Neonatology Unit, Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria.
Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria.
PLoS One. 2021 Apr 26;16(4):e0250633. doi: 10.1371/journal.pone.0250633. eCollection 2021.
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.
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.
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.
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).
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.
全球每年约有 900 万新生儿患有围产期窒息，其中约有 120 万人死亡。大多数发病率和死亡率发生在中低收入国家。然而，对于尼日利亚目前围产缺氧缺血性脑病（HIE）的发病率趋势以及影响死亡率的因素知之甚少。
我们评估了五年内在拉各斯大学教学医院接受 HIE 治疗的婴儿的发病率和死亡率趋势，并评估了影响死亡率的因素。
对尼日利亚教学医院新生儿病房接受 HIE 治疗的婴儿进行时间趋势分析和回顾性队列研究。从新生儿病房记录中提取婴儿及其母亲的社会人口统计学和临床特征。使用 Stata 版本 16（StataCorp USA）统计软件评估 Kaplan-Meier 图和多变量 Cox 比例风险比来评估使用情况。
新生儿入院时的中位年龄为 26.5（10-53.5）小时，男女比例为 2.1:1。约五分之一（20.8%）和近一半（47.8%）分别在出生后 6 小时和 24 小时内入院，而大多数（84%）婴儿为外院出生。本研究中 HIE 的患病率和死亡率分别为 7.1%和 25.3%。2015 年至 2019 年，医院 HIE 的年发病率每年下降 1.4%，而年死亡率每年上升 10.3%。约 15.7%的婴儿在入院后 24 小时内死亡。死亡的危险与 HIE 的严重程度有关（p=0.001），母亲的产前预约状况（p=0.01）和分娩地点（p=0.03）。
我们中心 HIE 的病死率很高且呈上升趋势，主要是由外院出生的 HIE 病例入院模式驱动的。因此，应加强社区一级的干预措施，包括分娩时的熟练接生人员、对医疗保健人员进行新生儿复苏培训以及加强专门护理的能力建设，以减轻 HIE 的负担。
