Neurodevelopmental outcomes in newborns with birth asphyxia with special reference to hearing and visual impairment
Keywords:Birth asphyxia, HINES score, CP
Background: Birth asphyxia, the commonest cause of neonatal hospital admission with involvement of majority of an infant's organs but brain impairment is particularly worrisome. Early, severe neurologic dysfunction indicates significant hypoxic-ischemic insult and is the best predictor of neurologic sequelae. The survivors suffer from hypoxic–ischemic brain injury affecting vulnerable areas of the brain leading to neurodevelopmental sequelae including problems with sensory-motor, auditory and language processing.
Methods: This prospective cohort study conducted at Neonatal Section of JNMCH, AMU, Aligarh included 150 asphyxiated newborns fulfilling inclusion criteria. The discharged newborns were followed at 6,10 and 14 weeks and 6 months for neurological assessment using HINES along with screening assessment of visual and hearing. The findings noted compared with different Stages of HIE.
Results: Among a total of 150 eligible asphyxiated newborn enrolled in the study, 91 babies were discharged. 89% of the Stage I HIE discharged infant had HINES score of more than 70 at 6 months whereas score of more than 65 was seen in 96%, 81% and 35% in the three advancing stages of HIE respectively. All babies in stage I, 77% of stage II and 50% of stage III babies had normal ophthalmological examination. All babies with stage III had an abnormal hearing.
Conclusions: Majority of asphyxiated newborn of Stage I and II were having good hospital as well as neurodevelopment and visual outcome but the Stage III babies had high mortality and adverse neurological, ophthalmic and hearing sequalae in the survivors.
Lawn Je, Cousens S, Zupan J. 4 Million Neonatal Deaths: When? Where? Why? Lancet. 2005; 365(9462):891-900.
Unicef /for every child/75, Newborn and child health, Let’s end preventable neonatal deaths and ensure Every Child ALIVE. Available at: https://www.unicef. org/india/what-we-do/newborn-and-child-health. Accessed on 20 November 2022.
Van Petten C. Relationship between hippocampal volume and memory ability in healthy individuals across the lifespan: Review and meta-analysis. Neuropsychologia. 2004;42(10):1394-413.
Lee AC, Mullany LC, Tielsch JM, Katz J, Khatry SK, LeClerq SC, et al. Community-based stillbirth rates and risk factors in rural Sarlahi, Nepal. Int J Gynaecol Obstet. 2011;113(3):199-204.
Daga S, Fernandes C, Soares M, Raote G, Rao A. Clinical profile of severe birth asphyxia. Undefined. 1991.
Indian National Neonatal Perinatal Database. Available at: http://www.newbornwhocc.org/pdf/nnpd _report_2002-03.PDF. Accessed on 20 November 2022.
Tielsch JM. Neonatal Encephalopathy and Neurologic Outcome, 2nd ed. Washington, Dc: American college of obstetricians and gynecologists; 2014:74-112.
Mohan K, Mishra Pc, Singh Dk. Clin Newborn. 2013;3(1):10-9.
Thornberg E, Thiringer K, Odeback A, Milsom I. Birth Asphyxia: Incidence, Clinical Course and Outcome in A Swedish Population. Acta Paediatr. 1995;84(8):927-32.
Macdonald HM, Mulligan JC, Allen AC, Taylor PM. Neonatal Asphyxia. Relationship of obstetric and neonatal complications to neonatal mortality In 38,405 Consecutive Deliveries. J Pediatr.1980;96(5):898-902.
Gupta SK, Sarmah BK, Tiwari D, Shakya A, Khatiwada D. Clinical Profile of Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Central Nepal. JNMA J Nepal Med Assoc. 2014; 52(196):1005-9.
Romeo DMM, Cioni M, Palermo F, Cilauro S, Romeo MG. Neurological assessment in infants discharged from a neonatal intensive care unit. Eur J Paediatr Neurol. 2013;17(2):192-8.
Romeo DMM, Cioni M, Scoto M, Mazzone L, Palermo F, Romeo MG. Neuromotor development in infants with cerebral palsy investigated by the Hammersmith Infant Neurological Examination during the first year of age. Eur J Paediatr Neurol. 2008;12(1):24-31.
Romeo DM, Bompard S, Serrao F, Leo G, Cicala G, Velli C, et al. Early Neurological assessment in infants with hypoxic ischemic encephalopathy treated with therapeutic hypothermia. J Clin Med. 2019;8(8):23-8.
Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: Advances in diagnosis and treatment. JAMA Pediatr. Am Med Assoc 2017;141:897-907.
Haataja L, Mercuri E, Guzzetta A, Rutherford M, Counsell S, Flavia Frisone M, et al. Neurologic examination in infants with hypoxic-ischemic encephalopathy at age 9 to 14 months: use of optimality scores and correlation with magnetic resonance imaging findings. J Pediatr. 2010;138(3): 332-7.
Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010;86(6):329-38.
Molteno C, Grosz P, Wallace P, Jones M. Neurological examination of the preterm and full-term infant at risk for developmental disabilities using the Dubowitz Neurological Assessment. Early Hum Dev. 1995; 41(3):167-76.
Haataja L, Cowan F, Mercuri E, Bassi L, Guzzetta A, Dubowitz L. Application of a scorable neurologic examination in healthy term infants aged 3 to 8 months. J Pediatr. 2003;143:546.
Salati R, Borgatti R, Giammari G, Jacobson L. Oculomotor dysfunction in cerebral visual impairment following perinatal hypoxia. Dev Med Child Neurol. 2007;44(8):542-50.
Azzopardi D, Strohm B, Marlow N, Brocklehurst P, Deierl A, Eddama O, et al. Effects of Hypothermia for Perinatal Asphyxia on Childhood Outcomes. New Eng J Med. 2014;371(2):140-9.
Casteels I, Demaerel P, Spileers W, Lagae L, Missotten L, Casaer P. Cortical visual impairment following perinatal hypoxia: clinicoradiologic correlation using magnetic resonance imaging. J Pediatr Ophthalmol Strabismus. 1997;34(5):297-305.
Lim M, Soul JS, Hansen RM, Mayer DL, Moskowitz A, Fulton AB. Development of visual acuity in children with cerebral visual impairment. Arch Ophthalmol. 2005;123(9):1215-20.
Mercuri E, Haataja L, Guzzetta A, Anker S, Cowan F, Rutherford M, et al. Visual function in term infants with hypoxic-ischaemic insults: correlation with neurodevelopment at 2 years of age. Arch Dis Child Fetal Neonatal Ed. 1999;80(2):23-8.
Aziza M, Bs Y. Hearing Impairment in Infants with Asphyxia. Int Tinnitus J. 2022;26(1):11-5.
Fitzgerald MP, Reynolds A, Garvey CM, Norman G, King MD, Hayes BC. Hearing impairment and hypoxia ischaemic encephalopathy: Incidence and associated factors. Eur J Paediatr Neurol. 2019;23(1):81-6.
Michniewicz B, Wroblewska-Seniuk K, Amara JA, Al-Saad SR, Szyfter W, Karbowski LM, et al. Hearing Impairment in Infants with Hypoxic Ischemic Encephalopathy Treated with Hypothermia. 2022; 12(1):8-15.
Hamed E, Merchant N, Kulkarni AP. Permanent childhood hearing loss in infants with hypoxic ischaemic encephalopathy: incidence and risk factors. On J Otolaryngol Rhinol. 2021;4(5):32-8.