The continuing fall in incidence of hypoxic‐ischaemic encephalopathy in term infants

Abstract

Objective To examine trends in incidence of hypoxic-ischaemic encephalopathy in term infants over a twenty-one year period.Design A retrospective analysis of medical records of all term infants admitted to a neonatal unit with hypoxic-ischaemic encephalopathy during the years 1992-1996 (period C) and a comparison with data from the years 19761980 (period A) and 1984-1988 (period B) from the same unit (previously published').Setting A District Health Authority in Central England serving a population of about 450,000.Sample All term infants admitted with clinical features of hypoxic-ischaemic encephalopathy.Main outcome measures Incidence of three grades of hypoxic-ischaemic encephalopathy, disability and mortality.In each five year period there were similar numbers of births. Over the time-span of this study the stillbirth rate and neonatal mortality rate has consistently fallen. The overall incidence of hypoxicischaemic encephalopathy in term infants was significantly lower ( P < 0.001; OR 0-42 CI 0-29-0.59) in the present study period (C) compared with the earlier study period B (1-9 vs 4.6 per lo00 total live births). The fall in moderately and severely affected infants between the present and the first study period was significant (1.2 vs 2.6 per 1000 total live births, P c 0.001: OR 0.46 CI 0.29472). The number of deaths and the incidence of cerebral palsy in survivors fell progressively over the 21 years spanned by this study.Conclusion This study shows that the incidence of hypoxic-ischaemic encephalopathy and its sequelae in term infants has fallen significantly. The use of cardiotocography and caesarean section rates have risen but the relative contributions of changes in clinical practice are uncertain. Results INTRODUCTIONIn low risk pregnancies the incidence of stillbirths or neonatal deaths due to intrapartum asphyxia is regarded as a sensitive measure of the quality of intrapartum care24. The 4th annual report of the Confidential Enquiry into Stillbirths and Deaths in Infancy' recently identified sub-optimal care in many intrapartum deaths.In an earlier study we reported a fall in incidence of hypoxic-ischaemic encephalopathy in term infants during the period 1984-1988 (period B) compared with 1976-1980 (period A) in babies admitted to Derby City Hospital Neonatal Unit'.The aim of this study was to determine whether there had been a significant fall in incidence of moderate and severe hypoxic-ischaemic encephalopathy in the same neonatal unit, by looking at the period [1992][1993][1994][1995][1996] Correspondence: Dr K. Dodd, Derbyshire Children's Hospital, Uttoxeter Road, Derby DE22 3NE, UK. (period C). Information was also obtained on the subsequent morbidity and mortality of the three grades of hypoxic-ischaemic encephalopathy in the latest study period. The findings were looked at in the context of other changes occurring over the time period of this study such as demographic changes and clinical practice. METHODS The infantsIn the first study', for practical reasons, constrained by time a...

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