Assessment of early neurodevelopmental outcome of patients with moderate to severe hypoxic ischemic encephalopathy at 3 and 6 Months: A Multicenter Study in Addis Ababa.

Abstract

Abstract Background:- Neonatal hypoxic ischemic encephalopathy is an important cause of permanent damage to central nervous system tissues that may result in neonatal death or manifest later as cerebral palsy or developmental delay or learning disability and epilepsy. Surviving neonates with severe birth asphyxia and hypoxic ischemic encephalopathy has variable neurodevelopmental outcomes. Despite advancements in neonatal intensive care, a significant proportion of neonates who survive moderate to severe HIE continue to face adverse outcomes, including cerebral palsy, developmental delays, and cognitive impairments. Objective:- Assessment of early neurodevelopmental outcome of patients with moderate to severe hypoxic ischemic encephalopathy in Addis Ababa. Methods:- hospital-based, prospective cohort study with descriptive longitudinal analysis was conducted from June, 2025,– February, 2026, G.C. The data were collected using a standard questionnaire using a pretested structured interviewed and chart review questionnaire. The sample size was calculated based on the primary binary outcome (normal vs abnormal HINE score at six months). Using a 95% confidence level (Z = 1.96) and an expected proportion of abnormal outcomes of 20% from previous high-risk infant cohorts, the required sample size to estimate this proportion with a margin of error of 10%. rounded to 62. To increase precision, 10% of dropout/no responders was added and a total of 70 infants were enrolled. All enrolled infants completed follow-up assessments, and there was no loss to follow-up. Results: At three months, the median HINE score was 51.0 (; range 22–60), with 57% of infants demonstrating abnormal neurological findings, and 55% classified as having severe neurological impairment. At six months, the median HINE score increased slightly to 58.0 (range 19–69), with 61% of infants continuing to show abnormal findings, of whom 72% had severe impairment. Among infants with normal neurological performance at three months, 86.7% remained normal at six months, while 97.5% of those with abnormal findings at three months continued to demonstrate abnormal performance. Severity-based analysis revealed predominantly persistent outcomes, particularly among infants with severe impairment at baseline. After adjustment, neonatal seizures remained an independent predictor of poor outcome at six months (adjusted odds ratio 14.7; 95% CI: 10.55–49.62; p < 0.001). Conclusion: Abnormal neurological findings are highly prevalent among infants with moderate to severe HIE, particularly in those with stage III HIE and neonatal seizures. prolonged resuscitation also has poor outcome. Early identification, close follow-up, and timely neuroprotective interventions are essential to support neurological development and optimize outcomes in this high-risk population. Key word:-encephalopathy, neurodevelopment, SPHMMC