Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec:6:26-35.
doi: 10.1016/j.eclinm.2018.12.001.

Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study

Cally J Tann  1   2   3 , Emily L Webb  4 , Rachel Lassman  5 , Julius Ssekyewa  6 , Margaret Sewegaba  2 , Margaret Musoke  2 , Kathy Burgoine  7 , Cornelia Hagmann  8 , Eleanor Deane-Bowers  9 , Kerstin Norman  10 , Jack Milln  2 , Jennifer J Kurinczuk  11 , Alison M Elliott  2   12 , Miriam Martinez-Biarge  13 , Margaret Nakakeeto  14 , Nicola J Robertson  3 , Frances M Cowan  13
Affiliations

Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study

Cally J Tann et al. EClinicalMedicine. 2018 Dec.

Abstract

Background: Neonatal encephalopathy (NE) is a leading cause of global child mortality. Survivor outcomes in low-resource settings are poorly described. We present early childhood outcomes after NE in Uganda.

Methods: We conducted a prospective cohort study of term-born infants with NE (n = 210) and a comparison group of term non-encephalopathic (non-NE) infants (n = 409), assessing neurodevelopmental impairment (NDI) and growth at 27-30 months. Relationships between early clinical parameters and later outcomes were summarised using risk ratios (RR).

Findings: Mortality by 27-30 months was 40·3% after NE and 3·8% in non-NE infants. Impairment-free survival occurred in 41·6% after NE and 98·7% of non-NE infants. Amongst NE survivors, 29·3% had NDI including 19·0% with cerebral palsy (CP), commonly bilateral spastic CP (64%); 10·3% had global developmental delay (GDD) without CP. CP was frequently associated with childhood seizures, vision and hearing loss and mortality. NDI was commonly associated with undernutrition (44·1% Z-score < - 2) and microcephaly (32·4% Z-score < - 2). Motor function scores were reduced in NE survivors without CP/GDD compared to non-NE infants (median difference - 8·2 (95% confidence interval; - 13·0, - 3·7)). Neonatal clinical seizures (RR 4.1(2.0-8.7)), abnormalities on cranial ultrasound, (RR 7.0(3.8-16.3), nasogastric feeding at discharge (RR 3·6(2·1-6·1)), and small head circumference at one year (Z-score < - 2, RR 4·9(2·9-5·6)) increased the risk of NDI.

Interpretation: In this sub-Saharan African population, death and neurodevelopmental disability after NE were common. CP was associated with sensorineural impairment, malnutrition, seizures and high mortality by 2 years. Early clinical parameters predicted impairment outcomes.

Keywords: Cohort; Impairment; Neonatal encephalopathy; Neurodevelopment; Outcomes; Study; Uganda.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Diagram showing how participants moved through the study.
Fig. 2
Fig. 2
Flow diagram of participants.
Fig. 3
Fig. 3
Survival estimates for those with and without neonatal encephalopathy during the neonatal period.
Fig. 4
Fig. 4
Griffiths Mental Development Scales global developmental quotient (DQ) and six-subscale scores of comparison group, NE survivors without impairment, and those with impairment. The blue, red and green bars represent comparison cohort without neonatal encephalopathy (non-NE) with no NDI, neonatal encephalopathy (NE) cohort with no NDI, and NE cohort with NDI, respectively. P-values for comparison between NE cohort with NDI and the other two groups all < 0.001.
See this image and copyright information in PMC

References

    1. Lawn J.E., Blencowe H., Oza S. Every newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384(9938):189–205. - PubMed
    1. Lee A.C., Kozuki N., Blencowe H. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res. 2013;74(Suppl. 1):50–72. - PMC - PubMed
    1. Dixon G., Badawi N., Kurinczuk J.J. Early developmental outcomes after newborn encephalopathy. Pediatrics. 2002;109(1):26–33. - PubMed
    1. Mwaniki M.K., Atieno M., Lawn J.E., Newton C.R. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet. 2012;379(9814):445–452. - PMC - PubMed
    1. United Nations Children's Fund Early Child Devlopment Unit . UNICEF; New York: 2006. Programming experiences in early Child development.