Risk Factors of Birth Asphyxia among Newborns at Debre Markos Comprehensive Specialized Referral Hospital, Northwest Ethiopia: Unmatched Case-Control Study.

Background: Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal deaths. Globally, neonatal deaths accounts for 45% of under-five deaths, birth asphyxia causes 23-40% of neonatal deaths in Ethiopia. There is limited data on risk factors of asphyxia in Ethiopia, particularly in the study area. Therefore, this study aimed to identify the risk factors of birth asphyxia among newborns. Methods: This research followed a hospital-based unmatched case-control study design at Debre Markos comprehensive specialized referral hospital, Northwest Ethiopia, among 372 newborns (124 cases and 248 controls). Data were collected by interviewing index mothers and chart review using a pre-tested questionnaire. Then it was entered in Epi-data version 3.1 and transferred to STATA version 14.0 for analysis. Bivariate and multiple variable logistic regression were carried out to the possible risk factors. Finally, statistical significance was declared using adjusted odds ratio with 95% CI and p-value <0.05. Results: Prolonged labor >12, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, noncephalic presentation, comorbidity, birthweight<2500grams were found to be significant factors of birth asphyxia. Conclusion: In this study, Prolonged labor >12 hours, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, non-cephalic presentation comorbidity, fetal distress, birthweight<2500grams were found to be risk factors of birth asphyxia were risk factors of birth asphyxia. Therefore, to reduce neonatal mortality associated with birth asphyxia, attention should be given to holistic pregnancy, labor and delivery care, and post-natal care. Moreover, interventions aimed at reducing birth asphyxia should target the identified factors.

Use and completion of partograph during labour is associated with a reduced incidence of birth asphyxia: a retrospective study at a peri-urban setting in Ghana.

BACKGROUND: Morbidity of birth asphyxia has been estimated to be 42 million disability-adjusted life years. The study sought to assess the impact of the use and completion of partograph during labour on reducing birth asphyxia at the St Anthony's Hospital, Dzodze, in the Volta Region of Ghana. METHODS: A retrospective study design using a quantitative approach was adopted for the study. A simple random sampling technique was used to select a total of 200 folders of labouring women who were admitted and delivered at St Anthony's Hospital, Dzodze, between 1st May 2015 and 30th April 2016. A structured checklist, which was developed by using labour and foetal monitoring parameters based on the standards of the World Health Organization partograph usage, was used to review all the 200 existing maternal records. RESULTS: The findings revealed that partographs were used by midwives at St Anthony's Hospital with the majority of the maternal folders fully completed. The use and completion of partograph were found to be associated with less non-asphyxiated birth outcomes. Labours which were monitored with partograph were 4.29 times less likely to result in birth asphyxia [AOR (95% CI) 4.29 (1.35-14.81)], and those that were monitored with a completed partograph were 5.3 times less likely to result in birth asphyxia [AOR (95% CI) 5.31 (2.011-16.04)]. CONCLUSION: Midwives used partographs during labour at St Anthony's Hospital. The use and completion of partograph were significantly associated with a reduced incidence of birth asphyxia at the hospital. Birth asphyxia could be reduced if partographs are used and completed by midwives during labour in all cases.

Short-term outcome of functional integrity of the auditory brainstem in term infants who suffer perinatal asphyxia.

OBJECTIVES: To assess short-term outcome of impaired functional integrity of the auditory brainstem in term infants who suffer perinatal asphyxia. METHODS: Maximum length sequence brainstem auditory evoked response (MLS BAER) was recorded and analyzed at a mean age of 3months in term infants after perinatal asphyxia. The data were compared with age-matched normal term infants. RESULTS: The infants after asphyxia showed an increase in the latency of MLS BAER wave III at 91, 455 and 910/s, and wave V at all click rates of 91-910/s. The interpeak intervals in the infants after asphyxia were increased at almost all click rates. The IV and I-III intervals were increased at all click rates, and the III-V interval was increased at 455 and 910/s. These increases were generally more significant at higher than at lower click rates. The amplitudes of waves I, III and V in the infants after asphyxia were reduced at all click rates. The V/I amplitude ratio was increased at 91-455/s clicks. The slope of III-V interval-rate function was abnormally increased. 17.1% of the infants after asphyxia had an abnormal increase in IV intervals. CONCLUSIONS: MLS BAER was moderately abnormal at 3months of age in term infants after perinatal asphyxia, suggesting moderate impairment in the functional integrity of the auditory brainstem. The impairment occurs in 17.1% of the infants. Compared with that found at term, the impairment has improved, but not completely recovered.

Global Burden, Epidemiologic Trends, and Prevention of Intrapartum-Related Deaths in Low-Resource Settings.

Intrapartum-related neonatal deaths include live-born infants who die in the first 28 days of life from neonatal encephalopathy or die before onset of neonatal encephalopathy and have evidence of intrapartum injury. A smaller portion of the population in poorer countries has access to basic obstetric and postnatal care causing neonatal mortality rates to be higher. Presence of a skilled birth attendant and provision of basic emergency obstetric care can reduce intrapartum birth asphyxia by 40%. With the announcement of Sustainable Development Goals and global Every Newborn Action Plan, there is hope that interventions around continuum of care will save lives.

Incidence of birth asphyxia as seen in central hospital and GN children's clinic both in Warri Niger Delta of Nigeria: an eight year retrospective review.

BACKGROUND: Birth asphyxia is one of the commonest causes of neonatal morbidity and mortality in developing countries. Together with prematurity and neonatal sepsis, they account for over 80% of neonatal deaths. AIM: To determine the incidence and mortality rate of birth asphyxia in Warri Niger Delta of Nigeria. MATERIALS AND METHOD: Recovery of case notes of all the newborn babies seen from January 2000 to December 2007 at Central Hospital Warri and GN children's Clinic, Warri, was undertaken. They were analyzed and those with birth asphyxia were further analyzed, noting the causes, severity of asphyxia, sex of the babies, management given. RESULTS: A total of 864 out of 26,000 neonates seen within this period had birth asphyxia. 525 (28/1000 live births) had mild asphyxia while 32% were severely asphyxiated. 61.5% of the asphyxiated were born at maternities, churches or delivered by traditional birth attendants or at home. Prolonged labour was the commonest cause of asphyxia and asphyxia was more in neonates from unbooked patients. CONCLUSION: The incidence of bith asphyxia in Warri is 28/1000. Majority of patients are from prolonged labour and delivery at unrecognized centres. Health education will dratically reduce the burden of asphyxia neanatorum as unsubtanciated religous beliefs have done a great havoc.

Prognostic value of 1H-MRS in neonatal encephalopathy.

The aim of this study was to determine the prognostic value of proton magnetic resonance spectroscopy in neonatal encephalopathy. Studies were carried out in 11 consecutive term newborns with encephalopathy probably caused by hypoxic-ischemic injury. The clinical evaluation included pregnancy data, labor conditions, encephalopathy grade, presence of seizures, and necessity of antiepileptic drug therapy. Polygraphic recordings were obtained in all cases. Interest areas evaluated by spectroscopy were the basal ganglia and thalami. Among the cases, N-acetylaspartate/creatine, choline/creatine, and lactate/creatine ratios were calculated and related to the clinical variables, polygraphic recordings, and 6-month neurodevelopmental outcome. Abnormal follow-up occurred in 5 of 11 patients (45.4%) and was clearly related to an Apgar score <5 at 5 minutes (P = 0.003), encephalopathy grade (P = 0.02), early neonatal seizures (P = 0.02), and antiepileptic therapy (P = 0.01). No relationship was observed between spectroscopy results and polygraphic recordings profile. The lowest mean N-acetylaspartate/creatine ratio was observed in four of five patients with an adverse outcome and, although not statistically significant, demonstrated a clear trend to unfavorable follow-up (t test = 0.06). The choline/creatine ratios could not be related to follow-up in our sample. The most consistently observed abnormality on the spectra was the presence of the lactate peak in four of five patients with unfavorable outcome, with a high relative risk to determine evolution in the sample, relative risk 7.0 (chi2 = 0.01, 95% confidence interval = 1.1-42.9).

Relative risk of birth asphyxia in babies of booked women who deliver in unorthodox health facilities in Calabar, Nigeria.

Babies of booked women who delivered in unorthodox health facilities in Calabar, Nigeria were studied. The aims were to determine the relative risk of birth asphyxia in these babies and to find out the management of birth asphyxia in these unorthodox delivery centres. The incidence (14.3%) of birth asphyxia in the study population was significantly higher than the incidence (4.8%) in babies of booked women who delivered in the University of Calabar Teaching Hospital (P < 0.001) with a relative risk of 3.0 (95% C.I.=1.74-5.19). Apart from prolonged labour, the predisposing factors to birth asphyxia in both the study group and control did not show any significant difference (P > 0.05). The treatment of birth asphyxia in unorthodox delivery centres consisted mainly of prayers (43.8%) and immersion of the asphyxiated baby in cold water (25%). A birth asphyxia case fatality rate of 20.8% was recorded in these unorthodox delivery facilities but no death in the control population. Appropriately directed antenatal health education on the benefit of delivering under supervision of trained personnel is strongly advocated.

[Risk factors of 3rd stage retinopathy of prematurity progression]. / Czynniki ryzyka rozwoju 3 stadium retinopatii wczesniaków.

Retinopathy of prematurity is a vasoproliferative, multifactorial disease of retina affecting the preterm neonates. Purpose of the study was to assess the association between a range of clinical features and the development of the stage 3 ROP. The studies comprised 79 preterm infants with diagnosed 3rd stage of ROP and 1117 preterm neonates without ROP as a control group. The analysis included the clinical data of patients--gestational age, birth weight, presence of hypotrophy, Apgar score, duration of oxygen therapy, ventilation and phototherapy. Among the potential risk factors, hypotrophy and duration of phototherapy had no significant influence on the development of 3rd stage ROP. High risk of development of 3rd stage ROP was observed in neonates born before 28th week of gestation, weighing at birth less than 1000 g. The significant risk factors were also the asphyxia, duration of ventillation exceeding 30 days and oxygen therapy longer than 40 days.

Icterícia neonatal: levantamento dos casos ocorridos no Hospital Universitário Regional de Maringá (HUM), entre novembro de 1993 e julho de 1995 / Newborn jaundice: survey of the cases occured in the Hospital Universitário Regional de Maringá (HUM) from November 1993 to July 1995

O objetivo do estudo foi traçar o perfil do serviço de neonatologia do HUM quanto ao atendimento ao recém-nascido ictérico. Foram levantados todos os prontuários com diagnóstico de trabalho de parto registrados entre novembro de 1993 e julho de 1995 no HUM e considerados como populaçäo de estudo todos os recém-nascidos que apresentaram icterícia entre o nascimento e a alta hospitalar. Os dados foram processados pelo sistema EPI-info/Excel e utilizado teste näo-paramétrico (Qui-quadrado) para análise dos resultados. No período, nasceram 574 crianças, das quais 281 (48,95 por cento) tiveram icterícia neonatal, sendo 53,38 por cento do sexo masculino e 46,62 por cento do sexo feminino. As crianças ictéricas foram distribuídas em 2 grupos (tratadas e näo tratadas) e classificadas de acordo com a idade gestacional, peso ao nascimento, tipo de parto, presença de asfixia ao nascimento, distúrbios associados. O teste do Qui-quadrado revelou-se significativo entre todas as variáveis, exceto quanto ao tipo de parto. Dos RN ictéricos, 74,38 por cento näo receberam tratamento, 25,27 por cento foram submetidos à fototerapia isolada e 0,35 por cento a exsangüíneo-transfusäo. Dentre os tratado, em 70,83 por cento o diagnóstico foi de icterícia fisiológica e em 9,72 por centro foi referido algum grau de desidrataçäo como complicaçäo da fototerapia. O observado näo diferiu de dados da literatura, mostrando somente a alta freqüência de icterícia e a diversidade de conduta frente ao mesmo nível de bilirrubina e à mesma idade gestacional.

Risk factors for birth asphyxia and brain damage in pregnancy and labour.

In this review the patho-physiology and risk factors of birth asphyxia are discussed. Simple and appropriate, but scientifically sound, technology for the prevention of birth asphyxia is described. This can be used at home, in the community, in health sub-centres and health centres to identify and assess risk factors so that appropriate referral can be made. Based on experience in developing countries, actions which can be performed by the mother, relatives, neighbours, traditional birth attendants and nurses and midwives are described.