Outcome at 1 year of neonatal encephalopathy in Kathmandu, Nepal

Abstract

To determine the outcome at 1 year of neonatal encephalopathy (NE) and to estimate the possible contribution of birth asphyxia to childhood disability in a lowincome South Asian country, a prospective cohort study was undertaken in the principal maternity hospital of Kathmandu, where over 50% of local women give birth. From a total population cohort of 21 609 live births, 131 term infants with NE (after exclusion of cases associated with neonatal sepsis, congenital malformations, or primary hypoglycaemia) and 208 term control infants were recruited. Of these, 102 (78%) infants with NE and 106 (51%) control infants were followed-up to 1 year of age. Outcome measures were death or neurodevelopmental impairment, graded as major, minor or none. Of the 131 term infants with NE, 83 were graded with moderate or severe NE according to conventional definition. By 1 year of age, 45 (44%) of the infants with NE had died, 18 (18%) had severe impairments, and two (2%) had minor impairments; four (4%) of the control subjects had died and two (2%) had minor impairments. Most deaths in subjects with NE occurred in the early neonatal period; NE carried no excess risk of death beyond the neonatal period. Of the 18 children with major impairment, 14 (78%) had spastic tetraplegic cerebral palsy and eight (44%) had multiple impairments. Compared with the control group the relative risk of death by 1 year was 5 (95% CI 1.4 to 15) for mild NE, 8 (95% CI 3 to 23) for moderate, and 26 (95% CI 10 to 67) for severe. Twenty-seven of 38 (71%) infants with moderate NE either died or survived with major impairment. An upper estimate for the prevalence of major neuroimpairment at 1 year attributable to birth asphyxia is 1 per 1000 live births in this population.

296 Birth Asphyxia Survivors in a Developing Country.

“…Our findings are consistent with those of Ellis et al, 10 who found that 20% of infants with neonatal encephalopathy had neurologic impairments at 1 year follow-up versus 50% in our study, though at an earlier age. The Ellis study was conducted at a single hospital in Nepal, and serial follow-up was conducted at 6 weeks, 6 months and 1 year.…”

“…[5][6][7][8][9] One of the best population studies of asphyxia in a developing country reported that 18% of survivors of mild to moderate birth asphyxia had neonatal encephalopathy and permanent severe neurologic impairment. 10 Birth asphyxia was a common cause of mental retardation, cerebral palsy and other neurodevelopmental disorders.…”

“…Therefore, neurodevelopmental examinations as early as 6 weeks of age may provide an indication of the magnitude of the problem. 10 Although accurate estimates of neurodevelopmental sequelae from birth asphyxia in developing countries are not available, studies in developed countries have found that 15 to 18% of infants who suffer moderate to severe asphyxia are disabled by 8 years of age. 7 Moderate to severe asphyxia was defined as altered consciousness with altered muscle tone or primitive reflexes after 1 h of age along with intrapartum fetal distress, immediate neonatal distress, or immediate neonatal resuscitation.…”

Does aetiology of neonatal encephalopathy and hypoxic–ischaemic encephalopathy influence the outcome of treatment?

“…34 Longitudinal studies indicate that hypoxia and inflammation are related to CP via a pathway that includes neonatal encephalopathy, 12,35 and maternal thyroid disorders are also associated with risk of neonatal encephalopathy. 19,36 Vulnerability to neonatal encephalopathy is likely, in future, to be a fruitful subject for genetic and genomic investigation.…”

Relação entre índice de resistência obtido pela ultra-sonografia Doppler transfortanela e o neurodesenvolvimento até o primeiro ano de vida em recém-nascidos a termo com encefalopatia hipóxico-isquêmica leve e moderada

“…Dos 20 RN incluídos neste estudo, 15 apresentaram anormalidades transitórias na avaliação neurológica e no desenvolvimento, com normalização a partir do final do segundo trimestre de vida. A evolução do neurodesenvolvimento no fi nal do primeiro ano de vida foi adequada para a idade em todos os pacientes, o que está de acordo com outros relatos na literatura que destacaram a boa evolução dos casos de EHI leve e moderada em países desenvolvidos 2,26 , no entanto sem a correlação com um exame de avaliação vascular como o Doppler.…”