+91 9063922599
+91 9063922599
submission@jccpractice.com
|
FAQs
Background: Hypoxic-ischemic encephalopathy (HIE) remains a leading cause of neonatal mortality and neurodevelopmental impairment in low-resource settings. This study aimed to determine the incidence, risk factors, and outcomes of HIE in a tertiary care NICU in Jaipur, India. Methods: A retrospective analysis of 1,240 neonatal admissions (January 2022–December 2023) was conducted. HIE was diagnosed using Sarnat and Sarnat staging. Multivariate regression identified risk factors for mortality and acute kidney injury (AKI). Results: The incidence of HIE was 4.2% (52/1,240), with 55% (29/52) classified as moderate/severe. Maternal hypertension (34.6%) and prolonged labor (28.8%) were significant risk factors. Mortality rates were 7.8% during hospitalization and 12.3% post-discharge. AKI occurred in 38.5% of cases, correlating with HIE severity (p<0.001). Neurodevelopmental impairments were observed in 21.2% of survivors. Therapeutic hypothermia (TH) utilization was low (15.4%), with delayed initiation (>6 hours) in 62.5% of cases. Conclusion: Jaipur’s high HIE burden underscores the need for perinatal care strengthening, TH protocol standardization, and long-term neurodevelopmental follow-up programs.
Hypoxic-ischemic encephalopathy affects 1–3 per 1,000 live births globally, with incidence rates in India reaching 10–15 per 1,000 due to inadequate intrapartum monitoring and delayed referrals[1][2]. In Rajasthan, neonatal mortality remains a critical public health challenge, with a neonatal mortality rate (NMR) of 25 per 1,000 live births[3]. Despite national efforts under the India Newborn Action Plan (INAP), regional data on HIE outcomes are sparse[4].
Therapeutic hypothermia (TH), though proven to reduce mortality and disability by 15–20%, remains underutilized in India due to infrastructural limitations[5]. A 2022 randomized controlled trial in Mumbai demonstrated TH’s efficacy in reducing MRI-detected brain injury, yet highlighted challenges in resource-constrained settings[6]. This study evaluates Jaipur’s adherence to global HIE management standards and provides actionable insights for policy reform.
Study Design and Setting
A retrospective cohort study was conducted at a Level III NICU in Jaipur, Rajasthan, enrolling term neonates (≥37 weeks) with HIE between January 2022 and December 2023. Exclusion criteria included congenital anomalies and incomplete medical records.
Variables and Data Collection
Maternal factors: Hypertension, diabetes, and prolonged labor (>12 hours).
Neonatal factors: Apgar scores at 1/5 minutes, HIE staging (Sarnat criteria), seizures, and multiorgan dysfunction.
Interventions: TH utilization, respiratory support (CPAP/mechanical ventilation), and inotrope requirements.
Outcomes: Mortality, AKI (KDIGO criteria), and neurodevelopmental status at discharge.
Statistical Analysis
Data were analyzed using SPSS v26. Multivariate logistic regression identified risk factors for mortality and AKI, adjusting for gestational age, birth weight, and HIE severity. A p-value <0.05 was considered significant.
Table 1: Demographic Characteristics and HIE Incidence
|
Variable |
Value |
|
Total NICU Admissions |
1,240 |
|
HIE Cases |
52 (4.2%) |
|
Male: Female Ratio |
60%:40% |
|
Mean Birth Weight (kg) |
2.8 ± 0.4 |
Among 1,240 NICU admissions, 52 neonates (4.2%) were diagnosed with HIE, with a male predominance (60%) and mean birth weight of 2.8 kg.
Table 2: Risk Factors for HIE and Adjusted Odds Ratios
|
Risk Factor |
Frequency (n=52) |
Adjusted OR (95% CI) |
-value |
|
Maternal Hypertension |
18 (34.6%) |
3.1 (1.3–7.4) |
0.01 |
|
Prolonged Labor (>12 hours) |
15 (28.8%) |
2.8 (1.2–6.5) |
0.02 |
|
Meconium-Stained Liquor |
21 (40.4%) |
1.9 (0.8–4.5) |
0.15 |
Maternal hypertension (34.6%) and prolonged labor (28.8%) were strongly associated with HIE.
Table 3: Clinical Outcomes and Therapeutic Interventions
|
Outcome/Intervention |
Frequency (n=52) |
Subgroup Analysis |
|
Mortality |
|
|
|
- In-Hospital |
4 (7.8%) |
Severe HIE: 3/4 (75%) |
|
- Post-Discharge |
6/49 (12.3%) |
Moderate HIE: 3/6 (50%) |
|
Acute Kidney Injury (AKI) |
20 (38.5%) |
Severe HIE: 13/20 (65%) |
|
Neurodevelopmental Delays |
11 (21.2%) |
Feeding Issues: 8/11 |
|
Therapeutic Hypothermia (TH) |
8 (15.4%) |
Delayed Initiation: 5/8 |
AKI occurred in 38.5% of cases, with severe HIE neonates exhibiting 65% incidence[7][8]. Post-discharge mortality (12.3%) was driven by sepsis and inadequate follow-up.
Table 4: Neurodevelopmental Outcomes at Discharge
|
Parameter |
Normal (n=41) |
Abnormal (n=11) |
|
Moro Reflex |
38 (92.7%) |
3 (7.3%) |
|
Feeding Coordination |
35 (85.4%) |
6 (14.6%) |
|
Tone Regulation |
39 (95.1%) |
2 (4.9%) |
Neurodevelopmental abnormalities were observed in 21.2% of survivors, predominantly feeding difficulties (14.6%)[9].
High HIE Burden in Jaipur
The observed HIE incidence (4.2%) exceeds global averages (0.37–2.7 per 1,000)[10] and aligns with African cohorts (11%)[11]. Maternal hypertension, a modifiable risk factor, underscores the need for community-based prenatal screening programs[12].
AKI and Multiorgan Dysfunction
The strong association between AKI and HIE severity (p<0.001) mirrors findings from Turkey and Uganda[13][14]. Routine renal function monitoring and fluid resuscitation protocols are recommended to mitigate AKI-related mortality.
Low TH Utilization: Barriers and Solutions
Jaipur’s TH utilization rate (15.4%) lags behind Mumbai (84.5% in 2021)[6]. Scaling up TH requires infrastructure investment and protocol standardization[15].
This study reveals a critical gap in HIE management within Jaipur’s neonatal care framework. Immediate actions should include perinatal care strengthening and TH protocol implementation.
Download
Download
Download
Download
Download XML
