Outcome at 1 year of neonatal encephalopathy in Kathmandu, Nepal

To determine the outcome at 1 year of neonatal encephalopathy (NE) and to e stimate the possible contribution of birth asphyxia to childhood disability in a low-income South Asian country, a prospective cohort study was undert aken in the principal maternity hospital of Kathmandu, where over 50% of lo cal women give birth. From a total population cohort of 21 609 live births, 181 term infants with NE (after exclusion of cases associated with neonata l sepsis, congenital malformations, or primary hypoglycaemia) and 208 term control infants were recruited, Of these, 102 (78%) infants with NE and 106 (51%) control infants were followed-up to 1 year of age, Outcome measures were death or neurodevelopmental impairment, graded as major, minor or none . Of the 131 term infants with NE, 83 were graded with moderate or severe N E according to conventional definition. By 1 year of age, 45 (44%) of the i nfants with NE had died, 18 (18%) had severe impairments, and two (2%) had minor impairments; four (4%) of the control subjects had died and two (2%) had minor impairments. Most deaths in subjects with NE occurred in the earl y neonatal period; NE carried no excess risk of death beyond the neonatal p eriod. Of the 18 children with major impairment, 14 (78%) had spastic tetra plegic cerebral palsy and eight (44%) had multiple impairments. Compared wi th the control group the relative risk of death by 1 year was 5 (95% CI 1.4 to 15) for mild NE, 8 (95% CI 3 to 23) for moderate, and 26 (95% CI 10 to 67) for severe. Twenty-seven of 38 (71%) infants with moderate NE either di ed or survived with major impairment. An upper estimate for the prevalence of major neuroimpairment at 1 year attributable to birth asphyxia is 1 per 1000 live births in this population.