Perinatal asphyxia in less developed countries (original) (raw)
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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.
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.
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.
Determinants of Birth Asphyxia among Newborn in a Zonal Hospital
Janaki Medical College Journal of Medical Science
Background & Objective: Birth asphyxia is a leading cause of brain damage. Early identification and managing of its contributing factor would change the burden of birth asphyxia. Therefore, the objective of this study was to identify the determinants of birth asphyxia among newborn in a zonal hospital, Dhanusha, Nepal. Material and Methods: A case control study was carried out among 192 newborns where cases and controls were taken in the ratio of 1:1. Newborns with an APGAR score of less than 7 at 1 min and 5 min were taken as cases, and those with greater or equal to 7 were taken as controls. Case includes all asphyxiated newborns at time of data collection. There were total 96 birth asphyxiated newborn and equal number of non-asphyxiated newborn meeting the inclusion criteria were included as a control group. Data was collected by using structured interview schedule and chart review. The data was entered into SPSS version 16. The data were analyzed by frequency, percentage, mean, ...
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.
Study of risk factors in children with birth asphyxia
International Journal of Contemporary Pediatrics, 2017
Background: Birth asphyxia is a serious clinical problem worldwide and contributes greatly to neonatal mortality and morbidity. Perinatal asphyxia is the fifth largest cause of under-5 deaths (8.5%) after pneumonia, diarrhea, neonatal infections and complications of preterm birth. Risk factors of birth asphyxia have been divided into antepartum, intrapartum and fetal. Risk factors include increasing or decreasing ma-ternal age, prolonged rupture of membranes, meconium stained fluid, multiple births, non-attendance for antenatal care, low birth weight infants, malpresentation, augmentation of labour with oxytocin, antepartum haemorrhage, severe eclampsia and pre-eclampsia, ante partum and intrapartum anemia. The objective of this study was to study the risk factors in children with birth asphyxia.Methods: Observational prospective study was conducted on babies delivered in our hospital and requiring resuscitation (basic and/or advanced). Their clinical course was observed and studied...
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.
Clinical Profile of Birth Asphyxia in Newborn
2013
Background Perinatal asphyxia is an insult to the fetus and newborn due to lack of oxygen or a lack of perfusion to the various organs. 1 Available datas indicate that perinatal asphyxia continues to be one of the major causes of preventable perinatal mortality and morbidity, especially in the developing countries. Material and methods, this study aims to describe various clinical features and severity of birth asphyxia with their outcome in newborns. .120 neonates with birth asphyxia admitted to the neonatal intensive care unit, formed the basis of study. 40 newborns who were normal or faced mild asphyxia were taken as control for comparision. Results, out of 120 newborns, 28(23.33%) expired. Recovery rate in moderate asphyxiated babies was 8% and in severely asphyxiated was 65%. Conclusion, proper antenatal care,early detection and appropriate management involving advanced life support can reduce morbidity and mortality due to birth asphyxia.
KYAMC Journal, 2017
Background: Perinatal asphyxia (PNA) is one of the most important causes of perinatal mortality and morbidity which can be preventable and managable.Objectives: The purpose of the study was to determine the prevalence of perinatal asphyxia and to explore the factors influencing or related to the development of the PNA.Materials and Methods: It is a cross-sectional study conducted in the neonatal unit of department of pediatrics, KYAMC hospital from January 2015 to December 2016. Two hundred eleven neonates admitted in neonatal unit including SCABU were enrolled in the study considering inclusion criteria. Necessary information about sociodemography, peri-natal history (including antepartum, intrapartum and fetal risk factors) were collected by detailed history taking on a pre-designed questionnaire. Clinical examinations and outcomes were also recorded. We used Student's t-test and ?2-test to determine the association of PNA with various risk factors.Results: The male to female ...