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

Abstract

To describe the outcome of neonates with hypoxic ischaemic encephalopathy (HIE) admitted to the University Hospital of the West Indies. 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. 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). The incidence of HIE was 6/1000 live births and HIE was associated with significant morbidity and mortality in infants with severe encephalopathy.