Outcome of neonates with hypoxic ischaemic encephalopathy admitted to the neonatal unit of the University Hospital of the West Indies

Abstract

Aim: To describe the outcome of neonates with hypoxic ischaemic encephalopathy (HIE) admitted to the University Hospital of the West Indies.

Method: A retrospective review of all cases of HIE admitted to the neonatal unit of the University Hospital of the West Indies during the 6-year period 1998 to 2003 was conducted. Descriptive analyses were performed; differences in neonates by Sarnat staging were determined using analysis of variance.

Results: Ninety-five term neonates fulfilled criteria for recruitment to the study, 55 (58%) of whom were males. Eighty-six were inborn, giving an incidence of 6/1000 live births with HIE during the study period. There was a 12% mortality rate and all non-survivors had stage 3 encephalopathy. Infants with stage 3 encephalopathy had increased neurological deficits and more severe end organ damage than infants with stage 2 or stage 1 encephalopathy (p<0.05). Only 34 (40%) of the survivors were still attending follow-up clinic at 1 year of age. At this age, all infants with stage 2 and stage 3 encephalopathy had significantly smaller head circumferences than those with stage 1 encephalopathy (p<0.05). A significantly higher proportion (78%) of infants with stage 3 encephalopathy did not achieve milestones appropriately compared with infants with stage 2 (35%) and stage 1 encephalopathy amongst whom none had delayed milestones (p=0.004).

Conclusion: The incidence of HIE was 6/1000 live births and HIE was associated with significant morbidity and mortality in infants with severe encephalopathy.