title: The burden of hypoxic-ischaemic encephalopathy in Malaysian neonatal intensive care units.
abstract: BACKGROUND
  This study aimed to determine the incidence of hypoxic-ischaemic encephalopathy (HIE) and predictors of HIE mortality in Malaysian neonatal intensive care units (NICUs).
  
  
  METHODS
  This was a retrospective study of data from 37 NICUs in the Malaysian National Neonatal Registry in 2012. All newborns with gestational age ≥ 36 weeks, without major congenital malformations and fulfilling the criteria of HIE were included.
  
  
  RESULTS
  There were 285,454 live births in these hospitals. HIE was reported in 919 newborns and 768 of them were inborn, with a HIE incidence of 2.59 per 1,000 live births/hospital (95% confidence interval [CI] 2.03, 3.14). A total of 144 (15.7%) affected newborns died. Logistic regression analysis showed that the significant predictors of death were: chest compression at birth (adjusted odds ratio [OR] 2.27, 95% CI 1.27, 4.05; p = 0.003), being outborn (adjusted OR 2.65, 95% CI 1.36, 5.13; p = 0.004), meconium aspiration syndrome (MAS) (adjusted OR 2.16, 95% CI 1.05, 4.47; p = 0.038), persistent pulmonary hypertension of the newborn (PPHN) (adjusted OR 4.39, 95% CI 1.85, 10.43; p = 0.001), sepsis (adjusted OR 4.46, 95% CI 1.38, 14.40; p = 0.013), pneumothorax (adjusted OR 4.77, 95% CI 1.76, 12.95; p = 0.002) and severe HIE (adjusted OR 42.41, 95% CI 18.55, 96.96; p < 0.0001).
  
  
  CONCLUSIONS
  The incidence of HIE in Malaysian NICUs was similar to that reported in developed countries. Affected newborns with severe grade of HIE, chest compression at birth, MAS, PPHN, sepsis or pneumothorax, and those who were outborn were more likely to die before discharge.
authors.affiliation: Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor.
authors.forename: Nem-Yun
authors.initials: NY
authors.lastname: Boo
authors.affiliation: Department of Paediatrics, Paediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
authors.forename: Irene Guat-Sim
authors.initials: IG
authors.lastname: Cheah
mesh_terms: D005260:Female; D005865:Gestational Age; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology* / Q000401:mortality; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008296:Malaysia; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D018805:Sepsis / Q000473:pathology
keywords: hypoxic-ischaemic encephalopathy; predictors of early mortality; term newborns