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 recorded 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