title: Risk factors for hypoxic ischemic encephalopathy in children.
abstract: OBJECTIVE
  To determine underlying risk factors in neonates with hypoxic ischemic encephalopathy.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Neonatology Unit at the Children's Hospital and the Institute of Childhealth, Lahore, from March to July 2005.
  
  
  METHODS
  All neonates (153) with the diagnosis of Hypoxic Ischemic Encephalopathy (HIE) were included in the study. Controls (187) were selected from admissions on the same day. Possible risk factors such as maternal age, parity, antenatal monitoring, place of delivery, prolonged second stage of labour, type of delivery, type of attendant at delivery and the gestational age were noted and compared.
  
  
  RESULTS
  Sixty one (39.9%) mothers of asphyxiated babies reported no antenatal visits compared to 24.1% in the control group (OR 2.1, 95% CI 1.3-3.2; p=0.002). Only 6.5% of cases were born in government hospitals (teaching and district) in comparison to 20.9% of controls (OR 3.8, 95% CI 1.9-7.6; p=0.001). In 28.1% of cases, mothers had history of prolonged 2nd stage of labour in comparison to 5.9% of controls (OR 6.3, 95% CI 3.3-11.9; p<0.001). Fifty five cases (35.9%) were delivered by unskilled birth attendants compared to 28 (14.9%) controls (OR 3.2, 95% CI 1.9-5.3; p<0.001). No significant difference was found in maternal age, maternal parity, gestational age and the mode of delivery between the two groups.
  
  
  CONCLUSIONS
  Delivery by unskilled birth attendant, prolonged second stage of labour, birth in a non-government hospital setup and absence of antenatal care were significant risk factors for hypoxic ischemic encephalopathy in neonates. Improvement in antenatal and intrapartum care may be helpful in decreasing the frequency of this problem.
authors.affiliation: Department of Paediatrics, The Services Institute of Medical Sciences, Lahore. tayyabutt@hotmail.com
authors.forename: Tayyaba Khawar
authors.initials: TK
authors.lastname: Butt
authors.forename: Rehan
authors.initials: R
authors.lastname: Farooqui
authors.forename: M Aman Ullah
authors.initials: MA
authors.lastname: Khan