Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study

Tann, Cally J; Webb, Emily L.; Lassman, Rachel; Ssekyewa, Julius; Sewegaba, Margaret; Musoke, Margaret; Burgoine, Kathy; Hagmann, Cornelia; Deane-Bowers, Eleanor; Norman, Kerstin; Milln, Jack; Kurinczuk, Jennifer J; Elliott, Alison M.; Martinez‐Biarge, Miriam; Nakakeeto, Margaret; Robertson, Nicola J.; Cowan, Frances

doi:10.1016/j.eclinm.2018.12.001

Cited by 26 publications

(36 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Globally, the last three decades have witnessed considerable decline in under five mortality, but neonatal mortality has not mirrored this feat [1]. Birth asphyxia now accounts for about a quarter of newborn deaths and is associated with significant morbidity among survivors, who suffer disabling motor and cognitive deficits [1][2]. There is currently significant global variation in morbidity and mortality among neonates with asphyxia, as greater than 95% of all asphyxia-related deaths and impairment in these group occur in low resource settings [3].…”

Section: Introductionmentioning

confidence: 99%

Postnatal Outcomes and Risk Factors for In-Hospital Mortality among Asphyxiated Newborns in a Low-Resource Hospital Setting: Experience from North-Central Nigeria

Ogunkunle¹,

Odiachi²,

Chuma³

et al. 2020

Annals of Global Health

View full text Add to dashboard Cite

Background: Birth asphyxia accounts for a third of global newborn deaths and 95 percent of these occur in low-resource settings. A key to reducing asphyxia-related deaths in these settings is improving care of these newborns and this requires an understanding of factors associated with adverse outcomes. Objectives: In this study, we report outcomes and risk factors for mortality among newborn infants with birth asphyxia admitted to a typical low-resource hospital setting. Methods: We prospectively followed up 191 asphyxiated newborn infants admitted to a referral tertiary hospital in North-central Nigeria. At baseline, care-givers completed a structured questionnaire. Using univariable analysis, we compared baseline characteristics between participants who died and those who survived till discharge. We also fitted a multivariable logistic regression model to identify risk factors for mortality among the cohort. Results: Majority (60.7%) of the study participants presented to the hospital within the first six hours of life. Despite this, mortality among the cohort was 14.7% with a third dying within the first 24 hours of admission. The presence of respiratory distress at admission increased the risk for mortality (AOR = 3.73, 95% CI 1.22 to 11.35) while higher participant weight at admission decreased the risk (AOR = 0.11, 95% CI 0.03 to 0.40). Intrapartum factors such as duration of labour and maternal age, although significant on univariable analysis, were not significant on multivariable analysis. Conclusions: Hospital mortality among newborns with birth asphyxia is high in North-central Nigeria and majority of deaths occur during acute care. Respiratory distress at presentation and admission weights were identified as key risk factors for asphyxia mortality. Intrapartum factors on the other hand might have indirect effects on mortality through an increased risk for neonatal complications.

show abstract

Section: Introductionmentioning

confidence: 99%

Postnatal Outcomes and Risk Factors for In-Hospital Mortality among Asphyxiated Newborns in a Low-Resource Hospital Setting: Experience from North-Central Nigeria

Ogunkunle¹,

Odiachi²,

Chuma³

et al. 2020

Annals of Global Health

View full text Add to dashboard Cite

show abstract

“…Neuromotor impairment will be further assessed according to the HINE, a standardised paediatric neurological examination and classified by type. We have used both these tests extensively in previous studies in Uganda and found them easy to administer in this setting and at this age 15. The assessments will be conducted in the local language using the standard manual material to ensure internal consistency in the assessments technique.…”

Section: Methodsmentioning

confidence: 99%

“…Since 2011, the ABAaNA studies (‘Abaana’, meaning ‘children’ in the local language Luganda) have been examining risk factors for, and outcomes from, neonatal encephalopathy (NE) in Uganda 15. Studies examining early neurodevelopmental outcomes after NE revealed a high prevalence of neurodevelopmental impairment (NDI) with 25% of those affected also having malnutrition from related feeding difficulties 15. Qualitative work highlighted the stigma and broad-ranging social, emotional and financial impacts on affected families 3…”

Section: Methodsmentioning

confidence: 99%

Randomised controlled pilot feasibility trial of an early intervention programme for young infants with neurodevelopmental impairment in Uganda: a study protocol

Nampijja¹,

Webb²,

Nanyunja³

et al. 2019

BMJ Open

View full text Add to dashboard Cite

IntroductionEarly intervention programmes (EIPs) for infants with neurodevelopmental impairment have been poorly studied especially in low-income settings. We aim to evaluate the feasibility and acceptability of a group participatory EIP, the ‘ABAaNA EIP’, for young children with neurodevelopmental impairment in Uganda.Methods and analysisWe will conduct a pilot feasibility, single-blinded, randomised controlled trial comparing the EIP with standard care across two study sites (one urban, one rural) in central Uganda. Eligible infants (n=126, age 6–11 completed months) with neurodevelopmental impairment (defined as a developmental quotient <70 on Griffiths Scales of Mental Development, and, or Hammersmith Infant Neurological Examination score <60) will be recruited and randomised to the intervention or standard care arm. Intervention arm families will receive the 10-modular, peer-facilitated, participatory, community-based programme over 6 months. Recruited families will be followed up at 6 and 12 months after recruitment, and assessors will be blinded to the trial allocation. The primary hypothesis is that the ABAaNA EIP is feasible and acceptable when compared with standard care. Primary outcomes of interest are feasibility (number recruited and randomised at baseline) and acceptability (protocol violation of arm allocation and number of sessions attended) and family and child quality of life. Guided by the study aim, the qualitative data analysis will use a data-led thematic framework approach. The findings will inform scalability and sustainability of the programme.Ethics and disseminationThe trial protocol has been approved by the relevant Ugandan and UK ethics committees. Recruited families will give written informed consent and we will follow international codes for ethics and good clinical practice. Dissemination will be through peer-reviewed publications, conference presentations and public engagement.Trial registration numberNCT44380971; protocol version 3.0, 19th February 2018.

show abstract

“…The research methodology and primary results have been described previously. [17][18][19][20] In summary, term infants (≥37 weeks gestation) with NE (Thompson score 21 ≥6 within 12 h of birth) and an unmatched comparison group of term infants without NE were included. Control infants were contemporaneously recruited (at a case:control ratio of 1:2), systematically sampled from the labor ward admission book, and were eligible if their Thompson score was <3 (as assessed by trained MNRH study physicians).…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…The procedure used in the current study for neurodevelopmental follow-up has been previously reported. 18 In summary, children were assessed at 12-15 and 27-30 months of age, either in outpatient clinic or at home (<5%). Transport costs were remunerated.…”

Section: Early Childhood Outcomesmentioning

confidence: 99%

Elevated serum IL-10 is associated with severity of neonatal encephalopathy and adverse early childhood outcomes

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Neonatal encephalopathy (NE) contributes substantially to child mortality and disability globally. We compared cytokine profiles in term Ugandan neonates with and without NE, with and without perinatal infection or inflammation and identified biomarkers predicting neonatal and early childhood outcomes. Methods In this exploratory biomarker study, serum IL-1α, IL-6, IL-8, IL-10, TNFα, and VEGF (<12 h) were compared between NE and non-NE infants with and without perinatal infection/inflammation. Neonatal (severity of NE, mortality) and early childhood (death or neurodevelopmental impairment to 2.5 years) outcomes were assessed. Predictors of outcomes were explored with multivariable linear and logistic regression and receiver-operating characteristic analyses. Results Cytokine assays on 159 NE and 157 non-NE infants were performed; data on early childhood outcomes were available for 150 and 129, respectively. NE infants had higher IL-10 (p < 0.001), higher IL-6 (p < 0.017), and lower VEGF (p < 0.001) levels. Moderate and severe NE was associated with higher IL-10 levels compared to non-NE infants (p < 0.001). Elevated IL-1α was associated with perinatal infection/inflammation (p = 0.013). Among NE infants, IL-10 predicted neonatal mortality (p = 0.01) and adverse early childhood outcome (adjusted OR 2.28, 95% CI 1.35–3.86, p = 0.002). Conclusions Our findings support a potential role for IL-10 as a biomarker for adverse outcomes after neonatal encephalopathy. Impact Neonatal encephalopathy is a common cause of child death and disability globally. Inflammatory cytokines are potential biomarkers of encephalopathy severity and outcome. In this Ugandan health facility-based cohort, neonatal encephalopathy was associated with elevated serum IL-10 and IL-6, and reduced VEGF at birth. Elevated serum IL-10 within 12 h after birth predicted severity of neonatal encephalopathy, neonatal mortality, and adverse early childhood developmental outcomes, independent of perinatal infection or inflammation, and provides evidence to the contribution of the inflammatory processes. Our findings support a role for IL-10 as a biomarker for adverse outcomes after neonatal encephalopathy in a sub-Saharan African cohort.

show abstract

Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study

Cited by 26 publications

References 27 publications

Postnatal Outcomes and Risk Factors for In-Hospital Mortality among Asphyxiated Newborns in a Low-Resource Hospital Setting: Experience from North-Central Nigeria

Postnatal Outcomes and Risk Factors for In-Hospital Mortality among Asphyxiated Newborns in a Low-Resource Hospital Setting: Experience from North-Central Nigeria

Randomised controlled pilot feasibility trial of an early intervention programme for young infants with neurodevelopmental impairment in Uganda: a study protocol

Elevated serum IL-10 is associated with severity of neonatal encephalopathy and adverse early childhood outcomes

Contact Info

Product

Resources

About