Clinical Profile of Birth Asphyxia in Newborn (original) (raw)
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Perinatal Factors Leading to Birth Asphyxia among Term Newborns in a Tertiary Care Hospital
PubMed, 2014
Objective: To determine various perinatal factors leading to birth asphyxia among term newborns in a tertiary care hospital. Methods: In a cross sectional study, a total of 196 asphyxiated cases were selected through consecutive non-probability sampling technique from neonatal intensive care unit (NICU) of a tertiary care Military Hospital in Pakistan from 1st December 2012 to 1st December 2013. Data obtained was analyzed using SPSS version 15.0. Descriptive statistics were used to calculate means, standard deviations and frequencies. Stratification with respect to maternal age, gestational age, newborns weight, parity and gravidity was done and post stratification chi-square test was applied to find statistical significance. Findings: Out of 196 cases, 125 (64%) were males and 71 females (36%). Mean maternal age was 27.04+4.97 years and gestational age of babies was 39.86+1.24 weeks. Majority (57.14 %) of 112 mothers were 1-3 para and ≥4 parity was recorded in 84 (42.86%) cases. Majority (64.80%) of the 127 mothers were 1-3 gravida while 69 (35.20%) had ≥4 gravidity, mean of 3.45+0.87. Mode of delivery as a factor leading to birth asphyxia was found in 32.14% (n=63) cesarean section, 44.39% (n=87) spontaneous vertex delivery, and instrumental delivery in 23.47% (n= 46). Prolonged second stage of labor reported in 72% (n=141), 29.08% (n=57) had prolonged rupture of membranes, 7.65% (n=15) had meconium staining, 5.61% (n=11) had multiple births, 21.94% (n=43) had maternal fever, and 58.84% (n=113) had anemia at delivery. Conclusion: Birth asphyxia is a preventable problem and long term neurological sequelae almost untreatable. Timely identification of the perinatal risk factors and their prompt solution can prevent and reduce the neonatal morbidity and mortality from birth asphyxia. Early identification of high-risk cases with improved antenatal and perinatal care can further decrease such high mortality.
Background: Perinatal asphyxia a leading cause of mortality and morbidity in under 5 years age group is a manifestation of both maternal and child health status of a country. Identifying both maternal and fetal health risk factors contributing to perinatal asphyxia, proper intervention and appropriate newborn care and follow up of NICU graduates can plummet the health burden of asphyxia. Our study aims at identifying both maternal and fetal risk factors precipitating perinatal asphyxia, monitoring the outcome of asphyxia on standard treatment protocol, and follow up of surviving asphyxiated babies and their neurological impairment. Materials and Methods: It's a combination of cross sectional descriptive and observational prospective single center based study with a cohort of 98 newborns who satisfied the inclusion criteria and got enrolled consecutively. The study was conducted at Pediatric Medicine department at a tertiary care hospital over a time period of 1 year from May 2018 till April 2019. We followed the definition of perinatal asphyxia enunciated by WHO and NNF, and excluded babies with birth weight < 1500gm or with major congenital anomalies. Results: Out of 98 enrolled newborn who suffered perinatal asphyxia, 6 babies died during hospital stay and rest 92 got discharged and they were followed up till next 6 months. The mean maternal age is 23.98 ± 3.38 years and mean birth weight of the babies were 2.34 ±0.38 kg , with Anemia being the commonest maternal risk factor (34.69%) and preterm delivery (42.85%) was the commonest fetal risk factor. Vaginal delivery (73.47%) being the commonest mode of delivery and most of the labour cases were booked (75.5%) and multigravida (52.04%). 68.3% babies suffered mild to moderate asphyxia and rest 31.6% had severe asphyxia but total 55% total had hypoxic-ischemic encephalopathy(HIE) consequences. There was variable level of organ damage with perinatal asphyxia and most of them had statistically significant correlation with extent of asphyxia except necrotizing enterocolitis (NEC). On post discharge 6 months follow up we recorded and found, 26.08% having feeding problem, 19.55% having microcephaly, 22.83% neurological problem as per Hammersmith infant neurological examination chart (HINE) , 7.6% having hearing loss, 17.39% having vision problem. Conclusion: Anemia correction, adequate antenatal care, essential newborn care and socioeconomic elevation can bring down incidence of perinatal asphyxia. Also early neurological assessment of newborn can detect anomaly and an early intervention will minimize neurological handicap due to neuronal plasticity.
Clinical Profile and Outcome of Asphyxiated Newborn in a Medical College Teaching Hospital
Journal of Lumbini Medical College, 2016
Introduction: Perinatal asphyxia, a major topic in neonatology, is a severe condition which has a high impact on neonatal mortality and morbidity and neurological and intellectual development of the infant. It is defined by WHO as "failure to initiate and sustain breathing at birth". It is estimated that around four million babies are born asphyxiated and among those one million die and an equal number of babies develop serious neurological consequences ranging from cerebral palsy and mental retardation to epilepsy. This study was done to identify the occurrence, clinical profile and, immediate outcome of perinatal asphyxia in Lumbini Medical College Teaching Hospital. Methods: It was a retrospective study where 82 cases who fulfilled the inclusion criteria were included between December 2014 to November 2015. Inclusion criteria included newborns with: a) Apgar score equal to or less than six at five minutes, b) requirement of more than one minute of positive pressure v...
Outcome Assessment of Perinatal Asphyxia in Children
Scholars Journal of Applied Medical Sciences
Original Research Article Perinatal Asphyxia (also known as Neonatal Asphyxia or Birth Asphyxia in children) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. Perinatal Asphyxia in children is defined by the World Health Organization "the failure to initiate and sustain breathing at birth." The aim of this study was to assess the outcome of Perinatal Asphyxia in children. There were 204 live birth asphyxia neonates whose were clinically diagnosed admitted in the Department of Pediatrics, Shaheed M. Monsur Ali Medical College & 250 beded Genaral Hospital, Sirajgonj, Bangladesh during the period from January 2017 to December 2018. Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The SCANU records provided additional information about new born infant (birth asphyxia, stages of Perinatal Asphyxia in children, birth weight, sex and subsequent mortality).The outcome of treatment in babies with Perinatal Asphyxia in children showing in (Table-3) Recovery rate in group one (HIE I) was 28(13.78%), in group two (HIE II) was 150(73.53%) and in group three (HIE III) was 10(4.9%) and Death ratio was in group one (HIE I) was 2(0.98%), in group two (HIE II) was 4(1.96%) and in group three (HIE III) was 10(4.90%). The morbidity and mortality in cases of Perinatal Asphyxia in children the highest causes of death in stage 3(HIE III), Preterm with Hyaline membrane disease was 4(25%) and then the higher causes of death in stage-II was Neonatal sepsis 3(18.75%). Perinatal Asphyxia in children was one of the commonest causes of admission and mortality in SCANU and others beds. Babies with HIE Stage-III had a very poor prognosis. Perinatal Asphyxia in children combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of Perinatal Asphyxia in children. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergency caesarean section, preterm and male sex were the risk factors for Perinatal Asphyxia in children.
Introduction: Perinatal asphyxia (also known as neonatal asphyxia orPerinatal Asphyxia in children) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain.Perinatal Asphyxia in children is defined by the World Health Organization "the failure to initiate and sustain breathing at birth Aim of the Study:The aim of this study was to assess the outcome of perinatal asphyxia in childrenand neonatal risk factors, and study the cause of death. Material & Methods: There were 127 live births asphyxiated neonates who were clinically diagnosed and admitted in the department of Pediatrics, Natore District Hospital, Natore, Bangladesh during the period from January 2018 to December 2018.Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The Hospital records provided additional information about new born infant (birth asphyxia, stages of Perinatal Asphyxia in children, birth weight, sex and subsequent mortality). Results:The outcome of treatment in babies with birth asphyxia showing the recovery rate in group one (HIE I) was 18(14.17%) , in group two (HIE II) was 90(70.87%) and in group three (HIE III) was 7(5.51%) and Death ratio was in group one (HIE I) was 2(1.57%) , in group two (HIE II) was 3(2.36%) and in group three (HIE III) was 7(5.51%). In Table-4 the morbidity and mortality in cases of birth asphyxia the highest causes of death in stage 3(HIE III) was 7(58.53%) Preterm with Hyaline membrane disease was 3(25%) and then the higher causes of death in stage II were Neonatal sepsis 2(16.67%). Conclusion: Birth asphyxia was one of the commonest causes of admission and mortality in the department of Pediatrics, Natore District Hospital, Natore, Bangladesh l. Babies with HIE Stage III had a very poor prognosis. Birth asphyxia combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of birth asphyxia. Maternal gravida, pregnancy complication with PROM,Thick meconium stain, APH, emergency caesarean section, term and male sex were the risk factors for birth asphyxia.
Neonatal asphyxia is a condition in which a baby can not breathe spontaneously and regularly soon after birth so can cause infant growth is not optimal due to lack of oxygen from the mother to the fetus that can cause the baby hypoxia. The occurrence of asphyxia due to several factors such as maternal age, gestational age, parity, birth weight, type of delivery and prolonged labor. This is a descriptive study that aims to describe the causes of neonatal asphyxia in newborns in Perinatology space Hospital Dr. Pirngadi MedanTahun 2014. This study was a survey, and the population in this study were all women who give birth to babies with neonatal asphyxia, amounting to 90 people. The result showed that majority of respondents (80%) age <20 years, 41.3% of respondents preterm gestational age (28-36 weeks), 47.4% of respondents grandemultipara (number of children> 5), 51.1% of respondents having a baby with normal birth weight, 57.1% of respondents do not normal childbirth and 59.3% of respondents who gave birth to a baby with neonatal asphyxia experienced prolonged labor. Mother suggested to give more attention to health both before and after childbirth and health workers also to improve their knowledge and skills in performing the management of asphyxia by means ranging from aspects promotive, curative, rehabilitative so that mortality and morbidity in infants decreased.
Progress in perinatal asphyxia
Seminars in Neonatology, 1999
Key words: birth asphyxia, neonatal encephalopathy, hypoxic-ischaemic encephalopathy, flesh stillbirth, perinatal mortality, meconium, traditional birth attendant Neonatal encephalopathy (NE) is a more specific marker than low Apgar score for significant perinatal asphyxia in term infants. The proportion of NE associated with intrapartum hypoxia is probably higher in low income than high income settings. The perinatal mortality rate associated with asphyxia ranges typically between 10 and 20 per 1000, and the prevalence of neonatal encephalopathy between 5 and 25 per 1000 total births in low income countries. The impact of traditional birth attendant programmes is limited by the low specificity of maternal risk assessment schemes and poor referral pathways, although there is emerging evidence of a role for domiciliary resuscitation. Primary prevention in hospital settings should focus on intrapartum monitoring and appropriate management guidelines, including amnioinfusion for meconium-stained liquor. Resuscitation guidelines should emphasize measures to minimize meconium aspiration in the depressed infant. Neuroprotective strategies are entering the stage of clinical trials. Appropriate neonatal management guidelines for the developing country clinician are described.
Indian Journal of Child Health, 2017
erinatal asphyxia is the third major cause of neonatal mortality in India [1]. It is also the fifth largest cause of underfive mortality and exerts a great pressure on the health system [2]. According to the World Health Organization (WHO), around 4 million babies develop birth asphyxia, and asphyxiated newborn may develop severe consequences such as epilepsy, cerebral palsy, developmental delay, and mental retardation. Furthermore, of 1.2 million neonatal deaths in India, 300,000-350,000 babies die due to perinatal asphyxia mostly within first 3 days of life [3]. Asphyxial injury may involve virtually every organ system of the body, but hypoxic ischemic encephalopathy (HIE) is the most studied and serious sequelae. The severity of HIE symptoms reflects the timing and duration of insult. The majority (90%) of the insults occur in the antenatal and intrapartum period. The remainder is in the immediate postnatal period due to cardio respiratory or neurological abnormalities [4]. The means of assessment include Apgar scores, blood pH, fetal heart rate abnormalities, need for resuscitation, neurological changes, and evidence of multiorgan dysfunction [5]. Umbilical cord blood gas analysis is now recommended in all high risk deliveries by both the British and American college of obstetricians and gynecologists. Low cord pH in neonates without cardiopulmonary compromise does not indicate an increased risk of adverse outcome. Babies, with pH <7 at birth and nonvigorous, have high risk of adverse outcome. In a study by Yeh et al., the ideal cord arterial blood pH was 7.26-7.30. The risk of adverse neurological outcome starts to rise at a pH <7.10, with the risk being highest at a pH <7 [6]. A systematic review in 2010 concluded that low arterial pH in umbilical cord strongly correlated with adverse outcomes such as HIE, periventricular leukomalacia (PVL), intracranial hemorrhage, cerebral palsy, and death [7]. An umbilical cord pH <7.2 immediately after birth is used as a prognostic factor for unfavorable short-term outcome in newborn [8]. In an asphyxiated newborn, an artery cord sample may underestimate the acidosis in fetus or newborn since lactic acid produced by hypoxia at tissue level will not be cleared to central circulation. As the baby is resuscitated, circulation improves and tissue lactic acid reaches the central circulation. The postnatal base deficit obtained from an asphyxiated newborn within 1 st h after delivery is found to be worse than cord levels, and hence, this blood gas parameter is one of the most accurate predictors of neurological outcome [9]. In spite of improvements in obstetric and neonatal care, the incidence of birth asphyxia in India is high. The neonatal mortality has slightly decreased but morbidity in the form of neurological damage is same or increased due to survival of asphyxiated ABSTRACT Introduction: In India, in spite of improvement in perinatal-neonatal care, perinatal asphyxia accounts for 23% of the neonatal deaths. Objective: The objective of the study was to study the clinical profile and short-term outcome of perinatally asphyxiated term neonates. Materials and Methods: This prospective study conducted at a tertiary care teaching hospital in Southern Kerala from June 2011 to June 2015. 120 term asphyxiated neonates fulfilling the inclusion criteria admitted in the NICU were followed up till death or survival. Results: 49.2% babies were inborn and 50.8% babies were outborn. Of the total, 53 (44.2%) were delivered vaginally, 54 (45%) by cesarean section, and 13 (10.8%) by instrumental delivery. Antenatal complications were seen in 58 (48.3%) and intrapartum complications in 93 (77.5%). Hypoxic ischemic encephalopathy (HIE) was diagnosed in 78.3%, with HIE 1 in 19.3%, HIE 2 in 27.5%, and HIE 3 in 31.6%. The mortality was 31 (25.8%) and it was more in out born babies compared to inborn. Factors associated with development of severe HIE (HIE 3) were male gender (p=0.0057), need for endotracheal intubation (p=0.0114), instrumental delivery and pH <7.2 (p=0.0013). Factors associated with mortality were instrumental delivery (p=0.0032), place of birth (p=0.0012), pH ≤ 7 (p=0.0006), HIE 3 (p<0.0001), and 5 min Apgar ≤3 (p=0.0372). Conclusion: HIE was seen in 78.3% perinatally asphyxiated babies with HIE 3 contributing to 31.6%. The mortality rate in HIE 3 was 81.6% which was significantly associated with place of birth, instrumental delivery, pH <7, and 5 min Apgar ≤3.
Background: Many clinical, pathological, biochemical and metabolic changes occur as a result of perinatal asphyxia. These changes affect many organ and systems like central nervous system, cardiovascular system, pulmonary, renal, adrenal, gastrointestinal tract, skin and haemopoetic systems. The aim of the study was to identify various clinical and biochemical determinants of outcome in perinatal asphyxia so as to institute proactive the management of such babies. Methods: All newborn infants with birth asphyxia over 5 year period (2009-2013) were retrospectively studied. The data studied included place of birth, gestational age, Apgar score, mode of resuscitation, details of complete physical examination especially as regard each of the system. Results of investigations like haematocrit, serum electrolytes and urea, blood glucose done in the first 24 hours of life and also other investigations like lumbar puncture, full blood count, cultures were noted. The outcome studied was survival and death of the babies. Results: One thousand, six hundred and seven babies were admitted into special care baby"s unit over the 5 year period, between 2009 and 2013. Nine hundred and seventy nine (60.9%) of them were males while 628 (39.1%) were females, M:F ratio was 1.6:1. Of the 1607 babies, 563 (35.0%) were asphyxiated. Of 1607 admitted during the period of study, 304 (18.9%) died while 128 (22.7%) of 563 babies with perinatal asphyxia died. Therefore, perinatal asphyxia accounted for 42.1% of the total mortality. 22 (7.8%) of the 280 babies who suffered moderate asphyxia compared with 106 (37.9%) of 283 babies who suffered severe asphyxia died. (χ2 = 72.4, p=0.000). Many of the asphyxiated babies had multisystemic adverse features. Significantly more babies who were out born, low birth weight, macrosomic and hypothermic than otherwise died. Also more babies with cyanosis, respiratory distress, apnoea, abdominal distension, feed intolerance, oliguria/anuria, bleeding disorder, abnormal muscle tone, seizures, bulging frontannel, and coma died, p ≥ 0.001. Also, mean haematocrit, plasma potassium and urea was significantly lower while plasma sodium was significantly higher among the babies who survived (p ≥0.001). Conclusions: Our findings have highlighted the major role of asphyxia in neonatal mortality and multisystemic morbidities or complications which contributed to death. It is therefore, likely that efforts at preventing perinatal asphyxia will be more rewarding. Such efforts include free and compulsory antenatal care, training of more skilled labour attendants and women empowerment.
Journal of Nepal Medical Association
Introduction: Perinatal asphyxia is one of the major causes of perinatal and early neonatal mortality in developing countries. The main objective of this study was to observe the prevalence of perinatal asphyxia in babies born at Kathmandu Medical College Teaching Hospital. Methods: This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six month period (January to June 2019). All preterm, term and post term babies delivered at Kathmandu Medical College Teaching Hospital were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College (Ref.:2812201808). Convenient sampling method was applied. Data analysis was done in Statistical Package for Social Sciences (SPSS 18), point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: A total of 1284 babies delivered over six months period were enrolled in this study and 47 (3.66 %) b...