score <6. Results. Four hundred and y infants were included in the study; 185 (41.1%) were females, the mean birth weight (± standard deviation) was 3 034.8±484.9 g, and the mean gestational age was 39.1±2.2 weeks. Most of the infants were born at CMJAH (391/450, 86.9%) and by normal vaginal delivery (270/450, 60.0%). e overall survival rate was 86.7% (390/450). Forty-two infants were admitted to the intensive care unit (ICU). e ICU survival rate was 88.1% (37/42). Signi cant predictors of survival were place of birth (p=0.006), mode of delivery (p=0.007) and bag-mask ventilation at birth (p=0.040). Duration of hospital stay (p=0.000) was signi cantly longer in survivors than in non-survivors (6.5±6.6 days v. 2.8±9.8 days). e remaining factors, namely gender, antenatal care, chest compressions, diagnosis of meconium aspiration syndrome or persistant pulmonary hypertension, did not di er signi cantly between the two groups. e rate of perinatal asphyxia (5-minute Apgar score <6) was 4.7/1 000 live births, and there was evidence of hypoxic ischaemic encephalopathy (HIE) in 3.6/1 000 live births. Of the 390 babies discharged from CMJAH, 113 (29.0%) had follow-up records to a mean corrected age of 5.9±5.0 months. e majority (90/113, 79.6%) had normal development. Conclusions. (i) e high overall survival and survival a er ICU admission provides a benchmark for further care; (ii) obtaining adequate data for long-term follow-up was not possible with the existing resources -surrogate early markers of outcome and/or more resources to ensure accurate follow-up are needed; and (iii) the high incidence of HIE suggests that a therapeutic hypothermia service, including a longterm follow-up component, would be bene cial. Fetal distress 91 (20.2) Meconium-stained liquor 49 (10.9) Fetal distress + meconium-stained liquor 39 (8.7) Multiple problems 15 (3.3) Cord around the neck 14 (3.1) Prolonged second stage 9 (2.0) Cord prolapse 4 (0.9) Poor progress 4 (0.9) Malpresentation 1 (0.2) Cephalopelvic disproportion 1 (0.2) Shoulder dystocia 1 (0.2)

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa

Padayachee

Ballot

2013

S Afr J CH

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“…Birth asphyxia results in significant morbidity and is the third most common (23%) global cause of death in the neonatal period . Although it has not been well documented in sub‐Saharan Africa, two studies r eported an incidence of hypoxic‐ischaemic encephalopathy (HIE) resulting from birth asphyxia that ranged between 3.8 and 8.3 per 1000 live births in two different regions in South Africa.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic hypothermia for neonatal hypoxic‐ischaemic encephalopathy had favourable outcomes at a referral hospital in a middle‐income country

et al. 2016

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“…The incidence of HIE in developed countries is estimated to be 1.5 per 1,000 live births [3]. Estimates in developing countries range from 2.3–26.5 per 1,000 live births [4,5]. A recent meta-analysis found that therapeutic hypothermia commenced by age 6 hours for infants with moderate or severe (moderate-severe) HIE, significantly reduces death or disability: in three studies an abnormal amplitude integrated electro-encephalogram (aEEG) was required as an additional criterion for cooling [6].…”

Section: Introductionmentioning

confidence: 99%

Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours

et al. 2013

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BackgroundAn early clinical score predicting an abnormal amplitude-integrated electroencephalogram (aEEG) or moderate-severe hypoxic ischemic encephalopathy (HIE) may allow rapid triage of infants for therapeutic hypothermia. We aimed to determine if early clinical examination could predict either an abnormal aEEG at age 6 hours or moderate-severe HIE presenting within 72 hours of birth.MethodsSixty infants ≥ 36 weeks gestational age were prospectively enrolled following suspected intrapartum hypoxia and signs of encephalopathy. Infants who were moribund, had congenital conditions that could contribute to the encephalopathy or had severe cardio-respiratory instability were excluded. Predictive values of the Thompson HIE score, modified Sarnat encephalopathy grade (MSEG) and specific individual signs at age 3–5 hours were calculated.ResultsAll of the 60 infants recruited had at least one abnormal primitive reflex. Visible seizures and hypotonia at 3–5 hours were strongly associated with an abnormal 6-hour aEEG (specificity 88% and 92%, respectively), but both had a low sensitivity (47% and 33%, respectively). Overall, 52% of the infants without hypotonia at 3–5 hours had an abnormal 6-hour aEEG. Twelve of the 29 infants (41%) without decreased level of consciousness at 3–5 hours had an abnormal 6-hour aEEG (sensitivity 67%; specificity 71%). A Thompson score ≥ 7 and moderate-severe MSEG at 3–5 hours, both predicted an abnormal 6-hour aEEG (sensitivity 100 vs. 97% and specificity 67 vs. 71% respectively). Both assessments predicted moderate-severe encephalopathy within 72 hours after birth (sensitivity 90%, vs. 88%, specificity 92% vs. 100%). The 6-hour aEEG predicted moderate-severe encephalopathy within 72 hours (sensitivity 75%, specificity 100%) but with lower sensitivity (p = 0.0156) than the Thompson score (sensitivity 90%, specificity 92%). However, all infants with a normal 3- and 6-hour aEEG with moderate-severe encephalopathy within 72 hours who were not cooled had a normal 24-hour aEEG.ConclusionsThe encephalopathy assessment described by the Thompson score at age 3–5 hours is a sensitive predictor of either an abnormal 6-hour aEEG or moderate-severe encephalopathy presenting within 72 hours after birth. An early Thompson score may be useful to assist with triage and selection of infants for therapeutic hypothermia.

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Defining hypoxic ischemic encephalopathy in newborn infants: benchmarking in a South African population

Abstract: The incidence and grade of HIE can vary more than 2-fold in the same population, depending on which defining criteria are used. Consensus definitions are needed for benchmarking.

Cited by 22 publications

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Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa

Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa

Therapeutic hypothermia for neonatal hypoxic‐ischaemic encephalopathy had favourable outcomes at a referral hospital in a middle‐income country

Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours

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