Hypoxic-Ischemic Encephalopathy Based on clinical biomarkers and associated risk factors in Neonates from Southern Ethiopian Public Hospitals: A Case Control Study

Hypoxic ischemic encephalopathy (HIE) is a serious condition that results from reduced oxygen supply and blood flow to the brain, leading to brain injury and potential long-term neurodevelopmental impairments. This study aimed to identify the maternal and neonatal factors that are associated with HIE among newborns in Ethiopia. An unmatched-control study was conducted in fifteen public hospitals in Southern Nation Nationalities and the Peoples Regional State of Ethiopia. Data were collected from 515 newborns with their index mothers (175 cases and 340 controls) using a structured questionnaire and clinical records which were created and managed by Kobo software for mobile-assisted data collection. Clinical biomarkers were used to diagnose Hypoxic ischemic encephalopathy. Logistic regression analysis was performed to identify the factors associated with Hypoxic ischemic encephalopathy. Maternal education, ultrasound checkup status, gestational age at delivery, mode of delivery, and labor duration were significantly associated with Hypoxic ischemic encephalopathy. Newborns born to illiterate mothers (AOR= 1.913, 95%CI: 1.177, 3.109), those whose mothers did not have an ultrasound checkup during pregnancy (AOR= 1.859, 95%CI: 1.073, 3.221), those who were born preterm (AOR= 4.467, 95%CI: 1.993, 10.012) or post-term (AOR= 2.903, 95%CI: 1.325, 2.903), those who were delivered by cesarean section (AOR= 7.569, 95%CI: 4.169, 13.741), and those who were delivered after prolonged labor (AOR= 3.591, 95%CI: 2.067, 6.238) had higher odds of developing Hypoxic ischemic encephalopathy than their counterparts. This study provides valuable insights into the risk factors for Hypoxic ischemic encephalopathy among newborns in Southern Ethiopia. Improving maternal education and health care services during pregnancy and delivery may help reduce the incidence and severity of Hypoxic ischemic encephalopathy. Future research should use laboratory or imaging investigations, including private health institutions, and explore the mechanisms and outcomes of Hypoxic ischemic encephalopathy. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board (IRB) of Dilla University, College of Medicine and Health Sciences approved this study ethically (protocol unique number 010/18-06) and wrote an official support letter to the regional health department of SNNPR. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Availability of Data and Materials: The data that supports this study is not publicly available due to ethical and privacy concerns. However, the corresponding author will share the data upon reasonable request. The data include anonymized demographic and clinical data of the participants and questionnaires. The data will be accessible for 10 years after the publication of this paper. To request data access, please contact Getnet Melaku Ayele at getsen12@gmail.com.