Abstract
BackgroundHypoxic-ischemic encephalopathy (HIE) is a rare neonatal condition affecting about 1‰ births. Despite a significant improvement in the management of this condition in the last ten years, HIE remains associated with high rates of death and severe neurological disability. From September 2015 to March 2017, a French national cohort of HIE cases was conducted to estimate the extent of long-term moderate and severe neurodevelopmental disability at 3 years and its determinants.MethodsThis prospective population-based cohort includes all moderate or severe cases of HIE, occurring in newborns delivered between 34 and 42 completed weeks of gestation and admitted to a neonatal intensive care unit. Detailed data on the pregnancy, delivery, and newborn until hospital discharge was collected from the medical records in maternity and neonatology units. All clinical examinations including biomarkers, EEG, and imaging were recorded. To ensure the completeness of HIE registration, a registry of non-included eligible neonates was organized, and the exhaustiveness of the cohort is currently checked using the national hospital discharge database. Follow-up is organized by the regional perinatal network, and 3 medical visits are planned at 18, 24 and 36 months. One additional project focused on early predictors, in particular early biomarkers, involves a quarter of the cohort.DiscussionThis cohort study aims to improve and update our knowledge about the incidence, the prognosis and the etiology of HIE, and to assess medical care. Its final objective is to improve the definition of this condition and develop prevention and management strategies for high-risk infants.Trial registrationNCT02676063. Date of registration (Retrospectively Registered): February 8, 2016.
Highlights
Hypoxic-ischemic encephalopathy (HIE) is a rare neonatal condition affecting about 1‰ births
Hypoxic ischemic encephalopathy: Definition, incidence and risk factors Hypoxic-Ischemic Encephalopathy is defined as the clinical manifestation of impaired neonatal brain function following asphyxia due to an antenatal and/or perinatal adverse event
The main objective is the occurrence of death, or severe or moderate neurodevelopmental disability at 3 years of age, in a large population-based cohort of children born at full-term, or late preterm, with moderate or severe HIE
Summary
Hypoxic-ischemic encephalopathy (HIE) is a rare neonatal condition affecting about 1‰ births. Despite a significant improvement in the management of this condition in the last ten years, HIE remains associated with high rates of death and severe neurological disability. The incidence of HIE is currently imprecise with numbers ranging from 1 to 8 per 1000 live births worldwide [3, 4], but is nearer to between 1 and 2 per 1000 full term births in population-based studies conducted in high income countries [5,6,7]. In a regional population-based study in France, the prevalence of moderate or severe HIE per 1000 live births was estimated to be 0.86 (95% CI 0.61 to 1.10) in 2000 [8]. A persistent occipito-posterior position, an acute intrapartum event (hemorrhage, maternal convulsions, uterine rupture, snapped cord, and birth before arrival at an obstetric facility), and instrumental vaginal delivery or emergency caesarean section are all labor-related events associated with HIE
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