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Abstract
Introduction: Birth asphyxia is defined by the World Health Organization "the failure to initiate and
sustain breathing at birth." The WHO has estimated that 4 million babies die during the neonatal period
every year and 99% of these deaths occur in low-income and middle income countries. Three major
causes account for over three quarters of these deaths, serious infection (28%) complication of preterm
birth (26%) and birth asphyxia (23%). This estimation implies that birth asphyxia is the cause of around
one million neonatal deaths each year. One of the present challenges is the lack of a gold standard for
accurately defining birth asphyxia. Because of same reason the incidence of birth asphyxia is difficult to
quantify. Objective: The aim of this study was to assess the prevalence of birth asphyxia, identify the
common obstetric and neonatal risk factors, and study the cause of death. Methodology: All babies born
in Dhulikhel Hospital (DH) from Jan 2007 to Oct 2009 with a diagnosis of birth asphyxia (5 min Apgar
< 7 and those with no spontaneous respirations after birth) were included in the study (n=102). 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 NICU
records provided additional information about new born infant (birth asphyxia, stages of birth asphyxia,
birth weight, sex and subsequent mortality). Results: Among the 3784 live births there were 102 babies
with birth asphyxia prevalence of 26.9/1000 live births. Babies with Hypoxic ischemic encephalopathy
(HIE) Stage 1 had a very good outcome but HIE III was associated with a poor outcome. Males, primipara
and pregnancies with complications were associated with a higher rate of birth asphyxia. Septicaemia,
necrotizing enterocolitis, preterm delivery, convulsion and, pneumothorax were associated with higher
mortality and morbidity. Conclusion: Birth asphyxia was one of the commonest causes of admission and
mortality in NICU. 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, meconium, APH, emergency
caesarean section, preterm and male sex were the risk factors for birth asphyxia.
Key words: Birth asphyxia, HIE, Neonatal sepsis
Introduction
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Results
Between Jan 2007 and Oct 2009, there were 3784
live births in Dhulikhel Hospital, of whom 719 new born
infants were admitted to NICU and 56 babies died. The
mortality rate was therefore 7.7 % of those admitted to
NICU and 1.4% of all live births.
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Male
Female
Total
HIE I
42
54.54
35
45.45
77
75.49
HIE II
46.66
53.33
15
13.72
HIE III
80
20
10
9.80
Grand Total
57
45
102
ANC visit
Gestational Age
Gravida
Pregnancy Complications
Induction of Labour
Mode of Delivery
Birth weight
Sex
Category
< 18 years
18-35 years
>35 years
Dhulikhel hospital
Health post
none
< 37 weeks
37-42 weeks
>42 weeks
1
2-4
>4
Prolapsed
Heart disease
Fetal anomaly
Thick meconium
Infection
Pre-eclampsia
APH
Placenta previa
Hypertension
PROM
Done
Not done
Spontaneous
Vaccum
c-section
<2500 kg
2500-3000 kg
>3000 kg
Male
Female
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Number (n=102)
12
80
10
62
24
16
20
78
4
60
36
6
1
3
2
38
12
7
16
4
2
21
Percent (%)
11.76
78.43
9.8
60.7
23.52
15.68
19.60
78.47
3.92
58.82
35.29
5.88
0.98
2.94
1.96
37.25
11.76
6.8
15.68
3.92
1.96
20.58
28
74
53
9
40
31
51
20
57
45
27.45
72.54
51.96
8.82
39.21
30.39
50
19.60
55.88
44.11
HIE I (77)
HIE II (15)
Recovery
75 (97.40%)
10 (66.66%)
1 (10%)
Death
2 (2.50%)
5 (33.33%)
9 (90%)
HIE III
Cases
Mortality
1 (0.12%)
1(0.12%)
Neonatal sepsis
4(26.66%)
Hydrocephalus
1(6.66%)
Neonatal Sepsis
2(22.22%)
2(22.22% )
4(44.44%)
1(11.11%)
Discussion
In spite of major advances in monitoring technology
and knowledge of fetal and neonatal pathologies,
perinatal asphyxia or more appropriately, hypoxic
ischemic encephalopathy (HIE) remain a serious
condition, causing significant mortality and long term
morbidity. It is a tragedy for a normally developed
fetus to sustain cerebral injury during the last hours of
intrauterine life and to exist for many years with major
handicap. It is seen that for every early neonatal death,
three disabled children survive. Birth asphyxia and the
hypoxic ischemic encephalopathy are one of the common
neonatal problems in our country. It is the commonest
cause of hospital admission of a newborn10.
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Conclusion
Birth asphyxia is one of the commonest causes of
admission and mortality in NICU. Among all stages of
birth asphyxia, HIE stage I is the most common, then
HIE stage II and finally HIE stageIII. Babies with HIE
Stage III had a very poor prognosis where as HIE stage
I had a very good prognosis. Sepsis is the commonest
morbidity in cases of birth asphyxia. Low birth weight
and preterm babies more commonly suffered from birth
asphyxia. Maternal gravida, pregnancy complication
with PROM, meconium, APH, emergency caesarean
section, preterm and male sex were the risk factors
for birth asphyxia. Mortality and morbidity were more
common in males than in females.
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9.
Acknowledgement: none
Funding: none
Conflict of Interest: none
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