Early childhood outcomes after neonatal encephalopathy in Uganda: a cohort study
<strong>Background</strong> Neonatal encephalopathy (NE) is a leading cause of global child mortality. Survivor outcomes in low-resource settings are poorly described. We present early childhood outcomes after NE in Uganda. <br/><br/> <strong>Methods</strong> We c...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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Elsevier
2018
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| _version_ | 1797086596203282432 |
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| author | Tann, C Webb, E Lassman, R Ssekyewa, J Sewegaba, M Musoke, M Burgoine, K Hagmann, C Deane-Bowers, E Norman, K Milln, J Kurinczuk, J Elliott, A Martinez-Biarge, M Nakakeeto, M Robertson, N Cowan, F |
| author_facet | Tann, C Webb, E Lassman, R Ssekyewa, J Sewegaba, M Musoke, M Burgoine, K Hagmann, C Deane-Bowers, E Norman, K Milln, J Kurinczuk, J Elliott, A Martinez-Biarge, M Nakakeeto, M Robertson, N Cowan, F |
| author_sort | Tann, C |
| collection | OXFORD |
| description | <strong>Background</strong> Neonatal encephalopathy (NE) is a leading cause of global child mortality. Survivor outcomes in low-resource settings are poorly described. We present early childhood outcomes after NE in Uganda. <br/><br/> <strong>Methods</strong> We conducted a prospective cohort study of term-born infants with NE (n = 210) and a comparison group of term non-encephalopathic (non-NE) infants (n = 409), assessing neurodevelopmental impairment (NDI) and growth at 27–30 months. Relationships between early clinical parameters and later outcomes were summarised using risk ratios (RR). <br/><br/> <strong>Findings</strong> Mortality by 27–30 months was 40·3% after NE and 3·8% in non-NE infants. Impairment-free survival occurred in 41·6% after NE and 98·7% of non-NE infants. Amongst NE survivors, 29·3% had NDI including 19·0% with cerebral palsy (CP), commonly bilateral spastic CP (64%); 10·3% had global developmental delay (GDD) without CP. CP was frequently associated with childhood seizures, vision and hearing loss and mortality. NDI was commonly associated with undernutrition (44·1% Z-score < − 2) and microcephaly (32·4% Z-score < − 2). Motor function scores were reduced in NE survivors without CP/GDD compared to non-NE infants (median difference − 8·2 (95% confidence interval; − 13·0, − 3·7)). Neonatal clinical seizures (RR 4.1(2.0–8.7)), abnormalities on cranial ultrasound, (RR 7.0(3.8–16.3), nasogastric feeding at discharge (RR 3·6(2·1–6·1)), and small head circumference at one year (Z-score < − 2, RR 4·9(2·9–5·6)) increased the risk of NDI. <br/><br/> <strong>Interpretation</strong> In this sub-Saharan African population, death and neurodevelopmental disability after NE were common. CP was associated with sensorineural impairment, malnutrition, seizures and high mortality by 2 years. Early clinical parameters predicted impairment outcomes. |
| first_indexed | 2024-03-07T02:24:08Z |
| format | Journal article |
| id | oxford-uuid:a500d765-b9f9-47e4-a591-f322b0c1e695 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:24:08Z |
| publishDate | 2018 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:a500d765-b9f9-47e4-a591-f322b0c1e6952022-03-27T02:37:31ZEarly childhood outcomes after neonatal encephalopathy in Uganda: a cohort studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a500d765-b9f9-47e4-a591-f322b0c1e695EnglishSymplectic Elements at OxfordElsevier2018Tann, CWebb, ELassman, RSsekyewa, JSewegaba, MMusoke, MBurgoine, KHagmann, CDeane-Bowers, ENorman, KMilln, JKurinczuk, JElliott, AMartinez-Biarge, MNakakeeto, MRobertson, NCowan, F<strong>Background</strong> Neonatal encephalopathy (NE) is a leading cause of global child mortality. Survivor outcomes in low-resource settings are poorly described. We present early childhood outcomes after NE in Uganda. <br/><br/> <strong>Methods</strong> We conducted a prospective cohort study of term-born infants with NE (n = 210) and a comparison group of term non-encephalopathic (non-NE) infants (n = 409), assessing neurodevelopmental impairment (NDI) and growth at 27–30 months. Relationships between early clinical parameters and later outcomes were summarised using risk ratios (RR). <br/><br/> <strong>Findings</strong> Mortality by 27–30 months was 40·3% after NE and 3·8% in non-NE infants. Impairment-free survival occurred in 41·6% after NE and 98·7% of non-NE infants. Amongst NE survivors, 29·3% had NDI including 19·0% with cerebral palsy (CP), commonly bilateral spastic CP (64%); 10·3% had global developmental delay (GDD) without CP. CP was frequently associated with childhood seizures, vision and hearing loss and mortality. NDI was commonly associated with undernutrition (44·1% Z-score < − 2) and microcephaly (32·4% Z-score < − 2). Motor function scores were reduced in NE survivors without CP/GDD compared to non-NE infants (median difference − 8·2 (95% confidence interval; − 13·0, − 3·7)). Neonatal clinical seizures (RR 4.1(2.0–8.7)), abnormalities on cranial ultrasound, (RR 7.0(3.8–16.3), nasogastric feeding at discharge (RR 3·6(2·1–6·1)), and small head circumference at one year (Z-score < − 2, RR 4·9(2·9–5·6)) increased the risk of NDI. <br/><br/> <strong>Interpretation</strong> In this sub-Saharan African population, death and neurodevelopmental disability after NE were common. CP was associated with sensorineural impairment, malnutrition, seizures and high mortality by 2 years. Early clinical parameters predicted impairment outcomes. |
| spellingShingle | Tann, C Webb, E Lassman, R Ssekyewa, J Sewegaba, M Musoke, M Burgoine, K Hagmann, C Deane-Bowers, E Norman, K Milln, J Kurinczuk, J Elliott, A Martinez-Biarge, M Nakakeeto, M Robertson, N Cowan, F Early childhood outcomes after neonatal encephalopathy in Uganda: a cohort study |
| title | Early childhood outcomes after neonatal encephalopathy in Uganda: a cohort study |
| title_full | Early childhood outcomes after neonatal encephalopathy in Uganda: a cohort study |
| title_fullStr | Early childhood outcomes after neonatal encephalopathy in Uganda: a cohort study |
| title_full_unstemmed | Early childhood outcomes after neonatal encephalopathy in Uganda: a cohort study |
| title_short | Early childhood outcomes after neonatal encephalopathy in Uganda: a cohort study |
| title_sort | early childhood outcomes after neonatal encephalopathy in uganda a cohort study |
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