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
. 2021 Apr 26;16(4):e0250633.
doi: 10.1371/journal.pone.0250633. eCollection 2021.

Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study

Beatrice Nkolika Ezenwa  1   2 , Gbenga Olorunfemi  3   4 , Iretiola Fajolu  1   2 , Toyin Adeniyi  2 , Khadijah Oleolo-Ayodeji  2 , Blessing Kene-Udemezue  2 , Joseph A Olamijulo  3 , Chinyere Ezeaka  1   2
Affiliations

Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study

Beatrice Nkolika Ezenwa et al. PLoS One. .

Abstract

Background: Globally, approximately 9 million neonates develop perinatal asphyxia annually of which about 1.2 million die. Majority of the morbidity and mortality occur in Low and middle-income countries. However, little is known about the current trend in incidence, and the factors affecting mortality from hypoxic ischaemic encephalopathy (HIE), in Nigeria.

Objective: We assessed the trends in incidence and fatality rates and evaluated the predictors of mortality among babies admitted with HIE over five years at the Lagos University Teaching Hospital.

Methods: A temporal trend analysis and retrospective cohort study of HIE affected babies admitted to the neonatal unit of a Nigerian Teaching Hospital was conducted. The socio-demographic and clinical characteristics of the babies and their mothers were extracted from the neonatal unit records. Kaplan-Meir plots and Multivariable Cox proportional hazard ratio was used to evaluate the survival experienced using Stata version 16 (StataCorp USA) statistical software.

Results: The median age of the newborns at admission was 26.5 (10-53.5) hours and the male to female ratio was 2.1:1. About one-fifth (20.8%) and nearly half (47.8%) were admitted within 6 hours and 24 hours of life respectively, while majority (84%) of the infants were out-born. The prevalence and fatality rate of HIE in our study was 7.1% and 25.3% respectively. The annual incidence of HIE among the hospital admissions declined by 1.4% per annum while the annual fatality rate increased by 10.3% per annum from 2015 to 2019. About 15.7% died within 24 hours of admission. The hazard of death was related to the severity of HIE (p = 0.001), antenatal booking status of the mother (p = 0.01) and place of delivery (p = 0.03).

Conclusion: The case fatality rate of HIE is high and increasing at our centre and mainly driven by the pattern of admission of HIE cases among outborn babies. Thus, community level interventions including skilled birth attendants at delivery, newborn resuscitation trainings for healthcare personnel and capacity building for specialized care should be intensified to reduce the burden of HIE.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
A. Trends in HIE admission. B. Trends in incidence and fatality rate for HIE (2015–2019). C. Trends in severity of admitted cases of HIE (2015–2019).
Fig 2
Fig 2. The Kaplan-Meier survival experience of the cohort (A), severity of HIE (B), by place of birth (C), and year of admission (D).
See this image and copyright information in PMC

References

    1. Wiswell TE. Evaluation for the etiology of neonatal encephalopathy and the diagnosis of FIRS. Seminars in Fetal and Neonatal Medicine, 2020; 25 (4):101140. 10.1016/j.siny.2020.101140 - DOI - PubMed
    1. Lawn JE, Manandhar A, Haws RA, Darmstadt GL. Reducing one million child deaths from birth asphyxia: a survey of health systems gaps and priorities. Health Res Policy Syst. 2007; 5:4. 10.1186/1478-4505-5-4 - DOI - PMC - PubMed
    1. Aliyu I, Lawal TO, Onankpa B. Prevalence and outcome of perinatal asphyxia: Ouraexperience in a semi—urban setting. Tropical journal of Medical Research. 2017;20(2):161–165.
    1. Gebregziabher GT, Hadgu FB, Abebe HT. Prevalence and Associated Factors of Perinatal Asphyxia in Neonates Admitted to Ayder Comprehensive Specialized Hospital, Northern Ethiopia: A Cross-Sectional Study. Int J Pediatr. 2020;2020:4367248. 10.1155/2020/4367248 - DOI - PMC - PubMed
    1. Namusoke H, Nannyonga MM, Ssebunya R. et al. Incidence and short term outcomes of neonates with hypoxic ischemic encephalopathy in a Peri Urban teaching hospital, Uganda: a prospective cohort study. Matern Health, Neonatol and Perinatol. 2018; 4: 6. 10.1186/s40748-018-0074-4 - DOI - PMC - PubMed