Risk Factors For Hypoxic Ischemic Encephalopathy In Children-Books Pdf

Risk Factors for Hypoxic Ischemic Encephalopathy in Children
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Risk factors for hypoxic ischemic encephalopathy, Health Lahore As there was no obstetric service within than 5 cases in any cell of the table they were pooled. the hospital all neonates were delivered elsewhere with the other relevant group P value was also. The study period was from March 2005 to July 2005 calculated using chi square or Fischer s exact test on. During this time 153 cases were identified and included SPSS 11 and value 0 05 was considered significant. A matched control group of 187 neonates was also, included Inclusion criterion was clinical diagnosis of RESULTS. hypoxic ischemic encephalopathy based on history of A total of 340 neonates were included in the study. delayed cry presence of thick meconium stained liquor Table I These included 153 cases and 187 controls. need for resuscitation APGAR scores of less than 4 at Male neonates numbered 126 82 4 of cases and. one minute or less than 7 at 5 minutes of age and early 67 4 of the controls in both the groups This. onset of encephalopathy in the absence of other difference was statistically significant OR 2 3 95 CI. causes History of at least two of the above with 1 3 3 8 p 0 002. abnormal neurological examination abnormalities in. Table I Patient characteristics, tone posture neonatal reflexes or conscious level was. Cases n 153 Controls n 187, taken as important Sex Number Percentage Number Percentage. Controls were selected from admissions on the same Males 126 82 4 126 67 4. day These included neonates with diagnoses other than Females 27 17 6 61 32 6. HIE Admissions immediately following the cases were OR 2 3 95 CI 1 3 3 8 p 0 002. selected If more than one baby presented at the same Gestational age. time both were included Neonates with major 37 weeks 17 11 1 31 16 6. congenital malformations and other causes of 37 42 weeks 136 88 9 155 82 9. 42 weeks 0 0 1 0 5, encephalopathy infectious or metabolic were excluded.
OR 0 63 95 CI 0 33 1 18 p value 0 05, from both the groups. The possible risk factors studied included maternal Age at admission. age 18 years 18 30 years 30 years parity 48 hours 102 66 7 36 19 2. primigravida 1 4 previous live births 5 or more live 2 7 days 36 23 5 70 37 4. 7 days 15 9 8 81 43 3, births history of antenatal care place of delivery. OR 8 3 95 CI 5 2 13 4 p 0 001, home private health facility government hospital. history of prolonged 30 minutes second stage of, labour type of delivery vaginal caesarean section Term babies accounted for the majority in both the. instrumental gestational age and the birth attendant at groups There was no statistical difference in gestational. delivery Birth attendants were divided into four groups age between the cases and controls OR 0 6 95 CI. untrained person e g family member traditional birth 0 3 1 2. attendant with no formal training but practical One hundred and two of the cases 66 7 presented to. experience in the field lady health visitor nurse with our unit within 48 hours of life Majority of babies. some formal training or a doctor The two former groups 43 3 in the control group were more than 7 days old. were considered as unskilled while the latter two as at admission Table I Babies with HIE were statistically. skilled birth attendants Antenatal care was determined more likely to present in the first 48 hours of age as. by asking about antenatal visits and antenatal ultra compared to controls OR 8 3 95 CI 5 2 13 4. sound scan performed at some stage in pregnancy p 0 001. History of at least two antenatal visits to a health care. Absence of antenatal care appeared to be a significant. provider and or even a single antenatal ultrasound scan. risk factor for HIE OR 2 1 95 CI 1 3 3 2 p 0 002, was considered as antenatal care Gestational age was.
Almost 40 mothers of asphyxiated babies had no, estimated either by date by cranial ultrasound scan or. antenatal monitoring compared to 24 1 mothers from. by physical examination Ballard scoring All teaching. control group Table II Fifty one women 33 3 in the. and district hospitals and government centers were. included under the term of government hospitals Table II Antenatal care in mothers. Private health care facilities included private clinics and. Cases n 153 Controls n 187, private maternity centres Details of history and Antenatal visit Number Percentage Number Percentage. examination were noted on a structured proforma and Yes 92 60 1 142 75 9. information subsequently entered on a data base No 61 39 9 45 24 1. OR 2 1 95 CI 1 3 3 2 p 0 002, Statistical analysis was carried out using STATA version. Antenatal scan, 9 2 All the variables were qualitative Odd ratio OR. Yes 102 66 7 146 78 1, and 95 confidence interval was calculated to No 51 33 3 41 21 9.
determine significance of risk factors If there were less OR 1 8 95 CI 1 1 2 9 p 0 018. Journal of the College of Physicians and Surgeons Pakistan 2008 Vol 18 7 428 432 429. Tayyaba Khawar Butt Rehan Farooqui and M Aman Ullah Khan. HIE group compared to 41 21 9 women in the control compared to controls OR 3 2 95 CI 1 9 5 3. group reported not having any ultrasound scan during p 0 001 Likewise history of prolonged second stage. their pregnancy OR 1 8 95 CI 1 1 2 9 p 0 018 of labour was significantly more likely to be present in. Fifty one babies in each group 33 3 cases 27 3 mothers of asphyxiated babies OR 6 3 CI 3 3 11 9. controls were born to primigravida mothers OR 1 3 p 0 001. 95 CI 0 8 2 1 while majority of the babies in both. groups were delivered to mothers with 1 4 previous live DISCUSSION. births 81 153 54 2 cases 119 187 63 6 controls Twenty three percent of all the newborn deaths are. Only 12 4 19 153 cases and 9 1 17 153 controls caused by birth asphyxia 5 It is important to be aware of. were born to mothers with 5 or more previous live births factors that may predispose a newborn to hypoxic insult. OR 1 4 95 CI 0 7 2 8 The parity of the mother was at birth with the aim of formulating preventive strategies. not significantly different between the two groups These factors may be antepartum in origin in 50 of the. Spontaneous vaginal delivery was the commonest cases intrapartum in 40 and postpartum in remaining. mode of delivery in both the groups 71 9 cases and 10 9 Given the reduced availability of skilled care. 74 9 controls This was followed by delivery by during delivery in developing countries intrapartum. caesarean section 23 5 cases 22 9 controls causes may have greater contribution 10. Seven 4 6 babies in the HIE group and 4 2 1 in Of the factors that we studied absence of antenatal. the control group needed forceps extraction Caesarean monitoring emerged as a significant risk factor Sub. section and instrumental delivery did not appear to be optimal fetal monitoring is well recognized as a common. major risk factors for HIE OR 1 2 95 CI 0 7 1 9 contributor to moderate or severe neonatal. Mothers of most babies in both the groups 86 9 encephalopathy It was seen as an antecedent event in. cases 85 controls were between 18 and 30 years of 42 of cases of moderate to severe neonatal. age Only 3 9 cases and 4 8 controls were born to encephalopathy 11 Failure to respond to signs of fetal. women less than 18 years old OR 0 8 95 CI 0 3 2 3 distress has been found to be linked to cerebral palsy. Remaining 9 1 cases and 10 2 controls were born OR 4 5 95 CI 2 4 8 4 3 Similarly non accessibility to. to mothers older than 30 years OR 0 9 95 CI 0 4 antenatal care is also a significant risk factor OR 1 89. 1 8 There was no statistically significant relationship for hypoxic ischemic encephalopathy 12 Same authors. between maternal age and the diagnosis of HIE in the also reported prolonged second stage of labour as being. neonates significant risk factor OR 6 67 In this study. comparable possible association was found between, Majority of babies in both groups were delivered in a prolonged second stage and HIE OR 6 3 95 CI 3 3. private health facility and fewer in government hospitals 11 9 Improving awareness of the importance of. Table III However significantly more babies with HIE antenatal monitoring with easy access to a health. were delivered in a non government hospital setup than services at delivery may play a part in reducing the. controls OR 3 8 95 CI 1 9 7 6 p 0 001 incidence of birth asphyxia. The type of birth attendant at the time of delivery was A significant correlation between the person conducting. also compared Table III Babies with HIE were more delivery and HIE has also been observed Infants with. likely to be delivered by unskilled birth attendants HIE were more likely to be delivered by unskilled birth. Table III Intrapartum risk factors attendant compared to babies in the control group OR. Cases n 153 Controls n 187 3 2 95 CI 1 9 5 3 A study in India showed that. Place of delivery Number Percentage Number Percentage traditional birth attendants were able to recognize signs. Home 67 43 8 67 35 8 of asphyxia but were mostly unable to deal with it 13. Private 76 49 7 81 43 3 Training programmes targeting at traditional birth. Government Hospital 10 6 5 39 20 9 attendants may be of benefit in decreasing birth. OR 3 8 95 CI 1 9 7 6 p 0 001, asphyxia in our country where only 31 of deliveries are. attended by skilled health personnel 14, Type of attendant at delivery. Doctor 80 52 3 116 62 0 Delivery in non government hospital setting home. Lady health visitor 18 11 8 43 23 0 private health facility emerged as a significant risk. Traditional birth attendant 51 33 3 27 14 4 factor for HIE OR 3 8 This may point to a better level. Untrained 4 2 6 1 0 5, of training in people working in government hospitals in. OR 3 2 95 CI 1 9 5 3 p value 0 01, comparison to the private sector It may also mean that.
Prolonged second stage labour, government hospitals being more capable of dealing. Present 43 28 1 11 5 9, with the problem themselves are less likely to refer. Absent 110 71 9 176 94 1 asphyxiated babies elsewhere Private health care. OR 6 2 95 CI 3 5 11 9 p 0 001 facilities may vary widely in terms of quality of care that. 430 Journal of the College of Physicians and Surgeons Pakistan 2008 Vol 18 7 428 432. Risk factors for hypoxic ischemic encephalopathy, they provide but there is no objective way of reported in literature as being more prone to ischemic. categorizing care as these facilities are not graded A injuries of the white matter 21 These babies are more. large majority of patients were from a socioeconomic likely to have several other potentially fatal problems. group who had no access to the expensive private compared to term infants Since all our patients were. hospitals The private facilities were mostly described by delivered elsewhere it is quite possible that many. the patients as private clinics or private centres No preterm babies failed to make it to the unit This may be. patient in either group was born in a privately managed the reason why preterm babies were underrepresented. teaching hospital It is noteworthy that collectively in in this study It is also true that neonatal brain injury is. both the groups 46 2 infants were delivered in private difficult to diagnose in premature infants because either. sector in comparison to 14 4 deliveries in government obvious signs are absent or if present are attributed to. hospitals Perhaps the private sector is more accessible developmental immaturity 22 Regional cortical volumes. to the general public Taking measures to standardize are significantly smaller in preterm brains 23 This may. and improve the level of health service in private sector lead to neurological findings which may be difficult to. may be of benefit to a large section of the population differentiate from HIE and thus to missed diagnosis in. There were significantly more male babies amongst the this particular group of neonates. cases OR 2 3 Male gender as being a risk factor for. HIE OR 4 8 has also been reported by others 15 The CONCLUSION. significance of this finding remains unclear Same study In the group studied lack of antenatal care in mothers. also reported inappropriate antenatal care as a delivery by unskilled birth attendants either at home or a. significant risk factor OR 9 49 15 Majority of the studied private health facility and prolonged labour emerged as. cases presented within 48 hours of life Similar results significant risk factors for asphyxial insult at birth These. were seen in a study on neonatal seizures Infants with babies are likely to present to hospital within 2 days of. seizures due to HIE were more likely to be admitted life Improving antenatal care of pregnant mothers and. within 48 hours of life 16 This may show a tendency providing training to people who assist the process of. towards early referral to an experienced unit where labour and delivery are areas that should be targeted in. there is suspicion of asphyxia at birth a practice that the health structure. should be encouraged and streamlined, Maternal age at delivery did not appear to be significant REFERENCES. This was similar to the results reported from Sweden 17 1 Maternal and Child Health Research Consortium 8th Annual. However other researchers found that maternal age report Confidential enquiry into stillbirths and deaths in infancy. CESDI London Maternal and Child Health Consortium 2001. 35 years was a risk factor OR 4 35 for neonatal, encephalopathy 18 A vast majority of present patient 2 Lawn JE Cousens S Zupan J Four million neonatal deaths.
preventable 8Birth asphyxia is clearly a problem where prevention should be the aim Any preventive strategy should be based on local facts and figures to be effective It is therefore vital to collect local data about the problem and to use that information to formulate guidelines aimed at reducing the incidence of birth asphyxia

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