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Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 98-110

Magnitude, short-term outcomes and risk factors for hypoxic ischemic encephalopathy at abha maternity and children hospital, Abha City, Saudi Arabia and literature review

Department of Neonatology, Abha Maternity and Children Hospital, Abha, Saudia Arabia

Correspondence Address:
Dr. Raja M Thigha
Dr. Hassan Albar Maternity and Children Hospital, Abha
Saudia Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcn.JCN_12_19

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Background: When hypoxia is the cause for neonatal encephalopathy, a clinical syndrome has been described known as hypoxic–ischemic encephalopathy (HIE). Aim of the Study: This study aimed to determine the magnitude of HIE occurrence, its short-term outcomes, and associated risk factors. Literature review was included for comparing our reported findings with other published ones. Methods: A retrospective, case–control study was conducted at “Abha Maternity and Children Hospital” (AMCH) that included all inborn term and late-preterm newborns with the “admission diagnosis” of HIE during 2016–2017. Healthy newborn babies were taken as controls. Data were extracted from neonatal medical files for HIE cases and maternal medical files for the controls. Results: Of 15,790 livebirths, 124 cases had HIE (7.85/1000 livebirths), of whom 3.98/1000 and 3.86/1000 livebirths were staged as mild and moderate-to-severe HIE, respectively. Short-term outcomes for HIE were 14 deaths (11.3%) and 33 cases with seizures (26.6%), which occurred exclusively among moderate–severe HIE cases; 87 cases (70.2%) required positive pressure ventilation, and 45 cases (36.3%) required mechanical ventilation, with significantly higher rate among moderate–severe HIE than mild cases (P < 0.001). By the 7th day of admission, moderate-to-severe HIE cases showed significantly higher rates for both lack of nutritive sucking reflex and respiratory support than mild HIE ones (P = 0.016 and P < 0.001, respectively). Among HIE cases who required cooling, 96.2% were subjected to it within the “therapeutic window” of ≤6 h. Risk factors associated with HIE were urinary tract infection/vaginitis (P = 0.001), late preterm (P = 0.002), meconium stain (P = 0.003), abnormal cardiotocographic tracing (P < 0.001), prolonged second stage of labor (P = 0.001), assisted delivery (P = 0.011), sentinel events (P = 0.027), and low 1-min APGAR scores (P < 0.001). Conclusions: The burden of moderate-to-severe HIE at AMCH is high with an associated high mortality rate. Early identification of high-risk pregnancy with improved antepartum, intrapartum, and neonatal care can reduce occurrence of HIE.

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