Abstract / Summary
Background: Hypoxic-ischemic encephalopathy is a major cause of neonatal mortality and long-term neurodevelopmental impairment, particularly in low- and middle-income countries. Evidence regarding HIE severity, survival outcomes, and predictors of mortality remains limited in Ethiopia. This study assessed the severity, survival outcomes, and predictors of mortality among neonates with HIE admitted to Jimma University Medical Center (JUMC), Southwest Ethiopia.
Methods: A retrospective cohort study was conducted among 373 neonates diagnosed with HIE following birth asphyxia and admitted to Jimma University Medical Center(JUMC). Data were extracted from medical records using a structured checklist. Kaplan-Meier survival analysis and the log-rank test were used to estimate and compare survival experiences. Cox proportional hazards regression identified predictors of mortality, while ordinal logistic regression was employed to determine factors associated with increasing HIE severity. Statistical significance was declared at p < 0.05.
Results: Among the 373 neonates, 121 (32.4%) had Stage I HIE, 169 (45.3%) had Stage II HIE, and 83 (22.3%) had Stage III HIE. The overall mortality rate was 9.1%, and the median event-free survival time was 30.6 days. Kaplan-Meier analysis showed survival probabilities of 0.99 (95% CI: 0.99-1.00) at day 1, 0.75 (95% CI: 0.65-0.86) at day 20, and 0.29 (95% CI: 0.15-0.59) at day 40. Survival differed significantly across HIE stages (log-rank χ² = 45.4, p = 0.00). Factors independently associated with increasing HIE severity included outborn status (AOR = 1.50; 95% CI: 1.00-2.26), acute kidney injury (AOR = 1.93; 95% CI: 1.21-3.08), macrosomia (AOR = 2.54; 95% CI: 1.29-5.07), and hypoglycemia (AOR = 1.59; p = 0.01). Maternal gestational diabetes showed a borderline association with severity (AOR = 1.99; 95% CI: 0.97-4.10). Predictors of mortality included Stage II HIE (AHR = 3.24; 95% CI: 2.55-4.13), acute kidney injury (AHR = 3.27; 95% CI: 2.47-4.31), Apgar score ≤ 3 (AHR = 3.71; 95% CI: 2.59-5.31), Apgar score 4-6 (AHR = 1.67; 95% CI: 1.30-2.13), outborn status (AHR = 1.62; 95% CI: 1.29-2.04), and neonatal sepsis (AHR = 2.12).
Conclusion: Hypoxic-Ischemic Encephalopathy remains a substantial contributor to neonatal mortality at Jimma University Medical Ceneter. Survival declined markedly with increasing disease severity. Mortality was independently associated with HIE stage, acute kidney injury, low Apgar score, outborn status, and neonatal sepsis, while HIE severity was associated with outborn status, acute kidney injury, macrosomia, and hypoglycemia. Strengthening referral systems, improving perinatal care, and ensuring early detection and management of neonatal complications are essential to improve neonatal outcomes.