Hypoxic Ischemic Encephalopathy: Think Outside the Box

ABSTRACT There are some factors that leads to hypoxic ischemic encephalopathy, like maternal age ≥ 35 years, social factors, family history of seizures or neurologic disease, infertility treatment, previous neonatal death, severe preeclampsia, multiple gestation, intrauterine growth restriction, trauma, breech presentation and antepartum hemorrhage. The aim of current study was to identify the associated risk factors which can lead to hypoxic ischemic encephalopathy. A descriptive cross-sectional study was conducted at Paediatrics Ward Unit-II of Civil Hospital, Karachi. All laboratory tests were done from the central laboratory of the civil hospital. The presence of hypoxic ischemic encephalopathy was staged using the Sarnat criteria at the time of admission. Data was collected on predesigned proforma consisting of demographic variables and the risk factors leading to HIE. Data was entered and analyzed in Statistical Package for Social Science (SPSS) version 20. The mean ± SD age of mother of neonates enrolled in this study was 27.41 ± 5.44 years. Mean ± SD gestational age was 34.63 ± 3.87 weeks. Risk factors for hypoxic ischemic encephalopathy include inadequate antenatal care (33.8%), maternal anemia (35.9%), history of hypertension (35.2%), prolonged second stage of labor (29%), vacuum extraction (23.4%), premature delivery (25.5%) and intrauterine growth retardation (16.6%). Overall, 95.2% neonates were identified to have one or more of these contributing factors. Stratified analysis showed that over all neonates of female gender were associated with having more frequency of HIE. Maternal anemia was found to be significantly associated with the occurrence of HIE. The frequency of HIE risk increased with increasing maternal age. Lowest the serum pH level, highest was the frequency of HIE risk factors. Prolonged 2nd stage of labor was significantly associated with lower neonatal weight, overall, very low and very high birth weight neonates were having higher frequency of HIE risk. To conclude the risk factors like insufficient antenatal care, high rates of maternal anemia, other maternal comorbid like history of hypertension, complications of delivery process and its management, prolonged second stage labor, vacuum extraction and fetus related factors like premature delivery and IUGR are quite common which prone the neonates to develop HIE.