South African neonates with mild and moderate hypoxic-ischaemic encephalopathy

Background. Clear risk profiles of neonates with mild and moderate hypoxic-ischaemic encephalopathy (HIE) are lacking.Objective. To describe and compare factors associated with mild and moderate HIE in South African neonates. Methods.A prospective, comparative design was used to describe factors among South African neonates with mild (n=13) and moderate (n=33) HIE in an urban tertiary academic hospital. HIE diagnosis and encephalopathy grading were conducted using the modified Sarnat stages. Thompson scores were recorded. Participants' clinical records were reviewed to identify factors. Descriptive data were obtained. Chi-square and Fisher's exact tests were used to compare categorical data, and Mann-Whitney tests were used to compare continuous data between groups. Results. Significant differences were found between groups' admission (p<0.001) and highest Thompson scores (p<0.001). The mild group's APGAR scores were significantly higher than those of the moderate group at five (p=0.012) and ten minutes (p=0.022). Duration of resuscitation (p=0.011) and time to spontaneous respiration (p=0.012) also differed significantly between groups. Significantly more moderate than mild participants received therapeutic hypothermia(TH) (p<0.001).Conclusion. Clinical tests and management factors differed significantly between groups. The findings provided the multidisciplinary team with an increased understanding of the heterogeneous HIE population and add to existing evidence for identifying neonates eligible for TH in resource-limited settings

Clinical neonatal hypoxic ischemic injury: Cranial ultrasound spectrum of findings in neonates admitted to a Newborn Unit in Nairobi, Kenya

Introduction: Birth asphyxia causes significant neurologic injury and neurodevelopmental delay in children. Cranial ultrasound (CUS) can be used for the diagnosis, early intervention, and prognostication of birth asphyxia. We determined the CUS findings among term neonates with clinical birth asphyxia and correlated sonographic findings with the modified Sarnat clinical grade.Materials and Methods: We conducted a prospective cross-sectional analytical study in Kenyatta National Hospital New Born Unit (KNH NBU) between June 2018 and October 2018. Term babies, older than 24 h with clinical birth asphyxia, were recruited and CUS was performed. Statistical analysis was done using proportions, means, and frequencies. Chi-square tests were used to assess correlation between imaging findings and the clinical Sarnat grading of asphyxia.Results: Periventricular deep white matter echogenicity and thalamus and/or basal ganglia deep gray matter was reported in 56.4% and 31.1%, respectively. Only 4.4% had cortical gray matter. Normal CUS findings were reported in 40.0% of the neonates. Prolonged labor and meconium-stained liquor were the predominant risk factors for perinatal asphyxia, seen in 58% of the neonates. Prolonged labor was independently reported in 43% of the neonates. Moderate and severe Sarnat grades correlated with abnormal sonographic changes of hypoxic ischemic encephalopathy (HIE) (Grades 2­8) (P = 0.038). There was a trend toward HIE severity with worsening Sarnat stages (trend test P= 0.039). Abnormal resistive indices (<0.5 and >0.8) were strongly associated with the presence of HIE brain changes (P = 0.003).Conclusion: The correlation between birth asphyxia severity and CUS was more robust in Doppler evaluation of the deep cerebral arteries

Factors associated with clinical outcomes among neonates admitted with acute bilirubin and hypoxic-ischaemic encephalopathies at a tertiary hospital in south-west Nigeria

Background:Babies who are delivered outside hospital are most at risk of serious illnesses such as perinatal asphyxia and severe hyperbilirubinaemia. These conditions are major contributors to neonatal mortalities in resource-poor settings. Objective: To explore the relationship between pre-admission and intra-facility care and immediate outcomes among neonates with acute bilirubin and hypoxic-ischaemic encephalopathies. Methods: Using a retrospective design, the outcome of outborn babies with acute bilirubin encephalopathy (ABE) and hypoxic-ischaemic encephalopathy (HIE) were studied in a Nigerian hospital between 2012 and 2016. Results: A total of 40 and 80 babies with ABE and HIE were studied. Among babies with ABE, 67.5% arrived at the hospital on self-referral and of the babies with official referral, only 61.5% had had a serum bilirubin check prior to referral. Among the babies with ABE, 25.0% had both social and facility-related challenges, 45.0% had only facility-related challenges and 20.0% had only social challenges. All the babies with ABE who died had either social or facility-related challenges. For the babies with HIE, 56.2% came on self-referral while 70% received no care prior to presentation at the hospital. Some 40% of babies with HIE had both social and facility-related challenges while 12.5% had only facility-related challenges. None of the babies who died presented early. Comparable proportions of babies who died or survived had social challenges and facility-related challenges. Conclusion: Most of the outborn babies with HIE and ABE who arrived at the hospital on self-referral and facility-based care were hindered by social issues and facility-related challenges