The association of nucleated red blood cells with the severity and outcome in full-term Hypoxic Ischaemic Encephalopathy infants treated with therapeutic hypothermi
Date
2018-12
Authors
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Abstract
Title: The association of nucleated red blood cells with the severity and outcome in full-term Hypoxic Ischaemic Encephalopathy infants treated with therapeutic hypothermia.
Background: Birth asphyxia results from deprivation of oxygen to a newborn infant during the peripartum and/or intrapartum period causing harm to the brain, heart, and other major organs. The damage to the injured brain may be permanent, depending on the severity of the insult. Birth asphyxia resulting in hypoxic ischaemic encephalopathy (HIE) is a worldwide problem commonly occurring in South Africa, accounting for thousands of perinatal deaths and stillbirths annually.
There are limited biomarkers with a high sensitivity and specificity to accurately predict the severity of birth asphyxia, the risk of dying from the HIE and which newborn infants require referral to regional hospitals for therapeutic intervention. Ideally, the biomarkers should be applicable at a primary health care level, which contribute significantly to the number of HIE cases.
Numerous publications have drawn attention to the association between the number of nucleated red blood cells (NRBC) and birth asphyxia. In contrast there are few biomarkers that predict the risk of developing severe HIE and even less that predict the long-term outcome of HIE.
Objectives: We aimed to describe the association between NRBC, the severity of HIE, and 1year outcome in newborn infants treated for HIE with therapeutic hypothermia.
Methods: This was a prospective descriptive sub-study of a larger study investigating therapeutic hypothermia (TH) of neonates with HIE at Tygerberg Hospital (TBH). A cohort of 100 patients with varying degrees of HIE admitted for cooling were recruited into the study. Clinical notes on Enterprise Content Management (ECM) database and cooling booklets, used routinely to prospectively record data on all therapeutically cooled neonates, were reviewed. NRBC done within 6 hours of admission were analyzed. Patients were followed up after discharge, over a period of 12 months, by a single developmental specialist. They were assessed using the Bayley Scales of Infant Development Third Edition Screening Test (Bayley-111® Screening Test).
Results: 75 patients had complete data. The mean gestation and birth weight was 38.6 (4.8) weeks and 3116.8 (+610) grams, respectively. Patients were divided into mild (n=42), moderate (n=20) and severe (n=13) HIE using the Thompson score. Using the NRBC patients were stratified into 3 categories; NRBC 0/100WBC (n=36), NRBC 1-29/100WBC (n=31) and NRBC 30/100WBC (n=8). We found no statistically significant difference in HIE severity between infants born inside and outside TBH (p =0.473). The inborn infants had a significantly higher number of infants with NRBC 30/100WBC (p= 0.005;Odds ratio 8.167 95% CI 1.5-44.27). There was no significant association between the category of NRBC and HIE severity (p=0.265). There was a significant association between infants with cerebral palsy and/or neurodevelopmental delay at 12 months of age and NRBC 30/100WBC (P=0.013; Odds ratio 20.17; 95% CI 1.017 – 399.6); Similarly, children that died on the initial admission to the NICU for therapeutic hypothermia had significantly higher levels of NRBC when compared to those that survived; (P=0.008; Odds ratio 9.40; 95% CI 1.7791 to 49.6649).
Conclusion: In newborn infants suffering from HIE requiring therapeutic cooling a NRBC 30/100 WBC, collected in the first 6 hours of life, had a significant correlation with early mortality and neurodevelopmental impairment at 1 year of age.
"Geen opsomming biskikbaar"
"Geen opsomming biskikbaar"
Description
Thesis (MMed)--Stellenbosch University, 2018.
Keywords
Hypoxic-ischemic encephalopathy, Red blood cells, Hypoxic Ischaemic Encephalopathy, Biochemical markers, Therapeutic hypothermia, UCTD