Risk factors for adverse outcome in asphyxiated new born in Eastern Nepal
Keywords:Birth asphyxia, Hypoxic ischemic encephalopathy, Mortality, New born
Background: Birth asphyxia is the third leading cause of neonatal deaths in developing countries. The present study was an attempt to find out the various risk factors associated with mortality in these cases.
Methods: This was a retrospective hospital based analysis of data in neonates with birth asphyxia admitted during the period February 2010 to January 2011. The demographic profile and outcome were recorded.
Results: Of 285 neonates, there were 212 (74.4%) outborn and 73 (25.6%) cases were inborn. Male were 207 (72.6%) and female were 78 (27.4%). One hundred eighty eight (66%) came from rural area. Two hundred sixty six (93.3%) were full term and 19 (6.7%) were preterm. Thirty two (11.2%) were delivered at home and 253 (88.8%) were institutional delivery among which 54 (18.9%) babies were born by caesarean section while 215 (75.4%) were by normal vaginal delivery and 16 (5.6%).were instrumental delivery. Thirty eight (13.3%) were found to be normal while clinical signs of HIE were present in 247(86.7%) babies, out of those 48 (16.8%) babies were in stage I, 136 (47.7%) in Stage II and 63 (22.1%) in stage III of HIE. Fifty nine (20.7%) babies died during the hospital stay. The babies who were born at home (p=0.028, OR=2.472, 95% CI 1.104-5.536), prematurity (p=0.024, OR=3.154, 95% CI 1.166-8.528) and shock at the time of admission (p=0.035, OR=2.261, 95% CI 1.061-4.821) had higher risk of mortality.
Conclusions: Thus unsupervised delivery at home, prematurity and presence of shock at admission affected the outcome in these babies. Therefore, institutional delivery with facility to care preterm baby and immediate treatment of complications are needed for better survival.
World Health Organization. Basic newborn resuscitation: a practical guide. World Health Organization; Geneva: WHO, 1998. Available at: http://www.who.int/maternal_child_ adolescent/ documents/who_rht_msm_981/en/1998. Accessed on July13, 2015.
Lawn, JE, Cousens, S, Zupan, J. For the Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: When? Where? Why? Lancet. 2005;365:891-900.
World Health Organization. The World Health Report, 1998: life in 21st Century F A vision for all. WHO: Geneva; 1998. Available at: www.who.int/whr/1998/en/ whr98_ en.pdf. Accessed on June 12, 2015.
Ellis M, Manandhar DS, Manandhar N, Wyatt J, Balam AJ, Costello AM. Stillbirths and neonatal encephalopathy in kathmandu, Nepal: an estimate of the contribution of birth asphyxia to perinatal mortality in low income urban population. Paediatr Perinat Epidermiol. 2000;14:39-52.
Lee AC, Mullany LC, Tielsch JM, Katz J, Khatry SK, Leclerq SC et al. Risk Factors for Neonatal Mortality due to Birth Asphyxia in Southern Nepal: A Prospective, Community-based Cohort Study. Pediatrics. 2008;121(5):1381-90.
Haider BA, Bhutta ZA. Birth asphyxia in developing countries: current status and public health implications. Curr Probl Pediatr Adolesc Health Care. 2006;36:178-88.
Bang AT, Bang RA, Baitule SB, Reddy HM, Deshmukh MD. Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitating with mouth-to-mouth, tube-mask or bag-mask. J Perinatol. 2005;25(suppl 1):82-91.
World Health Organization. Newborns: reducing mortality. Fact Sheet January 2016. Available at: http://www.who.int/mediacentre/factsheets/fs333/en/. Accessed on January 29, 2016.
Sarnat H, Sarnat M. Neonatal encaphalopathy following fetal distress. Arch Neurol. 1976;33:695- 705.
MoHP Nepal, New ERA, ICF International Inc. Nepal demographic and health survey 2011. Kathmandu, Nepal; Calverton, MD: Ministry of Health and Population, New ERA, and ICF International Inc., 2012. Available at: www.dhsprogram.com /pubs /pdf /FR257/ FR257%5B13 April2012%5D.pdf. Accessed on June 13, 2015.
Okolo AA, Omene JA. Trends in neonatal mortality in Benin City, Nigeria. Int J Gynaecol Obstet. 1985;23(3):191-5.
Mbweza E. Risk factors for perinatal asphyxia at queen eliza beth central hospital, Malawi. Clin Excell Nurse Pract. 2000;4(3):158-62.
Paul VK, Singh M, Sundaram KR, Deorari AK. Correlates of mortality among hospital born neonates with birth asphyxia. Natl Med J India. 1997;10(2):54-7.
Fotopoulos S, Mouchtouri A, Xanthou G, Lipsou N, Petrakou E, Xanthou M. Inflammatory chemokine expression in the peripheral blood of neonates with perinatal asphyxia and perinatal or nosocomial infections. Acta Paediatr. 2005;94(6):800-6.
Fotopoulos S, Pavlou K, Skouteli H, Papassotiriou I, Lipsou N, Xanthou M. Early markers of brain damage in premature low birth weight neonates who suffered from perinatal asphyxia and/or infection. Biol Neonate. 2001;79(3-4):213-8.
Xanthou M, Fotopoulos S, Mouchtouri A, Lipsou N, Zika I, Sarafidou J. Inflammatory mediators in perinatal asphyxia and infection. Acta Paediatr Suppl. 2002;91(438):92-7.
Dammann O, Leviton A. Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn. Pediatr Res. 1997;42(1):1-8.
Hansen AR, Soul JS. Perinatal asphyxia and hypoxic ischaemic encephalopathy, in manual of neonatal care. Wolters Kluwer Lippincott Williams & Wilkins, 7th ed. 2012;55:716-17.
Perlman JM, Tack ED, Martin T, Shackelford G, Amon E. Acute systemic organ injury in term infants after asphyxia. Am J Dis Child. 1989;143:617-20.
Sabatino G, Ramenghi LA, Verrotti A, Gerboni S, Chiarelli F. Persistently low cardiac output predicts high mortality in newborns with cardiogenic shock. Panminerva Med. 1998;40(1):28-32.