Short-term outcome of perinatal hypoxic-ischaemic encephalopathy at Chiang Mai University Hospital, Thailand: a 15-year retrospective study.

IF 1.4 4区医学 Q3 PEDIATRICS

Paediatrics and International Child Health Pub Date : 2022-08-01 Epub Date: 2023-01-17 DOI:10.1080/20469047.2022.2163135

Thanatcha Malai, Varangthip Khuwuthyakorn, Shanika Kosarat, Watcharee Tantiprabha, Satit Manopunya, Malika Pomrop, Kamornwan Katanyuwong, Chinnuwat Saguensermsri, Natrujee Wiwattanadittakul

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引用次数: 1

Abstract

Background: The outcome of perinatal hypoxic-ischaemic encephalopathy (HIE) in middle-to-low-income countries varies between regions.

Objectives: To determine the mortality and morbidity, and factors influencing the deaths of infants with perinatal HIE.

Methods: A retrospective study was conducted at Chiang Mai University Hospital, Thailand. Perinatal HIE infants of >35 weeks gestation, birthweight ≥2000 g and admitted during 2005-2019 were reviewed. Baseline Characteristics, clinical course and outcome at discharge were compared between the period before and after initiation of therapeutic hypothermia (TH). Risk of death in HIE infants who underwent TH was identified.

Results: A total of 162 HIE infants were included. Compared to the period before TH initiation, the mortality rate was significantly decreased in the TH period. (27% vs. 12.8%, p=0.04) Among 100 HIE infants who underwent TH, the mortality rates was 14%(14/100), of whom 2.5% (2/76) and 50% (12/24) were in the moderate and severe HIE groups. Apgar score at 5 mins ≤1, severe HIE, seizures, hypoglycaemia, organ involvement ≥ five sites, ammonia ≥100 umol/L, lactate ≥14 mmol/L, and requirement for two or more inotropic drugs were risks of death. Multivariate analysis demonstrated that severe HIE (aOR 732.8, 95% CI 4.7-114643, p=0.01) and a need for two or more inotropic drugs (aOR 45.7, 95% CI 1.5-1040, p=0.029) were significant factors for mortality.

Conclusion: In the period of TH, perinatal HIE infants had decreased mortality. Severe HIE and a need for two or more inotropic drugs were associated with death in the infant with HIE who underwent TH.Abbreviations: AED: anti-epileptic drug; BW, birthweight; CI: confidence interval; CMU: Chiang Mai University; EEG: electro-encephalogram; GA: gestational age; HIE: hypoxic-ischaemic encephalopathy; IQR: interquartile range; NICU: neonatal intensive care unit; SD: standard deviation; TH: therapeutic hypothermia.

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泰国清迈大学医院围产期缺氧缺血性脑病的短期疗效：一项15年回顾性研究。

背景：中低收入国家围产期缺氧缺血性脑病（HIE）的结局因地区而异。目的：确定围产期HIE婴儿的死亡率、发病率以及影响其死亡的因素。方法：在泰国清迈大学医院进行回顾性研究。回顾了2005-2019年期间入院的妊娠>35周、出生体重≥2000 g的围产期HIE婴儿。比较开始治疗性低温（TH）前后的基线特征、临床病程和出院时的结果。已确定接受TH的HIE婴儿的死亡风险。结果：共纳入162例HIE患儿。与TH开始前相比，TH期间的死亡率显著降低。（27%对12.8%，p=0.04）在接受TH的100名HIE婴儿中，死亡率为14%（14/100），其中2.5%（2/76）和50%（12/24）为中度和重度HIE组。5分钟Apgar评分≤1、严重HIE、癫痫发作、低血糖、器官受累≥5个部位、氨≥100 umol/L、乳酸≥14 mmol/L以及需要两种或两种以上的肌力药物是死亡风险。多因素分析表明，严重HIE（aOR 732.8，95%CI 4.7-114643，p=0.01）和需要两种或两种以上的肌力药物（aOR 45.7，95%CI 1.5-1040，p=0.029）是导致死亡率的重要因素。结论：在TH期，围产期HIE婴儿死亡率明显下降。严重HIE和需要两种或两种以上的肌力药物与接受TH的HIE婴儿的死亡有关。缩写：AED：抗癫痫药物；BW，出生体重；CI：置信区间；CMU：清迈大学；EEG：脑电图；GA：胎龄；HIE：缺氧缺血性脑病；IQR：四分位间距；新生儿重症监护室：新生儿重症监护病房；SD：标准偏差；TH：治疗性体温过低。

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来源期刊

Paediatrics and International Child Health PEDIATRICS-

CiteScore

3.30

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Paediatrics and International Child Health is an international forum for all aspects of paediatrics and child health in developing and low-income countries. The international, peer-reviewed papers cover a wide range of diseases in childhood and examine the social and cultural settings in which they occur. Although the main aim is to enable authors in developing and low-income countries to publish internationally, it also accepts relevant papers from industrialised countries. The journal is a key publication for all with an interest in paediatric health in low-resource settings.