Risk factors for development of hypoxic-ischemic encephalopathy in Abha City-southwestern Saudi Arabia.

Hypoxic ischaemic encephalopathy (HIE) is an important cause of permanent damage to central nervous system, which may result in neonatal death or manifest as cerebral palsy or mental deficiency. A matched-case control study of neonatal encephalopathy was conducted in Abha General Hospital, Abha City, Saudi Arabia to determine some possible risk factors for HIE. A total of 57 term infants with clinical evidence of HIE at birth were recruited over a period of 3 years, and compared with the same number of a control group of normal newborns. The cumulative incidence of HIE was 4.9 per 1000 live births (95% CI: 3.1 to 6.3). Moderate or severe encephalopathy occurred in about 63% of all infants, with seizures in 67% of these. All the 57 (100%) infants with encephalopathy required one or more of resuscitation measures compared with only 8 (14%) of the control. Significant antepartum risk factors for HIE include: primiparity (OR=3.13), nonaccessibility to antenatal care (OR=1.89), and pregnancy-induced hypertension(OR=2.13). Significant possible labour and delivery risk factors include: noncephalic presentation (OR=2.76)), antepartum haemorrhage (OR=4.32), instrumental delivery (OR=7.91), and prolonged second stage of labour (OR=6.67). In conclusion, both antepartum and intrapartum factors are important in the causation of HIE in Abha city. Improvement of both antenatal care and care during delivery is a necessity.