Neurodevelopmental Outcomes Following Perinatal Asphyxia Among Children Attending Sheikhan General Hospital, Nineveh, Iraq

Background: Perinatal asphyxia is a major cause of neonatal morbidity and mortality worldwide and remains an important contributor to long-term neurological disability among survivors. Children affected by perinatal asphyxia are at increased risk of developmental delay, cerebral palsy, seizure disorders, hearing impairment, and other neurodevelopmental abnormalities. Early identification of these outcomes is essential for timely intervention and improved long-term prognosis. Objectives: To evaluate the neurodevelopmental outcomes of children with a history of perinatal asphyxia attending Sheikhan General Hospital and to identify factors associated with adverse neurodevelopmental outcomes. Methods: This retrospective cohort study was conducted at Sheikhan General Hospital, Nineveh Governorate, Iraq, from July 2024 to March 2026. A total of 76 children with a documented history of perinatal asphyxia were included. Data were collected from neonatal records, hospital files, and follow-up clinic records. Demographic characteristics, neonatal variables, severity of perinatal asphyxia, presence of hypoxic-ischemic encephalopathy, and neurodevelopmental outcomes were analyzed. Statistical analysis was performed using SPSS version 31. Associations between clinical variables and adverse neurodevelopmental outcomes were assessed using Chi-square and multivariate logistic regression analyses. A P value of less than 0.05 was considered statistically significant. Results: Male children constituted 57.9% of the study population, and 35.5% had low birth weight. Hypoxic-ischemic encephalopathy was documented in 43.4% of patients. Moderate and severe perinatal asphyxia accounted for 44.7% and 21.1% of cases, respectively. Normal neurodevelopment was observed in 67.1% of children, whereas adverse neurodevelopmental outcomes occurred in 32.9%. Developmental delay was the most common abnormal outcome (18.4%), followed by cerebral palsy (9.2%), seizure disorders (7.9%), and hearing impairment (5.3%). Adverse outcomes were significantly associated with severe perinatal asphyxia (P < 0.001), low birth weight (P = 0.002), hypoxic-ischemic encephalopathy (P < 0.001), and low Apgar scores (P = 0.001). Multivariate logistic regression analysis identified severe perinatal asphyxia (OR = 5.84, 95% CI: 1.76–19.34, P = 0.004), hypoxic-ischemic encephalopathy (OR = 4.23, 95% CI: 1.39–12.86, P = 0.011), and low birth weight (OR = 3.17, 95% CI: 1.08–9.28, P = 0.036) as independent predictors of adverse neurodevelopmental outcomes. Conclusions: Perinatal asphyxia remains an important cause of neurodevelopmental impairment among children. Developmental delay was the most frequent neurological sequela, and severe perinatal asphyxia, hypoxic-ischemic encephalopathy, and low birth weight were the strongest predictors of adverse neurodevelopmental outcomes. Regular developmental follow-up, early rehabilitation programs, and improvements in neonatal resuscitation and perinatal care are essential to reduce long-term disability and improve quality of life among affected children.