A review of neonatal outcomes to discharge, of perinatal asphyxia and the use of induced hypothermia as a treatment modality, at a tertiary centre in South Africa

Simpson, Rebecca
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Background: Perinatal asphyxia (PA) is a significant cause of death and disability. Induced hypothermia (IH) has become crucial in it’s the management with improved mortality and morbidity, however is it a viable in low to middle income countries. Objectives: To review the neonatal clinical, demographic characteristics and outcomes of perinatal asphyxia with IH as a treatment modality in Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Methods: A descriptive retrospective analysis of an established database. Neonates admitted between January 2013 and July 2017 with a birth weight >1800g and a 5-minute Apgar score ≤5, with features of perinatal asphyxia, were included. Results: N=639 neonates with 399 males (62.4%). The majority of the neonates were inborn (499/639, 84.5%).527 neonates (82.5%) diagnosed HIE, with majority grade two,43.3%. The overall survival rate was 87.1% to discharge. An increased incidence of HIE 7.7 /1000 live births since previous study. 33.3% neonates received IH.IH side effects and death were not significantly increased. Incidence of death was increased with the presence of seizures, MSL, MAS, PPHN, HIE, and grade 3 HIE classification (p <0.05). Conclusion: IH did not increase survival rates significantly but a study to assess the impact on the morbidity is warranted. IH for severe HIE and possible adjunct therapies should be considered. The crude use of an Apgar <7 at 10-minutes could be used as a poor prognostic factor. The high incidence rate echoes’ the need for a set criterion for PA in resource limited settings to record the incidence and set a benchmark for improvement
A research report submitted to the Faculty of Health Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine in Paediatrics, 2020