Abstract
Hypoxic ischemic encephalopathy is a neurological condition occurring immediately after birth following a perinatal asphytic episode. Therapeutic hypothermia is a safe and effective intervention to reduce mortality and major disability in survivors. In Latin America, perinatal asphyxia is a major problem, but no data are available characterizing its current situation in the region or the impact of hypoxic ischemic encephalopathy on its management. Understand the prevalence, mortality and use of therapeutic hypothermia in newborns at ≥36 weeks gestational age with hypoxic ischemic encephalopathy admitted to neonatal units reporting to the Ibero-American Society of Neonatology Network. The Ibero-American Society of Neonatology Network groups various neonatology centers in Latin America that share information and collaborate on research and medical care. We evaluated data on newborns with ≥36 weeks gestational age reported during 2019. Each unit received a guide with definitions and questions based on the Society's 7th Clinical Consensus. Evaluated were encephalopathy frequency and severity, Apgar score, need for resuscitation at birth, use of therapeutic hypothermia and clinical evolution at discharge. Our analysis includes descriptive statistics and comparisons made using the chi-square test. We examined reports of 2876 newborns from 33 units and 6 countries. In 2849 newborns with available data, hypoxic encephalopathy prevalence was 5.1% (146 newborns): 27 (19%) mild, 36 (25%) moderate, 43 (29%) severe, and 40 (27%) of unknown intensity. In those with moderate and severe encephalopathy, frequencies of Apgar scores ≤3 at the first minute (p = 0.001), Apgar scores ≤3 at the fifth minute (p ⟨0.001) and advanced resuscitation (p = 0.007) were higher. Therapeutic hypothermia was performed in only 13% of newborns (19). Neonatal mortality from encephalopathy was 42% (61). Hypoxic ischemic encephalopathy is a neonatal condition that results in high mortality and severe neurological sequelae. In this study, the overall prevalence was 5.1% with a mortality rate of 42%. Although encephalopathy was moderate or severe in 54% of reported cases, treatment with hypothermia was not performed in 87% of newborns. These data reflect a regional situation that requires urgent action.
Highlights
Hypoxic ischemic encephalopathy is a neurological condition occurring immediately after birth following a perinatal asphytic episode
2876 newborns admitted to neonatal intensive care units in 33 healthcare institutions in 6 countries were reported to the SIBEN Network from January 1, 2019 through December 31, 2019 (Table 1)
The objective of this study was to determine the prevalence of Hypoxic ischemic encephalopathy (HIE) in neonates at ≥36 weeks of gestational age (GA) admitted to neonatal intensive care units (NICUs) that participated in the SIBEN Network registry in 2019, and to understand related mortality rates and the use of therapeutic hypothermia
Summary
Hypoxic ischemic encephalopathy is a neurological condition occurring immediately after birth following a perinatal asphytic episode. Hypoxic ischemic encephalopathy (HIE) is a neurological syndrome that presents immediately after birth after a perinatal asphytic episode It is characterized by alterations in alertness, with decreased ability to awaken and maintain muscle tone, decreased motor responses and reactivity. Therapeutic hypothermia (TH) is the reduction of body temperature by 3–4 °C in the first 6 hours of life, maintained for 72 hours It is a safe and effective intervention for reducing mortality and major disability in survivors.[3,4,5] It is currently the only standard therapy specific to HIE.[1,6,7,8,9,10] The Ibero-American Society of Neonatology (SIBEN) published a guide establishing standards and recommendations for HIE management in Latin America aimed at promoting a comprehensive therapeutic approach, including recommendation of TH.[1]
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