P3.102: Neonatal Hypoxic-Ischemic Encephalopathy in a Jamaica Tertiary Hospital : Progress in Incidence, Challenges in Outcome.

Background: Hypoxic Ischemic Encephalopathy (HIE) is a significant neonatal condition resulting from decreased oxygen supply and cerebral blood flow, often causing severe neurological impairment and mortality. While global efforts have reduced the burden of neonatal morbidity and mortality, HIE remains a leading cause of adverse neonatal outcomes in low- and middle-income countries (LMICs), including Jamaica. Despite the significance of this condition, recent data on incidence, outcomes, and predictive factors from Jamaican healthcare settings remain limited. This study aimed to evaluate the incidence of HIE, determine outcomes at hospital discharge, among neonates ≥36 weeks gestation managed at the University Hospital of the West Indies (UHWI) between 2018 and 2022 (second epoch) and make comparisons with historical data.

Methods: A retrospective descriptive chart review was performed for neonates ≥36 weeks gestation diagnosed with HIE at UHWI from January 1, 2018, to December 31, 2022. We compared the incidence. severity, poor outcome (including mortality) of HIE between this study and a previous study. Poor outcomes measured were major neurological status at discharge and mortality. Chi-square tests and one-way ANOVA were used for statistical analyses, with significance at p< 0.05. Logistic regression was used to assess independent predictors of poor outcome. Ethical approval for the conduct of the study was granted by the Mona Campus Research Ethics Committee.

Results: Of the 8,226 live-born neonates, 32 were diagnosed with HIE (incidence rate: 3.9 per 1000 live births compared to an incidence rate of 6 per 1000 live births in a previous study (first epoch) at the UHWI (1998-2003) (p =0.45). HIE severity distribution (stage 1: 31%, stage 2: 43%, stage 3: 26%) in the first epoch was similar (p = 0.98) to the second epoch (stage 1: 31.4%, stage 2: 40.6%, stage 3: 25%). Poor outcomes occurred in 36% (34/95) in the first epoch and 37.5% (12/32) in the second epoch of neonates (p> 0.05). This included neurological sequelae in survivors of 32% and mortality of 12% in the first epoch versus 25.9% neurological sequelae and 15.6% mortality in the second (p> 0.05 in both neurological sequelae and mortality). The severity of encephalopathy (p=0.01) was the only independent predictor of poor outcome in the second epoch.

Conclusion: The incidence of HIE at UHWI has decreased compared to previous decades; however, mortality rate and poor outcome have not demonstrated proportional improvement. These findings highlight the need to enhance the limited investigational diagnostic capacity to identify modifiable causes of neonatal encephalopathy. Further studies are warranted to develop targeted interventions to reduce the incidence of modifiable risk factors for severe HIE which may decrease mortality from neonatal HIE in LMIC contexts and aid in achieving the sustainable development goals.