A descriptive research audit of the long term developmental outcomes of 30 infants with Hypoxic Ischemic Encephalopathy (HIE) who received hypothermia at a secondary Hospital in South Africa

Abstract

Introduction: Hypothermia is a neuroprotective strategy proven to reduce death and disability in children presenting with Hypoxic
Ischemic Encephalopathy (HIE). Little evidence exists regarding the long term developmental outcomes of infants who received
hypothermia within a secondary hospital in South Africa.
Method: Drawing on a descriptive research audit this paper describes the development (up to five years) of 30 infants with HIE 
who received hypothermia at the George hospital in South Africa. Developmental outcomes were measured at 3, 9, 12, 24 and 
36 months using the Strive Towards Achieving Results Together (START) and at 48 and 60 months using the Early Childhood 
Developmental Criteria (ECDC). Summary data (variables considered risk factors) were collected retrospectively. The associations between this data and developmental outcomes are described.
Results: Twenty children presented with typical development, eight presented with cerebral palsy (CP) and two were lost to 
follow up. A significant association between a severe HIE score and CP was found (p=0.0005). The children performed equally in fine motor, gross motor and cognitive abilities at four years with poorer outcomes in cognitive and fine motor abilities recorder at five years. 
The perceptual activity both age groups struggled with the most was directionality. .
Conclusion: The results of the research audit support the need for long-term occupational therapy follow-up of children with 
HIE to monitor their development and provide specific interventions to promote their development and prevent barriers to 
learning.  This paper also advocates the need for occupational therapists working in the public health sector to have access to standardised assessment tools which allow them to closely monitor the development of infants who present with HIE at birth.

Key words: Hypoxic Ischemic Encephalopathy, hypothermia, developmental outcomes, environment