Prevalence and risk factors of hypoxic ischemic encephalopathy in neonates at Atbara hospital NICU, Sudan: A prospective study

Abstract

Background and Aims: Hypoxic ischemic encephalopathy (HIE) is a common cause of permanent neurological disability and mortality in neonatal across the globe. This study aims to evaluate the prevalence and identify the associated risk factors of HIE among neonates admitted to the Neonatal Intensive Care Unit (NICU) at Atbara Teaching Hospital. Methods: A prospective hospital-based study was conducted at Atbara Teaching Hospital from January to September 2022. The total sample included 1,674 live-born neonates, from which 68 cases were diagnosed with hypoxic ischemic encephalopathy (HIE). A purposive sampling method was used to include all neonates admitted to the Neonatal Intensive Care Unit (NICU) and clinically diagnosed with HIE during the study period. Data were collected using a structured, close-ended questionnaire filled by healthcare staff based on maternal and neonatal clinical records. The analysis aimed to measure the prevalence of HIE and identify associated maternal and neonatal risk factors. Data were analyzed using SPSS version 21, and statistical significance was considered at p < 0.05. Results: The results of this study indicated that out of 1,674 deliveries, 322 newborns were admitted to the NICU, and 68 of them (4.1%) were diagnosed with hypoxic ischemic encephalopathy (HIE). Among the maternal risk factors, 47.1% of mothers had meconium-stained amniotic fluid, and 61.8% experienced prolonged rupture of membranes. Regarding neonatal conditions, 77.9% of the affected neonates were diagnosed with sepsis, based on blood or umbilical cord culture results. Additionally, 56.5% of the neonates had a low APGAR score at five minutes. A statistically significant association was found between low APGAR score at five minutes and HIE outcomes (p-value ≤ 0.000). The case fatality rate among neonates with HIE was 38.2%. Conclusion: The prevalence and case fatality rate of HIE were notably high. Several maternal and neonatal factors, such as meconium-stained liquor, prolonged rupture of membranes, neonatal sepsis, and low APGAR scores, were significantly associated with HIE. These findings highlight the need for early identification and monitoring of risk factors to reduce the burden of HIE in resource-limited settings.

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