Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study

Autor: 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
Přispěvatelé: University of Zurich, Tann, Cally J
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: EClinicalMedicine, Vol 6, Iss, Pp 26-35 (2018)
Eclinicalmedicine
ISSN: 2589-5370
Popis: Background 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. Methods 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). Findings 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
Highlights • This is, to our knowledge, the largest published cohort describing childhood outcomes after neonatal encephalopathy (NE) in sub-Saharan Africa • Children with NE are at high-risk of multidomain neurodevelopmental impairment in a setting where access to supportive services are often lacking. • Mortality is highest in the early neonatal period and in those with severe neurodevelopmental impairment • Simple early clinical predictors may support a targeted approach to follow-up of particularly high-risk children Outstanding Questions • What is the contribution of NE to cerebral palsy and other developmental disorders in low resource African settings? • What strategies are effective to improve childhood outcomes in NE in way of prevention and intervention? • What are the school-age outcomes after NE and later impacts across the life course?
Databáze: OpenAIRE
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