Journal of Dr. NTR University of Health Sciences

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 7  |  Issue : 4  |  Page : 245--248

Birth asyphxia: Looking at trends of risk factors leading to birth asphyxia in a peripheral hospital


Anantsagar Motepalli, Manisha Ramanlal Patel, Venkateswara Rao 
 Department of Neonatal Intensive Care Unit, Venkata Padma Hospital, Vizianagaram, Andhra Pradesh, India

Correspondence Address:
Dr. Anantsagar Motepalli
Department of Neonatal Intensive Care Unit, Venkata Padma Hospital, Vizianagaram - 535 002, Andhra Pradesh
India

Abstract

Objectives: To look at the trends of risk factors leading to birth asphyxia, in newborns admitted to a peripheral hospital giving tertiary care. Methodology: Descriptive longitudinal study conducted over a period of 6 months (March 2016–August 2016) in babies fulfilling the criteria for birth asphyxia. Variables studied included antenatal care (ANC), period of gestation, place of delivery, mode of delivery, birth weight, pregnancy complication, and time of arrival to hospital. Results: The total number of admission in neonatal unit during the study period was 540, of which 58 babies fulfilled the inclusion criteria for birth asphyxia. The majority of admissions were referred from government hospital (68.91%), and all the mothers were booked and had ANC visits. Similarly, all were full terms except one preterm baby. Caesarean section was performed in 25.8%, and 74.2% had normal vaginal delivery. All were institutional/hospital delivery. The majority (65%) of babies were referred within 6 h, and 79.3% of babies weighed more than 2.5 kg. Conclusion: Birth asphyxia occurring in such a high number of booked cases with institutional/hospital delivery indicates inadequate perinatal services. It is advisable to have trained neonatal resuscitation personnel with all necessary equipments and medications at the time of delivery.



How to cite this article:
Motepalli A, Patel MR, Rao V. Birth asyphxia: Looking at trends of risk factors leading to birth asphyxia in a peripheral hospital.J NTR Univ Health Sci 2018;7:245-248


How to cite this URL:
Motepalli A, Patel MR, Rao V. Birth asyphxia: Looking at trends of risk factors leading to birth asphyxia in a peripheral hospital. J NTR Univ Health Sci [serial online] 2018 [cited 2019 Dec 7 ];7:245-248
Available from: http://www.jdrntruhs.org/text.asp?2018/7/4/245/249818


Full Text



 Introduction



Asphyxia is an insult to the fetus or newborn due to lack of oxygen or lack of perfusion to various organs.[1] National Neonatology Forum of India has defined asphyxia as gasping or ineffective breathing or lack of breathing at 1 min of life.[2]

Birth asphyxia is one of the most important causes of neonatal brain injury whose incidence ranges from 3.7 to 9/1000 deliveries in the west.[3] In addition to its contribution to mortality, birth asphyxia can result in cognitive impairment, epilepsy, cerebral palsy, and chronic disease in later life.[4],[5],[6],[7],[8] Birth asphyxia is the third largest (16%) reason for neonatal mortality and morbidity after prematurity (32%) and septicemia (19%).[9],[10],[11],[12]

About 0.75 million neonates die every year in India, the highest for any country in the world. The neonatal mortality rate (NMR) declined from 52/1000 live births in 1990 to 28/1000 live births in 2013, but the rate of decline has been slow.

Obviously, the “Committing to Child Survival: A Promise Renewed” goal of reducing under-five mortality to 20 or less per 1000 live births by 2035 will not be attained without specific efforts to reduce newborn mortality.[11] This study is an effort to study and analyze the risk factors leading to birth asphyxia in peripheral areas.

 Methodology



Prospective analysis of 58 babies admitted in neonatal intensive care unit of peripheral hospital giving tertiary care was carried out over a period of 6 months (March 2016–August 2016). The total admission during this period was 540, which included inborn and outborn. Of these, 58 patients fulfilled the inclusion criteria for birth asphyxia and thus were included in the analysis.

Inclusion criteria

Babies referred with a history of not crying immediately following birthRequiring resuscitation at least with bag and maskApgar score of less than 7 at 1 minAbnormal neurological signs (hypotonia, lethargy, poor sucking, seizures).

Newborns with severe congenital malformation, chromosomal anomalies such as Down's syndrome, TORCH [Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections] infections, septicemia, and RH incompatibility resulting in hemolysis were excluded.

 Results



Analysis of 58 patients with birth asphyxia showed that 38 were male and 20 were female. All were booked cases and had three antenatal visits and at least one visit was in the last trimester.

All had antenatal ultrasound done, and nine of them also underwent TIFFA (Targeted Imaging for Fetal Anomalies) scan. All of them were full term (except one preterm baby). None of the deliveries was conducted at home; 68.9% were born in government hospital and 31% were born in private hospital.

None of the inborn babies had birth asphyxia during the study period. Almost 74% had a normal vaginal delivery, of which 36.2% required induction. Out of the admitted babies with birth asphyxia, 55 improved and were discharged; 5 of them required ventilation, of which 2 survived.

Among the 58 patients included in this study, 38 patients (65.5%) came within 6 h of life with almost 98% patients (38 + 19 = 57) arriving to the hospital in 24 h.

 Discussion



The frequency of birth asphyxia was 10.7% in our study, while it varies from 9%[13] to 13%[14] in different studies. Hence, it was consistent with national data.

The risk factors for birth asphyxia include increasing or decreasing maternal age, prolonged rupture of membranes, meconium-stained fluid, multiple births, nonattendance for antenatal care (ANC), low birth weight (LBW) infants, malpresentation, augmentation of labor with oxytocin, antepartum hemorrhage, severe eclampsia and preeclampsia, and antepartum and intrapartum anemia.[15],[16]

Birth asphyxia can be caused by events that have their roots in the antepartum, intrapartum, postpartum periods, or combinations thereof. A recent review suggests that asphyxia is probably primarily antepartum in origin in 50% of cases, intrapartum in 40%, and postpartum in the remaining 10% of cases.[17]

The results in this study were contrary to our expectations. We found that the majority of the mothers were booked cases, had ANC including antenatal ultrasonography (USG), and delivered at government hospital or private maternity homes with deliveries attended by doctors/with trained personnel; in spite of this, the babies still suffered from birth asphyxia.

Previously published data proved that there is a huge difference in the neonatal deaths among those mothers who had regular antenatal visits when compared with unbooked cases. In a study conducted by Shaheen, the perinatal mortality rate was 111/1000 live births in nonbooked cases when compared with 17/1000 in booked cases.[18]

From this study, it was evident that the antenatal services have improved drastically as all the expectant mothers were booked, had ANC visits, USGs, and also all were delivered in hospital/maternity home, but the unexpected high rates of birth asphyxia are attributable to intrapartum causes and lack of trained neonatal resuscitation at the time of delivery.

Some of the promising points noted were that all the mothers had ANC visit, with at least one visit in the last trimester, and all were delivered in hospital and referred to tertiary hospital within 6 h of life [Figure 1].{Figure 1}

It is estimated that the risks of neonatal mortality and LBW are increased by almost 50% if the maternal age at childbirth is <20 years [Figure 2]. It is also estimated that shifting age at childbirth to above 20 years would reduce the overall NMR by 9.4%.[19],[20],[21] The majority of them (56%) were above 20 years in our study [Figure 3].{Figure 2}{Figure 3}

In spite of this, there were babies with Sarnat stage II [Figure 4] from a majority of peripheral government hospital (74.1%) indicating unawareness and lack of skills regarding neonatal resuscitation. None of the inborn babies admitted during the period had birth asphyxia. The art of neonatal resuscitation of asphyxiated babies has now become an important part of neonatal care. The slogan “give a breath and save a life” conveys the essence of the art.{Figure 4}

Meconium-stained amniotic fluid was found to be present as one of the risk factors [Figure 5], and findings were comparable to previous study also.[22] Preeclampsia was found to be associated significantly with increased risk of birth asphyxia.[23]{Figure 5}

It is important to recognize that birth asphyxia is one of the major determinants of infant mortality and morbidity and is preventable to a large extent. We have overcome many risk factors of birth asphyxia in recent years, and hence a trained personnel in labor room after giving basic care to the newborn baby, initiating resuscitation if necessary, and summon for help if needed. A properly trained person in neonatal resuscitation preferably a pediatrician should be present at every delivery especially the high-risk cases. The same has been recommended by the International Liaison Committee on Resuscitation (ILCOR), Neonatal Resuscitation Program (NRP), of the American Heart Association.[24]

The presence of working resuscitation equipments is another important requirement. Hospital paramedics should be trained regularly in basic newborn care and certified regularly for preliminary resuscitative measures. Prior stabilization and appropriate transport would be important determinants in further reducing mortality and morbidity of birth asphyxia.

 Conclusion



Birth asphyxia occurring in such a high number of booked cases with institutional/hospital delivery indicates inadequate perinatal services. It is advisable to have trained neonatal resuscitation personnel with all necessary equipments and medications at the time of delivery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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