Demographic, Maternal and Biochemical Predictors of Early Management Outcomes in Newborns with Hypoxic-Ischemic Encephalopathy in a Resource-Limited Setting

Background: Hypoxic-ischemic encephalopathy (HIE) remains a leading cause of neonatal mortality and long-term neurological disability, particularly in resource-limited settings. Understanding predictive factors for early outcomes is crucial for optimizing management strategies. Objective: To identify demographic, maternal, and biochemical predictors of early management outcomes in newborns with HIE in a Nigerian tertiary health institution. Methods: A prospective hospital-based study was conducted at Nnamdi Azikiwe University Teaching Hospital, Nnewi, from September 2023 to May 2024. Seventy term newborns with HIE admitted within 72 hours of delivery were enrolled. HIE diagnosis was based on abnormal neurological examination using the Thompson score. Data on demographic characteristics, maternal factors, and biochemical parameters were collected and analyzed using SPSS version 25. Fisher's exact test and Chi-square analysis was used to determine associations between variables, with p<0.05 considered significant. Results: Among 70 newborns, 45.7% (32/70) experienced short-term adverse outcomes. The case fatality rate was 17.1% (12/70), while 28.6% (20/70) developed complications including seizures (80%), absent nutritive suckling (65%), poor Moro reflex (25%), respiratory distress (20%), and altered consciousness (15%). Significant predictors of adverse outcomes included place of delivery (p=0.005), with outborn babies showing higher risk than inborn deliveries. HIE severity was strongly associated with outcomes (p<0.001), as was 5 ^th minute Apgar score <7 (p<0.001). Maternal factors significantly associated with adverse outcomes included mode of delivery (p=0.032) and maternal occupation (p=0.020). Random blood glucose levels showed significant association with outcomes (p<0.001), while serum magnesium levels did not (p=0.980). Conclusion: HIE severity, low Apgar scores, outborn delivery status, and abnormal blood glucose levels were significant predictors of early adverse outcomes in newborns with HIE. These findings emphasize the importance of skilled birth attendance, early recognition, and prompt glucose monitoring in improving outcomes for affected newborns in resource-limited settings.