Early adverse outcomes of neonatal hypoxic-ischemic encephalopathy in a resource-constrained setting

Hypoxic-ischemic encephalopathy (HIE) remains a leading cause of neonatal mortality and long-term neurological disability, particularly in resource-limited settings. Understanding factors associated with early adverse outcomes is crucial for optimizing management strategies.

To identify maternal and neonatal factors associated with early adverse outcomes in newborns with HIE in a Nigerian tertiary health institution.

A prospective hospital-based cross-sectional study was conducted at Nnamdi Azikiwe University Teaching Hospital, Nnewi, from September 2023 to May 2024. Seventy term newborns with HIE admitted within 72 h of delivery were enrolled. HIE diagnosis was based on abnormal neurological examination using the Thompson score. Data on demographic characteristics, maternal factors, and biochemical parameters were collected and analyzed using SPSS version 25. Fisher's exact test and Chi-square analysis was used to determine associations between variables, with p < 0.05 considered significant.

Among 70 newborns, 45.7% (32/70) experienced short-term adverse outcomes. The case fatality rate was 17.1% (12/70), while 28.6% (20/70) developed complications including seizures (80%), absent nutritive suckling (65%), poor Moro reflex (25%), respiratory distress (20%), and altered consciousness (15%). Place of delivery was significantly associated with adverse outcomes (p = 0.001), with outborn neonates exhibiting a higher risk compared with inborn neonates. Both HIE severity and a 5-minute Apgar score < 7 were significantly associated with adverse outcomes (p < 0.0001 for both). Maternal factors significantly associated with adverse outcomes included mode of delivery (p = 0.006) and maternal occupation (p = 0.026). Random blood glucose levels showed significant association with outcomes (p < 0.0001), while serum magnesium levels did not (p = 0.980).

HIE severity, a low 5-minute Apgar score, outborn delivery status, and abnormal blood glucose levels were significantly associated with early adverse outcomes in neonatal HIE. These findings emphasize the importance of skilled birth attendance, early recognition, and prompt glucose monitoring in improving outcomes for affected newborns in resource-limited settings.