Neuro developmental outcome of preterm babies with hypoxic ischemic encephalopathy
DOI:
https://doi.org/10.18203/2349-3291.ijcp20192035Keywords:
Early intervention, HIE, Neurodevelopment outcome, Preterm infants, Trivandrum development screening chartAbstract
Background: Neonatal encephalopathy, following severe birth asphyxia or perinatal hypoxia is referred to as hypoxic ischemic encephalopathy (HIE). Cerebral ischemia occurs as a consequence of cerebral oedema and reduced cerebral perfusion due to myocardial dysfunction as a result of hypoxic cardiomyopathy. Sarnat stage I -100% recovery, HIE stage II - 80% normal and 20% mortality and HIE stage III - 50% mortality and 50% morbidity. Relatively few studies have been made on outcome in HIE affected preterm infants. The aims and objectives of this study was to find out the neurodevelopmental outcome in preterm infants with HIE.
Methods: This study is an observational clinical study, undertaken in Kempegowda Institute of Medical sciences and research centre, Bangalore, India. Study was performed between November 2016 to September 2018. 31 preterm infants with HIE were included in the study. Regular follow-up was done at 3, 6, 9, 12.15, 18 months by using Trivandrum development screening chart (TDSC) to stage II HIE infants.
Results: The incidence of abnormal neurological outcome was 12.9%. Out of 31 preterm babies, stage I were 24, stage II was 4 (100% morbidity) and stage III were 3 (100% mortality).
Conclusions: In present study, stage II HIE had 100% morbidity and moderate disability, stage III 100% mortality. Thus at 3-5 months of age during follow-up, when authors identify developmental delay, it is an ideal time to start interventional therapy to improve long term outcome.
References
Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, et al. Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bull World Health Org. 2009;87:130-8.
Ekwochi U, Ndu IK, Nwokoye IC, Ezenwosu OU, Amadi OF, Osuorah DI. Pattern of morbidity and mortality of newborns admitted into the sick and special care baby unit of Enugu State University Teaching Hospital Enugu state. Nigerian J Clinic Practice. 2014;17(3):346-51.
Himmelmann K, Hagberg G, Beckung E, Hagberg B, Uvebrant P. The changing Panorama of cerebral palsy in Sweden XI. Prevalence and origin in birth period 1995-98. Acts Paediatr. 2005;94:287-94.
Cordes I, Roland EH, Hill A, Lupton BA. Early prediction of the development of microcephaly after hypoxic-ischemic encephalopathy in the full-term newborn. Pediatr. 1994;93(5):703.
Levene MI. Management and outcome of birth asphyxia. Fetal and neonatal neurology and neurosurgery. London: Churchill Livingstone. 1995:427-2.
Mizrahi EM, Kellaway P. Characterization and classification of seizures. Neurol. 1987;37:1837-44.
Robertson CMT, Perlman M. Follow up of the term infant after hypoxic Ischemic encephalopathy. Pediatr Child Health. 2006;11(5):278-82.
Barkovich AJ, Sargent SK. Profound asphyxia in the premature infant: imaging findings. Am J Neuroradiol.1995;16:1837-46.
Keeney SE, Adcock EW, McArdle CB. Prospective observations of 100 high-risk neonates by high-field (1.5 Tesla) magnetic resonance imaging of the central nervous system: I. Intraventricular and extracerebral lesions. Pediatr. 1991;87(4):421-30.
Salhab WA, Perlman JM. Severe fetal acidaemia and subsequent neonatal encephalopathy in the larger premature infant. Pediatr Neurol. 2005;32:25-9.
Cohen M, Roessmann U. In utero brain damage: relationship of gestational age to pathological consequences. Develop Med Child Neurol. 1994;36(3):263-8.
Yokochi K. Thalamic lesions revealed by MR associated with periventricular leukomalacia and clinical profiles of subjects. Acta Paediatr. 1997;86:493-6.
Marín-Padilla M. Developmental neuropathology and impact of perinatal brain damage. II: white matter lesions of the neocortex. J Neuropathol Exp Neurol. 1997;56(3):219-35.
Squier M, Keeling JW. The incidence of prenatal brain injury. Neuropathol Appl Neurobiol. 1991;17:29-38.
Mercuri E, Guzzetta A, Laroche S, Ricci D, Cowan FM, Dubowitz LM. 2003 Neurological examination of preterm infants at term age: comparison with term infants. J Pediatr. 2003;142:647-55.
Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol. 2005;47:571-6.
Baburaj S, Abraham B, Vasant PV, Raj S, Mohandas MK. Growth and development of high-risk graduates till one year from a rural neonatal intensive care unit in South India. Int J Biomed Res. 2013;4(12):695-700.
Padayachee N, Ballot DE. Outcome of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa. SAJCH. 2013;7:89-4.
Zafar M, Sheela L. A study on prevalence and antecedents of developmental delay among children less than 2 years attending well baby clinic. People’s J Sci Res. 2009;2(1):9-12.
Kaye D. Antenatal and Intrapartum Risk Factors for birth asphyxia among emergency obstetric referrals in Mulego Hospital. East African Med J. 2003;80(3):140-3.
Senthilkumar K. Neurodevelopmental outcome of babies with hypoxic ischemic encephalopathy. Int J Res Med Sci. 2017;5(7):3197.