Adhikari Sudhir, Rao Kalipatnam Seshagiri
Department of Pediatrics, Manipal College of Medical Sciences, Pokhara, Nepal.
Brain Dev. 2017 Feb;39(2):107-111. doi: 10.1016/j.braindev.2016.09.005. Epub 2016 Sep 30.
Perinatal asphyxia with hypoxic ischemic encephalopathy (HIE) causes significant mortality and morbidity in developing countries. There is limited information about long term neurodevelopmental outcome of infants with neonatal encephalopathy.
Term infants with the diagnosis of perinatal asphyxia were followed up in neurodevelopmental clinics of Manipal Teaching hospital, Nepal. Study design was prospective mixed longitudinal study. Prematurity, major congenital malformations, other intracranial pathology, birth weight <2500g and chromosomal abnormalities were excluded. After consent and enrollment their detailed perinatal history, Apgar score, resuscitation measures and outcome parameters were recorded on a predesigned proforma. Developmental assessment was done with Denver Developmental Screening Tool 2nd edition (DDST 2) at the age of 3months, 6months, 9months, 1year, 18months and 2years.
Total 187 assessments done in the age group of 3months to 2years among HIE stage 2 patients. Impaired hearing and vision was noted in 5.3% while language delay was observed in 19.2% of infants. Abnormal tone and deep tendon reflexes were noted in 46.2% infants at 3months. Abnormal tone and reflexes were noted only in 18.8% and 9.4% respectively at the age of 2years. Overall, gross motor delay was noted in 55(29.4%) of patient, 34(18.2%) showed fine motor delay and 17.1% social delay. Seizures were persistent in 15.6% patients at 2years age.
Infants affected with HIE have delay in all sectors of developmental milestones. Motor abnormalities are common and tend to improve with advancing age.
围产期窒息合并缺氧缺血性脑病（HIE）在发展中国家导致了显著的死亡率和发病率。关于新生儿脑病患儿长期神经发育结局的信息有限。
在尼泊尔马尼帕尔教学医院的神经发育诊所对诊断为围产期窒息的足月儿进行随访。研究设计为前瞻性混合纵向研究。排除早产、重大先天性畸形、其他颅内病变、出生体重<2500g和染色体异常。在获得同意并纳入研究后，将他们详细的围产期病史、阿氏评分、复苏措施和结局参数记录在预先设计的表格上。在3个月、6个月、9个月、1岁、18个月和2岁时使用丹佛发育筛查工具第二版（DDST 2）进行发育评估。
在HIE 2期患者中，共对3个月至2岁年龄组进行了187次评估。5.3%的婴儿存在听力和视力受损，19.2%的婴儿存在语言发育迟缓。3个月时，46.2%的婴儿出现肌张力和深腱反射异常。2岁时，肌张力和反射异常的比例分别仅为18.8%和9.4%。总体而言，55名（29.4%）患者存在大运动发育迟缓，34名（18.2%）存在精细运动发育迟缓，17.1%存在社交发育迟缓。2岁时，15.6%的患者癫痫持续存在。
患有HIE的婴儿在发育里程碑的各个方面均有延迟。运动异常很常见，且往往随着年龄增长而改善。
