Long term outcome of neonates with hypoxic ischemic encephalopathy

ORIGINAL ARTICLE

Long Term Outcome of Neonates with Hypoxic Ischemic Encephalopathy

Séraphin Nguefack^1,2, Fleurine Lekeulem Tebon³, Daniel Armand Kago Tague^1,2, Francklin Djifack Tetinou³, Nadia Adjifack Tetinou³, Félicitée Nguefack^1,2, Evelyn Mah^1,2, Andreas Chiabi^1,2.

¹Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon,
²Gynaeco-Obstetrics and Pediatric Hospital, Yaounde, Cameroon,
³Faculty of Medicine, Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon.

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Abstract
Aim: To determine the long-term outcome of neonates with hypoxic-ischemic encephalopathy (HIE).
Materials and Methods: This was a descriptive cross-sectional study carried over a period of 4 months from February 20 to May 22, 2018. We recruited consecutively 60 children aged 6 to 72 months who had survived HIE and had followed up in the outpatient department. Children born at term (≥37 weeks of amenorrhea) and who got an Apgar score ˂ 7 at the 5th minute of birth and / or mild, moderate or severe encephalopathy were included in the study. The parameters studied included age, gender, schooling for those at school age, the Apgar score at the 5th minute of birth, the degree of encephalopathy according to Sarnat grade, the resuscitation maneuvers used at birth, the duration of resuscitation (in minutes), the duration of the neonatal hospitalization (in days) and the child's pathologies during the neonatal hospitalization. Child’s vision, hearing and psychomotor development were assessed. Association between HIE severity and long-term outcome was assessed.
Results: Total 60 children with male: female ratio of 2:1 were included in the study. The mean age was 36.4 ± 19.0 months. Twenty-seven (45%) children were at school age. However, 19 (70.37%) of these school age children were not in school. Co-morbidities seen were cerebral palsy in 47 (78.3%), epilepsy in 17 (23.3%), blindness in 4 (5.5%) and deafness in 3 (4.1%). The majority of children with a history of perinatal asphyxia were born in a borough health center 24 (40.0%). Psychomotor assessment was normal in 8 (13.3%) children, mild retardation in 2 (3.3%), moderate retardation in 16 (16.6%) children, severe retardation in 7 (11.6%) and profound in 27 (45.0%) children. Thirty-five (59%) children had grade 3 HIE, 20 (33.3%) had grade 2 HIE and 5 (8.3%) had grade 1 HIE. An Apgar score of between 3 and 4 was associated with profound mental delay (p˂0.001). Children with Sarnat 1 HIE were at no risk of psychomotor retardation (p=0.001). Sarnat 3 HIE grade increased the risk of having profound psychomotor retardation (OR=13.2; p=0.01). Children resuscitated for more than 20 minutes were at significant risk of developing profound delay (OR˃1000; p=0.002). Co-morbidities strongly associated with profound psychomotor retardation were cerebral palsy (p=0.007) and epilepsy (p=0.001).
Conclusion: The children presenting a severe HIE had a profound mental delay. The neurological sequelae found were mainly psychomotor retardation, cerebral palsy, epilepsy and neurosensory abnormalities.

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