A Yung, V Wong, W Goh

Objective: To evaluate the neurodevelopmental outcome of babies suffering from severe birth asphyxia and to identify the perinatal risk factors associated with adverse outcome.

Subject: Term neonates with stage 2 & 3 hypoxic ischaemic encephalopathy (HIE), according to the clinical staging by Sarnat, (i.e. evidence of antenatal or intrapartum asphyxia and multisystem cardiac, renal, pulmonary and metabolic involvement) were included.

Method: All severely asphyxiated babies, both inborn and outborn, managed in the Queen Mary Hospital and assessed at the Duchess of Kent Children's Hospital over the past 10 years were recruited. They were followed up at the outpatient clinic for growth and neurological assessment. Developmental assessment, using the Griffith's Mental Developmental Scale was performed.

Result: Altogether 46 babies born with severe birth asphyxia were studied. Five (11%) died in the neonatal period. Among the survivors (n=20, 43%) suffered from physical or mental dysfunction. There were 16 children with cerebral palsy (quadriplegia=8, hemiplegia=5, diplegia=1 and dyskinesia=2). Four children were assessed to have global developmental delay (i.e. General Quotient < 70). The mean age of assessment for cerebral palsy and global developmental delay was 30 months. The majority of children suffering from cerebral palsy also had associated developmental delay. Only 3 hemiplegic children had normal development.

Conclusion: (1) The prognosis of children who survived stage 2 & 3 HIE was poor with 43% having neurological sequelae. (2) The perinatal risk factors which were significantly associated with adverse neurodevelopmental outcome include fetal bradycardia, extended Apgar scores at 20 minutes, prolonged mechanical ventilation, the need for inotropic support and multiorgan involvement.