Duration of birth depression and neurodevelopmental outcomes after whole-body hypothermia for hypoxic ischemic encephalopathy in India, Sri Lanka and Bangladesh – an exploratory analysis of the HELIX trial

Abstract

Effect of duration of birth depression on neurodevelopmental outcomes in low- and middle-income countries (LMICs) is not known. We examined the association of birth depression with brain injury, neurodevelopmental outcomes, and hypothermia after hypoxic ischemic encephalopathy (HIE) in south Asia. We compared cerebral magnetic resonance (MR) at 2 weeks, and adverse outcomes (death or moderate or severe disability) at 18 months in 408 babies with moderate or severe HIE who had long birth depression (positive pressure ventilation (PPV)>10min or Apgar score<6at 10min or cord pH<7.0) and short birth depression (PPV for 5-10min or Apgar score<6at 5min, but ≥6at 10min). Long depression group (n=201) had more severe HIE (32.8% versus 6.8%), mortality (47.5% versus 26.4%), death or disability at 18 months (62.2% versus 35.4%) (all p<0.001), MR injury (Odds ratio; 95% CI) to basal ganglia (2.4 (1.3, 4.1); p=0.003), posterior limb of internal capsule (2.3 (1.3, 4.3); p<0.001) and white matter (1.7 (1.1, 2.7); p=0.021), and lower thalamic N-acetylaspartate levels (7.69±1.84 versus 8.29±1.60); p=0.031) than short depression group (n=207). Three babies had no heartbeat at 5min, of which 1 died and 2 survived with severe disability. No significant interaction between the duration of birth depression and whole-body hypothermia was seen for any of the MR biomarker or clinical outcomes. Long birth depression was associated with more brain injury and adverse outcomes than short depression. Effect of hypothermia was not modified by duration of birth depression. National Institute for Health Research.