Are we doing better? Hypoxic Ischemic Encephalopathy in Pelonomi Hospital during two time periods
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Date
2016
Authors
Bruwer, D. G.
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Introduction: In 2007 a study was conducted in the Neonatal High care unit of Pelonomi Hospital in Bloemfontein which looked at the profile of neonates admitted with Hypoxic Ischemic Encephalopathy. In 2014, we replicated the study and compared the two study periods .This this gave us the opportunity to assess the current burden of HIE and also to compare the two time periods to answer the question of whether there was an improvement in incidence and outcome.
Methods: A retrospective observational study was performed to compare data from 2007 and 2014. All neonates admitted with Hypoxic Ischemic Encephalopathy to the Neonatal High Care Unit of Pelonomi Hospital during the year 2014 were included in the study. Data from the 2007 study were obtained and used for comparison to the current cohort.
Results: Hundred and sixty one cases were included in the study, compared to 132 cases captured in 2007. The neonates diagnosed with HIE still comprised more than 10% of the total admissions in our unit. Two thirds of babies included in both studies were male. The majority of infants were born to primiparous mothers during both time periods. Teenagers proved to have a higher relative risk for HIE compared to the other age groups. Maternal factors identified that could play a possible role in the prediction of the grade of HIE, were pre-eclampsia and anaemia, as well as hypertension. The majority of infants were diagnosed as having grade 1 HIE with a slight increase in the number of grade 2 and a decrease in grade 3 cases in 2014. The relationship between the grade of HIE and the neurological outcome, as well as the general outcome, remained statistically significant. Hyperglycaemia in an infant with HIE stood out as a very strong predictor for a higher grade of HIE. In 2007 HIV infection was identified as one of the the most common maternal risk factors but in our 2014 study there was a sharp decline in HIV positive mothers. Meconium exposure remained one of the top three risk factors for HIE. Booking late and or not at all for ante natal visits remain a major risk factor. Significant risk factors identified were a delay in referral, missing indicators of foetal distress and a prolonged second stage of labour without intervention. Inadequate theatre facilities, as a major preventable administrative risk factor, was accentuated once again. Although there were a decrease in HIE related deaths over the seven years, statistical significance was not reached. The number of babies classified as having abnormal neurology on follow up, increased in 2014.
Conclusion: HIE, although mostly preventable, remains a major burden in South African hospitals, including. Pelonomi Hospital. “Are we doing better?” If we look at our results, and the comparison between the two time periods, the answer may be a rather unfortunate “not yet”.
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Keywords
Neonatal high care unit, Hypoxic Ischemic Encephalopathy Remove (HIE), Neonates, Health care implications, Dissertation (M.Med. (Paediatrics))--University of the Free State, 2016