Factors associated with clinical outcomes among neonates admitted with acute bilirubin and hypoxic-ischaemic encephalopathies at a tertiary hospital in south-west Nigeria

Abstract

Background: Babies who are delivered outside hospital are most at risk of serious illnesses such as perinatal asphyxia and severe hyperbilirubinaemia. These conditions are major contributors to neonatal mortalities in resource-poor settings.

Objective: To explore the relationship between pre-admission and intra-facility care and immediate outcomes among neonates with acute bilirubin and hypoxic-ischaemic encephalopathies.

Methods: Using a retrospective design, the outcome of outborn babies with acute bilirubin encephalopathy (ABE) and hypoxic-ischaemic encephalopathy (HIE) were studied in a Nigerian hospital between 2012 and 2016.

Results: A total of 40 and 80 babies with ABE and HIE were studied. Among babies with ABE, 67.5% arrived at the hospital on self-referral and of the babies with official referral, only 61.5% had had a serum bilirubin check prior to referral. Among the babies with ABE, 25.0% had both social and facility-related challenges, 45.0% had only facility-related challenges and 20.0% had only social challenges. All the babies with ABE who died had either social or facility-related challenges. For the babies with HIE, 56.2% came on self-referral while 70% received no care prior to presentation at the hospital. Some 40% of babies with HIE had both social and facility-related challenges while 12.5% had only facility-related challenges. None of the babies who died presented early. Comparable proportions of babies who died or survived had social challenges and facility-related challenges.

Conclusion: Most of the outborn babies with HIE and ABE who arrived at the hospital on self-referral and facility-based care were hindered by social issues and facility-related challenges.

Keywords:

• Asphyxia
• health system
• hypoxic-ischaemic encephalopathy
• newborn
• referral
• severe hyperbilirubinaemia

Acknowledgement

The support of Mrs R.O. Omotayo of the Health Information Management Unit of OOUTH, Sagamu, Nigeria with the retrieval of hospital records is deeply appreciated.

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Funding – None.

Authors’ roles

OOB and OTA conceived and designed the study. OTA and AVA collected and analysed the data while OOB and OTA interpreted the data. The manuscript was drafted by OTA while OOB did the literature search and review. All the authors contributed to the intellectual content of the manuscript.

ORCID

Olusoga Babatunde Ogunfowora http://orcid.org/0000-0002-6143-6452