Evaluation of risk factors for neonatal hypoxic ischemic encephalopathy

Yıl 2022, , 32 - 38, 29.01.2022

Nuran Üstün

https://doi.org/10.21673/anadoluklin.951203

Cited By: 1

Öz

Aim: Hypoxic ischemic encephalopathy (HIE) is a serious condition in neonates and is associated with neuromuscular dysfunction and death. In this study, we aimed to investigate potential risk factors for neonatal HIE.

Methods: A retrospective case–control study was conducted on infants admitted to our neonatal intensive care unit between 2015 and 2020. Infants born at ≥36 weeks of gestation and diagnosed with HIE were included in the case group. For each case, 4 gestational agematched infants without HIE were selected and included in the control group. The groups were compared in terms of maternal demographic characteristics, pregnancy characteristics, and birth-related factors.

Results: The study included 75 infants with HIE and 300 controls. Nulliparity, history of antenatal care, medical complications during pregnancy, prolonged difficult birth, abnormal fetal heart rate, mode of delivery, and acute birth complications were found to be significantly associated with HIE in univariate analysis. In multivariate logistic analysis, the lack of antenatal care, abnormal fetal heart rate (FHR), and acute birth complication were the strongest factors associated with neonatal HIE.

Conclusion: Our findings demonstrated that the lack of antenatal care, abnormal FHR, and acute birth complications were risk factors for the development of HIE. Ensuring that pregnant women receive adequate antenatal care and applying necessary obstetric measures may help to reduce the HIE incidence.

Anahtar Kelimeler

risk factors, hypoxic ischemic encephalopathy, newborn

Neonatal hipoksik iskemik ensefalopati risk faktörlerinin değerlendirilmesi

Öz

Amaç: Hipoksik iskemik ensefalopati (HİE) yenidoğanlarda ciddi bir problem olup nöromüsküler disfonksiyon ve ölümle ilişkilidir. Bu çalışmada neonatal HİE için potansiyel risk faktörlerini araştırmak amaçlanmıştır.

Yöntem: 2015–2020 yıllarında yenidoğan yoğun bakım ünitemizde yatan bebekler üzerinde retrospektif bir vaka–kontrol çalışması gerçekleştirildi. Vaka grubu ≥36 gebelik haftasında doğan ve HİE tanısı alan bebeklerden oluşturuldu. Her vaka için, HİE’si olmayan, gestasyonel yaş bakımından eşlenik 4 bebek seçildi ve kontrol grubuna dahil edildi. Gruplar maternal demografik özellikler, gebelik özellikleri ve doğumla ilgili faktörler bakımından karşılaştırıldı.

Bulgular: Çalışma 75 HİE’li bebek ve 300 kontrol içerdi. Tek değişkenli analizde nulliparite, antenatal bakım geçmişi, gebelik sırasında tıbbi komplikasyon, uzun süreli zor doğum, anormal fetal kalp hızı, doğum şekli, ve akut doğum komplikasyonları HİE ile anlamlı olarak ilişkili bulundu. Çok değişkenli lojistik analizde antenatal bakım eksikliği, anormal fetal kalp hızı (FKH) ve akut doğum komplikasyonu neonatal HİE ile ilişkili en güçlü faktörler idi.

Sonuç: Bulgularımız antenatal bakım eksikliği, anormal FKH ve akut doğum komplikasyonlarının HİE gelişimi için risk faktörü olduğunu göstermiştir. Gebelerin yeterli antenatal bakım almalarını sağlamak ve gerekli obstetrik önlemleri uygulamak HİE insidansını azaltmaya yardımcı olabilir.

Anahtar Kelimeler

hipoksik iskemik ensefalopati, risk faktörleri, yenidoğan

Kaynakça

• Lee AC, Kozuki N, Blencowe H, Vos T, Bahalim A, Darmstadt GL, et al. Intrapartum related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res. 2013;74:50–72.
• Türk Neonatoloji Derneği Hipoksik İskemik Ensefalopati Çalışma Grubu. Türkiye’de yenidoğan yoğun bakım ünitelerinde izlenen hipoksik iskemik ensefalopatili olgular, risk faktörleri, insidans ve kısa dönem prognozları. Türkiye Çocuk Hastalıkları Derg. 2008;51:123–9.
• Cowan F, Rutherford M, Groenendaal F, Eken P, Mercuri E, Bydder GM, et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet. 2003;361:736–42.
• Badawi N, Felix JF, Kurinczuk JJ, Dixon G, Watson L, Keogh JM, et al. Cerebral palsy following term newborn encephalopathy: a population-based study. Dev Med Child Neurol. 2005;47:293–8.
• Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al. Moderate hypothermia to treat perinatal asphyxia encephalopathy. N Engl J Med. 2009;361:1349–58.
• Martinello K, Hart AR, Yap S, Mitra S, Robertson NJ. Management and investigation of neonatal encephalopathy: 2017. Update Arch Dis Child Fetal Neonatal Ed. 2017;102:F346–58.
• Shankaran S, Natarajan G, Chalak L, Pappas A, McDonald SA, Laptook AR. Hypothermia for neonatal hypoxic-ischemic encephalopathy: NICHD neonatal research network contribution to the field. Semin Perinatol. 2016;40:385–90.
• Martinez-Biarge M, Diez-Sebastian J, Wusthoff CJ, Mercuri E, Cowan FM. Antepartum and intrapartum factors preceding neonatal hypoxic-ischemic encephalopathy. Pediatrics. 2013;132:e952–9.
• Parker SJ, Kuzniewicz M, Niki H, Wu YW. Antenatal and intrapartum risk factors for hypoxic-ischemic encephalopathy in a US birth cohort. J Pediatr. 2018;203:163–9.
• Hayes BC, McGarvey C, Mulvany S, Kennedy J, Geary MP, Matthews TG, et al. A case-control study of hypoxic-ischemic encephalopathy in newborn infants at >36 weeks gestation. Am J Obstet Gynecol. 2013;209:29.e1–19.
• Locatelli A, Incerti M, Paterlini G, Doria V, Consonni S, Provero C, et al. Antepartum and intrapartum risk factors for neonatal encephalopathy at term. Am J Perinatol. 2010;27:649–54.
• Lundgren C, Brudin L, Wanby AS, Blomberg M. Ante- and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy. J Matern Fetal Neonatal Med. 2018;31(12):1595–601.
• Torbenson VE, Tolcher MC, Nesbitt KM, Colby CE, el-Nashar SA, Gostout BS, et al. Intrapartum factors associated with neonatal hypoxic ischemic encephalopathy: a case-controlled study. BMC Pregnancy Childbirth. 2017;17(1):415.
• Draycott T, Sibanda T, Owen L, Akande V, Winter C, Reading S, et al. Does training in obstetric emergencies improve neonatal outcome?. BJOG. 2006;113:177–82.
• The American College of Obstetricians and Gynecologists. Neonatal encephalopathy and cerebral palsy: executive summary. Obstet Gynecol. 2004;103:780–1.
• Mundhra R, Singh AS, Agarwal M, Kumar R. Utilization of antenatal care and its influence on fetal-maternal outcome: a tertiary care experience. Int J Reprod Contracept Obstet Gynecol. 2013;2(4):600–6.
• Aslam HM, Saleem S, Afzal R, Iqbal U, Saleem SM, Shaikh MWA, et al. Risk factors of birth asphyxia. Ital J Pediatr. 2014;40:94.
• Gumus H, Demir A. An evaluation of risk factors in cases of perinatal asphyxia. J Clin Exp Invest. 2021;12(1):em00763.
• Igboanugo S, Chen A, Mielke JG. Maternal risk factors for birth asphyxia in low-resource communities. A systematic review of the literature. J Obstet Gynaecol. 2020;40(8):1039–55.
• Peebles PJ, Duello TM, Eickhoff JC, McAdams RM. Antenatal and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy. J Perinatol. 2020;40:63–9.
• Johnston MV, Hagberg H. Sex and the pathogenesis of cerebral palsy. Dev Med Child Neurol. 2007;49:74–8.
• Rossi AC, Prefumo F. Antepartum and intrapartum risk factors for neonatal hypoxic-ischemic encephalopathy: a systematic review with meta-analysis. Curr Opin Obstet Gynecol. 2019;31(6):410–7.
• Laughon SK, Berghella V, Reddy UM, Sundaram R, Lu Z, Hoffman MK. Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynecol. 2014;124:57–67.
• Nelson KB, Dambrosia JM, Ting TY, Grether JK. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med. 1996;334:613–8.
• Michaeli J, Srebnik N, Zilberstein Z, Rotem R, Bin-Nun A, Grisaru-Granovsky S. Intrapartum fetal monitoring and perinatal risk factors of neonatal hypoxic-ischemic encephalopathy. Arch Gynecol Obstet. 2021;303(2):409–17.
• Graham EM, Adami RR, McKenney SL, Jennings JM, Burd I, Witter FR. Diagnostic accuracy of fetal heart rate monitoring in the identification of neonatal encephalopathy. Obstet Gynecol. 2014;124:507–13.
• Siassakos D, Hasafa Z, Sibanda T, Fox R, Donald F, Winter C, et al. Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training. BJOG. 2009;116:1089–96.
• Nelson DB, Lucke AM, McIntire DD, Sánchez PJ, Leveno KJ, Chalak LF. Obstetric antecedents to body-cooling treatment of the newborn infant. Am J Obstet Gynecol. 2014;211(2):155.e1–6.
• Zulfiqar R, Naeemullah S. Severity of hypoxic ischaemic encephalopathy in neonates with birth asphyxia. J Rawal Med Coll. 2007;11:18–22.
• Kiyani AN, Khushdil A, Ehsan A. Perinatal factors leading to birth asphyxia among term newborns in a tertiary care hospital. Iran J Pediatr. 2014;24:637–42