Abstract:
Background: Hypoxic ischaemic encephalopathy (HIE) is known to be
associated with significant morbidity and mortality in the full term
infant. It is evident from some studies that HIE in the long-term
produces a spectrum of neurological disabilities and impairments.
This study aimed at assessing the value of the HIE scoring system in
predicting early neurodevelopmental outcome of the infants who
suffered birth asphyxia.
Objective: To assess the value of the HIE score in predicting
neurodevelopmental outcome in infants with birth asphyxia at six
months of age.
Study design: Prospective cohort study.
A numeric scoring system for the assessment of HIE during the
neonatal period was tested for seven days (or any number of days
before discharge or death). The highest score attained at any of these
days was used to assess severity of birth asphyxia.
Materials and methods: One hundred and forty infants with a five
minute Apgar score of <7 were studied. Eighty-two infants were
evaluated at six months of age by taking a history from the mother
about development and presence of convulsions. Amiel-Tison method
of assessment of motor systems was used to assess the motor
function. A modified neurodevelopmental assessment using the
Griffith mental developmental charts was used to assess
Vll
neurodevelopment at six months. Thirty infants (21 %) of the survivors
were lost to follow-up.
Outcome measures: Normal development, delayed development,
morbidity (convulsions, abnormal muscle tone, cerebral palsy) or
death.
Results: Twenty- eight (20%) of the infants died during the neonatal
period while 112 (80%) survived. The RR of dying during the neonatal
period was 20 for moderate HIE and 46 for severe HIE. The PPV for
mortality
was
42.3%
for
moderate
HIE
and
93.8%
for severe HIE. NPV was 98% in both categories. Fifty-eight (70.7%) of
the infants were normal at six months of age while 24 (29.3%) had a
poor outcome. Of those who had abnormality some had more than
one finding. The risk of poor outcome increased with increasing HIE
score.
Neurodevelopmental abnormalities detected during the SIX months
follow-up were convulsions (17%), abnormal muscle tone (21%),
delayed developmental age (17%) and cerebral palsy (8.5%).
The HIE score had low sensitivity but it was highly specific In
detecting the neurodevelopmental abnormalities. The positive and
negative predictive values were found to be high. Twenty-three infants
(14 boys and 9 girls) had microcephaly by six months of age. HIE
score was found to be negatively correlated with the occipital frontal
