Developmental Profiles of Infants with Hypoxic Ischaemic Encephalopathy (HIE) at a Tertiary Hospital in South Africa

Abstract

Background: Hypoxic ischaemic encephalopathy is one of the most common causes of neonatal death and severe neurological deficit in children. Objectives: To describe the neurodevelopmental outcomes of infants with moderate and severe HIE at Chris Hani Baragwanath Academic Hospital (CHBAH) and the proportions with neurodevelopmental impairment (NDI) and neurological complications. To explore the effect of HIE severity and therapeutic hypothermia (TH) on the neurodevelopmental outcome. Methods: A retrospective, descriptive study was conducted at CHBAH Neonatal Neurodevelopmental Clinic (NNDC). 239 infants with moderate and severe HIE, attending between 2015 and 2020, met the inclusion criteria. Neurodevelopmental outcomes were assessed using the Griffiths Mental Developmental Scales at 1 year. General Quotient scores were used to define NDI. Clinical and investigation criteria determined those with neurological complications. Results: Of the 239 infants, 211 (88.3%) and 28 (11.7%) had moderate HIE and severe HIE, respectively. Cerebral palsy was diagnosed in 9.2% and NDI in 17.1% of the cohort. Severe HIE infants had significantly higher rates of NDI and CP, 50% (14) and 21.4% (6) respectively, as compared to moderate HIE infants, 12.7% (27) NDI and 7.6% (16) CP. One hundred and fifty- two (72%) moderate and 14 (50%) severe HIE infants received TH. Infants who received TH were less likely to have NDI (p=0.005), CP (p=0.002), epilepsy and visual impairment. Conclusions: Neurodevelopmental outcomes compared favourably with other countries. Developmental scores were in the average range for the cohort with equivalent profiles across domains. Therapeutic hypothermia was associated with decreased CP and NDI in both groups.