Clinical profile, outcome and clinical indicators for poor prognosis in full term babies born with severe birth asphyxia: study from tertiary care hospital from western India
Keywords:Outcome, Prognosis, Risk factors, Sever birth asphyxia
Background: The World Health Organization describes birth asphyxia as failure to initiate and sustain breathing at birth. The aim of the study was to study the clinical profile and outcome at 3 months of age of full term babies born with severe birth asphyxia and to analyze risk factors associated with adverse outcome.
Methods: This was a prospective observational study carried out over period of 12 months in year 2015-16. All full-term babies born with severe birth asphyxia (n = 45) during four months period were enrolled and were followed up for 3 months. Severe birth asphyxia was defined as APGAR score 3 or less at 1 minute. Baseline characteristics, clinical profile and outcome were noted. HIE was graded as per Sarnat and Sarnat staging. Neurological Assessment at 7th day and on discharge was done and children were assessed by Amiel Tison Scale at 3 months. Multivariate analysis by linear regression was done to find risk factors associated with adverse outcome.
Results: Of total 45 babies with SBA, 35 developed HIE, of which 13 (28.8%) were in HIE grade II and 13 (28.8%) were in HIE III. Mortality found was 20% while 28.5% of survivors had abnormal neurological outcome at 3 months. Multivariate analysis of risk factors shows that abnormal neurological findings on 7th day of life, APGAR ≤ 6 at 10 minute and HIE grade II or more were associated with abnormal outcome (p = 0.01). The risk factors associated with mortality were multiorgan dysfunction, difficult to control seizures, APGAR ≤4 at 10 minute (p = 0.07).
Conclusions: Full term neonates with severe birth asphyxia has significant mortality and significant number of survivors has abnormal neurological outcome at 3 months of age. Presence of certain clinical indicators is associated with increased risk of adverse outcome.
World Health Organization. Perinatal mortality: a listing of available information. Available at WHO/frh/msm/96.7.Geneva: WHO; 1996. Accessed on 12 November 2016
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? where? why? Lancet. 2005;365(9462):891-900.
Simon NP. Long-term neurodevelopmental outcome of asphyxiated newborns. Resuscitation Fetus Newborn. 1999;26:767-78.
Robertson CMT, Finer NN. Term infants with hypoxic-ischemic encephalopathy: outcome at 3.5 years. Dev Med Child Neurol. 1985;27:473-84.
Robertson CMT, Finer NN, Grace MGA. School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term. J Pediatr. 1989;114:753-60.
Cioni G, Prechtl HFR, Ferrari F, Paolicelli PB, Einspieler C, Roversi MF. Which better predicts later outcome in full term infants: quality of general movements or neurological examination? Early Hum Dev. 1997;50:71-85.
Brookhouser PE. Sensorineural hearing loss in children. Pediatr Clin North Am. 1996;43(6):1195-216.
Ellis M, Manandhar N, Shrestha PS, Shrestha L, Manadhar DS, Costello AM. Outcome at 1 year of neonatal encephalopathy in Kathmandu, Nepal. Dev Med Child Neurol. 1999;41:689-95.
Biarge M, Bregant T, Wusthoff CJ. White metter and cortical injury in hypoxic ischemic encephalopathy: Antecedent factors and 2 year outcome. J Pediatr. 2012;161:799-807.
Bairge M, Sebastian DJ, Rutherford MA, Cowan FM. Outcomes after central grey matter injury in term perinatal hypoxic ischemic encephalopathy. Early Hum Dev. 2010;86:675-82.
Vries LS, Jongmans MJ. Long term outcome after neonatal hypoxic ischemic encephalopathy. Arch. Dis Child. 2010;95:220-4.
Shah PS, Perlman M. Time courses of intrapartum asphyxia: neonatal characteristics and outcomes. Am J Perinatol. 2009;26(1):39-44.
Laerhoven VH, Haan R, Offringa M, Post B, Lee JH. Prognistic tests in term neonates with hypoxic ischemic encephalopathy: a systematic review. Pediatric. 2013;131:88-98.
Polat M, Simsek A, Tansug N. Prediction of neurodevelopmental outcome in term neonates with hypoxic ischemic encephalopathy. Eur J Paediatr Neurol. 2013;17:288-93.
Thoresen M, Liu X, Jary S. Lactate dehydrogenase in hypothermia treated newborn infants with hypoxic ischemic encephalopathy. Acta paeditr. 2012;101:1038-44.
Tison AC, Grenier A. Neurological assessment during the first year of life. New York: Oxford University press. 1986:96-145.
Thornberg E, Thiringer K, Milson I. Birth asphyxia: incidence, clinical course and outcome in aswedish population. Acta Pediatr. 1995;84(8):1927-32.
Monebenimp F, Tietche F, Eteki N. Asphyxie neonatale au centre hospitalieret. universitaire de yaounde, cameroun. Clinics Mother Child Health. 2005;2(2):335-8.
Airede AI. Birth asphyxia and hypoxic ischemic encephalopathy(HIE)incidence and severity. Ann Trop Pediatr. 1991;11(4):331-5.
Chandra S, Ramji S, Thirupuram S. Perinatal asphyxia: multivariate analysis of risk factors in hospital births. Indian Pediatrics. 1997;34(3):206-12.
Gonzales DJ, Moya M. Perinatal difference in asphyxia full term newnorns: an epidemiological study. Rev Neurol. 1996;24:812-9.
Shah GS, Singh R, Das BK. Outcome of newborns with birth asphyxia. J Nepal Med Asso. 2005;44(158):44-6.
Khatoon S, Kawser C, Talukder M. Clinical spectrum and outcome of birth asphyxiated babies in neonatal unit of IPGMR: A study of 122 cases. BJCH. 1989;13:7-15.
Boskabadi H, Ashrafzadeh F, Doosti H, Zakerihamidi M. Assessment of risk factors and prognosis in asphyxiated infants. Iranian J Pediatrics. 2015;25(4):1-5.
Klinger G, Beyene J, Shah P, Perlman M. Do hyperoxaemia and hypocapnia add to the risk of brain injury after intrapartum asphyxia? Arch Disease Childhood Fetal Neonatal. 2005;90(1):49-52.
Velaphi S, Pattinson R. Avoidable factors and causes of neonatal deaths from perinatal asphyxia-hypoxia in South Africa: national perinatal survey. Annals Tropical Paedia. 2007;27(2):99-106.
Hatami G, Motamed M, Darvishi Z. Outcome and survival of neonates with hypoxic ischemic encephalopathy (HIE) in university hospital in Bushehr port 1999-2006. ISMJ. 2006;9(1):36-44.
Hayakawa M, Ito Y, Saito S, Mitsuda N, Hosono S, Yoda H, et al. Incidence and prediction of outcome in hypoxic-ischemic encephalopathy in Japan. Pediatrics International. 2014;56(2):215-21.
Glass HC, Glidden D, Jeremy RJ, Barkovich AJ, Ferriero DM, Miller SP. Clinical neonatal seizures are independently associated with outcome in infants at risk for hypoxic-ischemic brain injury. J Pediatrics. 2009;155(3):318-23.