1. Hypoxic-Ischaemic Encephalopathy (HIE) in Wales R Adappa

2. Back ground Aims Methodology Results Summary

3. Background HIE important cause of neonatal mortality and morbidity Incidence in literature 1-6/1000 births * * De Vries LS, Jongmans MJ. Long-term outcome after neonatal hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2010;95:F220-F224

4. Background The incidence of moderate and severe HIE in literature is 0.5-2/1000 births* * UK TOBY. Whole body hypothermia for the treatment of perinatal asphyxia encephalopathy: Summary study protocol. 2005. www.npeu.ox.ac.uk/tobywww.npeu.ox.ac.uk/toby *Garcia-Alix A et als. Neonatal hypoxic-ischemic encephalopathy: incidence and prevalence in te first decade of the 21 st century. An Pediatri 2009;71(4):319-26

5. Background significant risk of mortality in severe HIE morbidity in survivors cognitive, behavioural memory problems seizures cerebral palsy of varying degrees

7. Background Therapeutic hypothermia 11 RCT’s with 1505 term and late preterm infants (mod and sev encephalopathy and evidence of intrapartum asphyxia) statistically significant and clinically important reduction in the combined outcome of mortality or major neurodevelopmental disability to 18 months of age (NNT 7) Cooling reduces mortality without increasing major disability in survivors. six hours of age *Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013 Jan 31

8. Aims Incidence of HIE in Wales Interrogate the badgernet database and attempt to describe diagnosis, management, short term outcome, location of care etc Indirect evidence/audit of badgernet data quality

9. Methodology Full data download for babies born in Wales in from BadgerNet 2013 Extract from the full download. All episodes with ‘birth asphyxia’ and ‘HIE’ in the ‘principle diagnosis list’ or ‘diagnosis at any time during stay’ were used to extract HIE cases.

10. Results Total number of neonates with diagnosis of HIE= 76 Incidence of HIE in Wales in 2013= 76/33805 2.2/1000 births *Literature 1-6/1000 births (33-202/year)

11. Results Grade 1= 31 (41%) Grade 2 = 25 (33%) Grade 3 = 20 (26%) Combined (2&3)= 45 moderate and severe HIE in Wales in 2013 =45/33805 Combined incidence of 1.3/1000 births. *Literature 0.5-2.0/1000 births (17-67)

12. Results median birth weight was 3115g median gestation of 40 weeks Male: Female ratio 1:1.2 Singleton babies accounted for 72/76 4 were one of twins (all 4 were 2 nd of twins 3 were <2500gms)

13. Results Grade 1 HIE: 31/76 (41%) 15 were cooled (48%) 4 had seizures (?) No deaths

14. Results Grade 2 HIE 25/76 (33%) 22 were cooled (88%) 6 had seizures (?) 1 died (congenital myotonic dystrophy)

15. Results Grade 3 HIE 20/76 (26%) 16 were cooled (80%) 12 had seizures (5 had more than 1 anticonvulsants) 10 died

16. Results 70% of all neonates with diagnosis of HIE were cooled (48% grade 1; 88% grade 2; 80% grade 3) 10/76 (13%) died - 8 cooled

18. Results North Wales- 9 South Wales-66 South Wales: Level 3 units (NNU)=32/11729 Level 2 units (LNU)= 34/11494

19. Results Level 3 units (NNU): Grade 1= 14 (10 cooled) Grade 2= 6 (6 cooled) Grade 3= 12 (12 cooled)

20. Results Level 3 units in South Wales: A: 2.7/1000 births B: 2.8/1000 births C: 1.6/1000 births Wales: 2.2/1000 births Literature: 1-6/1000 births

21. Results Level 2 units in South Wales A: 1.8/1000 births B: 1.8/1000 births C: 1.2/1000 births D: 5.1/1000 births E: 3.6/1000 births G: 2.3/1000 births E: 2.7/1000 births Wales: 2.2/1000 births Literature: 1-6/1000 births

22. Results North Wales: A: 1.4/1000 births B: 0.45/1000 births C: 2.1/1000 births Wales: 2.2/1000 births Literature: 1-6/1000 births.

23. Summary Incidence of HIE in Wales in 2013 =2.2/1000 Incidence of mod + severe HIE =1.3/1000 Grade 1 HIE =41%; Grade 2= 33%; Grade 3=26% If diagnosis of HIE= 70% cooled (48%vs88%vs80%) 10% babies died all grade 3

24. What next?