Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: population based study

Objectives: To ascertain the prevalence of newborn encephalopathy in term live births, and also the underlying diagnoses, timing, and outcome at 2 years of surviving infants. Design: Population based observational study. Setting: North Pas-de-Calais area of France, January to December 2000. Patients: All 90 neonates with moderate or severe newborn encephalopathy. Results: The prevalence of moderate or severe newborn encephalopathy was 1.6A per 1000 term live births (95% confidence interval (Cl) 1.30 to 1.98). The prevalence of birth asphyxia was 0.86 per 1000 term live births (95% Cl 0.61 to 1.10). The main cause of newborn encephalopathy was birth asphyxia, diagnosed in 47 (52%) infants. It was associated with another diagnosis in 11/47 cases (23%). The timing was intrapartum in 56% of cases, antepartum in 13%, ante-intrapartum in 10%, and postpartum in 2%. In 19% of cases, no underlying cause was identified during the neonatal course. Twenty four infants died in the neonatal period, giving a fatality rate of 27% (95% Cl 17% to 36%). Three infants died after the neonatal period. At 2 years of age, 38 infants had a poor outcome, defined by death or severe disability, a prevalence of 0.69 per 1000 term live births (95% Cl 0.47 to 0.91). In infants with isolated birth asphyxia, this prevalence was 0.36 per 1000 term live births (95% Cl 0.20 to 0.52). Conclusions: The causes of newborn encephalopathy were heterogeneous but the main one was birth asphyxia. The prevalence was low, but the outcome was poor, emphasising the need for prevention programmes and new therapeutic approaches.