Incidence and development of validated mortality prediction model among asphyxiated neonates admitted to neonatal intensive care unit at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia, 2021: retrospective follow-up study.

INTRODUCTION: Perinatal asphyxia is failure to maintain normal breathing at birth. World Health Organization indicates that perinatal asphyxia is the third major cause of neonatal mortality in developing countries accounting for 23% of neonatal deaths every year. At global and national level efforts have done to reduce neonatal mortality, however fatalities from asphyxia remains high in Ethiopia (24%). And there are no sufficient studies to show incidence and prediction of mortality among asphyxiated neonates. Developing validated risk prediction model is one of the crucial strategies to improve neonatal outcomes with asphyxia. Therefore, this study will help to screen asphyxiated neonate at high-risk for mortality during admission by easily accessible predictors. This study aimed to determine the incidence and develop validated Mortality Prediction model among asphyxiated neonates admitted to the Neonatal Intensive Care Unit at Felege-Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia. METHOD: Retrospective follow-up study was conducted at Felege-Hiwot Comprehensive Specialized Hospital from September 1, 2017, to March 31, 2021. Simple random sampling was used to select 774 neonates, and 738 were reviewed. Since was data Secondary, it was collected by checklist. After the description of the data by table and graph, Univariable with p-value < 0.25, and stepwise multivariable analysis with p-value < 0.05 were done to develop final reduced prediction model by likelihood ratio test. To improve clinical utility, we developed a simplified risk score to classify asphyxiated neonates at high or low-risk of mortality. The accuracy of the model was evaluated using area under curve, and calibration plot. To measures all accuracy internal validation using bootstrapping technique were assessed. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities. RESULT: Incidence of neonatal mortality with asphyxia was 27.2% (95% CI: 24.1, 30.6). Rural residence, bad obstetric history, amniotic fluid status, multiple pregnancy, birth weight (< 2500 g), hypoxic-ischemic encephalopathy (stage II and III), and failure to suck were identified in the final risk prediction score. The area under the curve for mortality using 7 predictors was 0.78 (95% CI 0.74 to 0.82). With ≥ 7 cutoffs the sensitivity and specificity of risk prediction score were 0.64 and 0.82 respectively. CONCLUSION AND RECOMMENDATION: Incidence of neonatal mortality with asphyxia was high. The risk prediction score had good discrimination power built by rural residence, bad obstetric history, stained amniotic fluid, multiple pregnancy, birth weight (< 2500 g), hypoxic-ischemic encephalopathy (stage II and III), and failure to suck. Thus, using this score chart and improve neonatal and maternal service reduce mortality among asphyxiated neonates.

Birth Asphyxia among Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital.

Introduction: Birth asphyxia causes significant morbidity and mortality among neonates, especially in low-income and middle-income countries like Nepal. However, there is a paucity of data regarding its burden. This study aimed to find the prevalence of birth asphyxia among neonates admitted to the neonatal intensive care unit of a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted among neonates at a tertiary care hospital between 15 January 2022 to 14 January 2023 after obtaining ethical approval from the Institutional Review Committee. Neonates with gestational age ≥35 weeks were included and those with major congenital anomalies were excluded. A convenience sampling method was used. A point estimate was calculated at a 95% Confidence Interval. Results: Among 902 neonates, 120 (13.30%) (11.08-15.52, 95% Confidence Interval) had birth asphyxia. A total of 108 (90%) were outborn, and 84 (70%) were males. HIE stage-I, II and III were seen in 47 (39.17%), 64 (53.33%) and 9 (7.50%) of the asphyxiated neonates respectively. Poor suck 92 (76.67%), seizures 73 (60.83%) and lethargy 70 (58.33%) were common abnormal neurological findings. Death occurred in 15 (12.50%) neonates in the hospital. Conclusions: The prevalence of birth asphyxia was found to be similar to other studies done in similar settings. The high burden underscores an urgent need to implement better perinatal care and delivery room management practices. Keywords: hypoxic-ischemic encephalopathy; neonates; prevalence.

Acute Kidney Injury among Neonates with Perinatal Asphyxia in a Tertiary Care Centre.

Introduction: Perinatal asphyxia is a very common cause of morbidity and mortality in both term and preterm neonates and ranks the second most important cause of neonatal death. The incidence and importance of acute kidney injury in the neonatal period are becoming increasingly apparent. Early diagnosis and timely management of acute kidney injury is very important in these newborns to avoid other long-term adverse events. This study aimed to find out the prevalence of acute kidney injury among neonates with perinatal asphyxia in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted at the neonatal intensive care unit and nursery in a tertiary care hospital of Eastern Nepal from 1 November 2021 to 31 October 2022 after obtaining ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 97 neonates, the prevalence of acute kidney injury was seen among 60 (61.86%) (50.25-69.75, 95% Confidence Interval) neonates. Out of which 42 (70%) were males and 18 (30%) were female. Conclusions: The prevalence of acute kidney injury among neonates with perinatal asphyxia was found to be higher than other studies done in a similar setting. Keywords: acute kidney injury; neonates; prevalence.

Prevalence of Perinatal Asphyxia Using Apgar Scores and Cord Blood pH and the Relationship between the Two Methods: A Study of FMC Umuahia.

BACKGROUND: Perinatal asphyxia contributes significantly to neonatal morbidity and mortality. It occurs worldwide, and the Apgar score is the most widely used method of diagnosis. Recently, umbilical cord arterial pH has been reported as the most objective way to assess fetal acidosis at birth as it predicts the adverse outcome of perinatal asphyxia. It is imperative to establish the concordance between these two diagnostic methods to reinforce the practicality of the Apgar score as the preferred diagnostic tool for perinatal asphyxia in developing nations, such as Nigeria. AIM: To determine the prevalence of perinatal asphyxia by using the Apgar score and arterial cord blood pH and the relationships between these methods at the Federal Medical Center (FMC), Umuahia. MATERIALS AND METHODS: This cross-sectional study enrolled 245-term newborns. Perinatal asphyxia was diagnosed using both Apgar scoring and arterial cord blood pH measurements. Data obtained were analyzed using SPSS version 20 and a P value < 0.05 was considered significant. RESULTS: Perinatal asphyxia was reported in 33.1% and 31.4% by using the Apgar score and arterial cord blood pH, respectively. There was a moderate agreement between the two methods for diagnosing perinatal asphyxia (κ = 0.44), and no statistically significant difference was observed in the prevalence of perinatal asphyxia between these methods (McNemar's χ2 = 0.27, P = 0.699). Furthermore, a strong positive correlation was observed between the Apgar score at 1 and 5 minutes of life and arterial cord blood pH (rs = 0.87, P ≤ 0.001 and rs = 0.80, P ≤ 0.001 respectively). CONCLUSION: The prevalence of perinatal asphyxia by the two methods was high, and there was no significant difference between both methods of assessing perinatal asphyxia. Thus, the diagnosis of perinatal asphyxia can effectively be made using either the Apgar score or arterial cord blood pH, affirming the practicality and reliability of the Apgar score in resource-limited healthcare settings.

Magnitude of neonatal asphyxia and its predictors among newborns at public hospitals of Wolaita Zone in Southern Ethiopia, 2023.

BACKGROUND: Neonatal asphyxia is one of preventable causes of neonatal mortality throughout the world. It could be improved by early detection and control of the underlying causes. However, there was lack of evidence on it in the study setting. Thus, the aim of this study was to assess the magnitude and predictors of neonatal asphyxia among newborns at public hospitals of Wolaita Zone in Southern Ethiopia. METHOD: A facility-based cross-sectional study was done among 330 mothers with neonates in selected public hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through an interviewer-administered questionnaire and checklist. The collected data were entered into EpiData version 4.6 and exported to SPSS version 26 for analysis. Logistic regression was fitted to examine the association between explanatory variables and outcome variable. In multivariable logistic regression, AOR with 95% CI was reported, and p < 0.05 was used to declare statistically significant variables. RESULTS: The magnitude of neonatal asphyxia was 26.4% with 95% CI: (21.8, 30.9). In multivariable logistic regression analysis primiparity (AOR = 2.63 95%CI 1.47, 4.72), low-birth-weight (AOR = 3.45 95%CI 1.33, 8.91), preterm birth (AOR = 3.58 95%CI 1.29, 9.92), and premature rupture of membranes (AOR = 5.19 95%CI 2.03, 13.26) were factors significantly associated with neonatal asphyxia. CONCLUSIONS: In this study, the magnitude of neonatal asphyxia was high. From the factors, premature rapture of the membrane, parity, birth weight of the newborn, and gestational age at birth were significantly associated with neonatal asphyxia. Attention should be given to early detection and prevention of neonatal asphyxia from complicated labor and delivery.

Intimate partner violence during pregnancy and its association with birth asphyxia in hospitals of Tigray region, Ethiopia.

BACKGROUND: Birth asphyxia is the main cause of neonatal mortality and morbidity worldwide. Some studies indicate intimate partner violence during pregnancy is a risk factor for birth asphyxia. In Ethiopia, intimate partner violence during pregnancy is reported to be high. Despite this high prevalence, there is a lack of data about the association of birth asphyxia and intimate partner violence. The aim of this study was to assess the prevalence of intimate partner violence during pregnancy and its associated factors with birth asphyxia in health facilities in the Tigray region of northern Ethiopia. METHODS: This was an institutional-based cross-sectional study conducted at select health facilities in the Tigray region of Ethiopia. Random sampling technique was employed to select health facilities and systematic sampling was used to select 648 study participants. Data was entered by using Epi info version 3.5.1 and was analyzed using SPSS version 20. Bivariate and multivariate analysis was done to assess the association between exposure to intimate partner violence during pregnancy and birth asphyxia after adjusting for possible confounders. RESULTS: The prevalence of intimate partner violence during pregnancy was 47(7.3%). Eighty two (12.7%) babies were delivered with birth asphyxia. Intimate partner violence during pregnancy had a significant association with birth asphyxia, AOR (95% CI) = 4.4(2-9.8). In addition to this, other factors that were associated with birth asphyxia include place of residence [ AOR (95% CI) = 2.7(1.55-4.8)], age > 19 [AOR (95% CI) = 2.9(1.29-6.5)], age 20-35 [AOR (95% CI) = 3.1(1.06-9.3)], gestational age < 37 weeks [AOR(95% CI) = 7.2(3.5-14.8)] and low birth weight [AOR(95% CI) = 3.9(2.1-7.3)]. CONCLUSIONS: The prevalence of birth asphyxia in this study is high and is further increased by intimate partner violence during pregnancy. Health care providers and policy makers should take measures aimed at preventing intimate partner violence during pregnancy to reduce harm to the mother and adverse birth outcomes.

Birth asphyxia and its association with grand multiparity and referral among hospital births: A prospective cross-sectional study in Benin, Malawi, Tanzania and Uganda.

INTRODUCTION: Birth asphyxia is a leading cause of neonatal mortality in sub-Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. MATERIAL AND METHODS: This was a prospective cross-sectional study. Data were collected using a perinatal e-Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks' gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5-minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. CLINICAL TRIAL: Pan African Clinical Trial Registry 202006793783148. RESULTS: Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17-1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34-16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13-1.68) and Uganda (OR 1.29, 95% CI 1.02-1.64), but was non-significant in Tanzania (OR 1.44, 95% CI 0.81-2.56) and Malawi (OR 0.98, 95% CI 0.67-1.44). CONCLUSIONS: There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration.

The determinants of neonatal asphyxia in the tropical province of China: A case-control study.

As the major public health problem among under-5 children in the world, neonatal asphyxia (NA) contributes to 24% of the main causes of neonatal death. The effects of NA is not only limited to death but also has a long-term brain injury with lifelong adverse effects. Therefore, the goal of this study was to identify determinants of NA among newborns in the tropical province of China to guide early interventions and improve the survival and quality of life of these infants. A case control study was conducted at Hainan Women and Children's Medical Center from January 1 to December 31, 2021. A total of 255 newborns (85 cases and 170 controls, 1:2 case to control ratio) were enrolled in the study. A systematic random sampling approach was adopted based on hospital delivery registration. Structured questionnaires were used to collected data. The data was entered into statistical software SPSS version 20.0 for analysis. In the bivariable analysis, variables with P values less than .1 were entered into multivariable logistic regression analysis. At a P value of .05, a statistically significant level was reported. Amniotic fluid stained by meconium/blood (AOR = 3.19, 95% confidence interval [CI]: 1.47-6.95), primiparity, fetal presentation of malpresentation (AOR = 3.89, 95% CI: 1.25-12.09), and low birth weight (AOR = 10.51, 95% CI: 3.02-36.55) were to be significantly associated with NA. This study identified that amniotic fluid stained by meconium/blood, primiparity, low birth weight were determinants of NA. Thus, preventive solutions such as close monitoring of fetus presentation, meliorating the obstetric care setup during antenatal care consultations should be stressed in China.

Association of consanguinity with neonatal asphyxia at birth: Evidence from Pakistan.

Consanguinity commonly known as inbreeding is a state of offspring borne to couple sharing same ancestors. It is a least researched non-obstetric determinant of adverse birth outcome in developing countries like Pakistan. This hospital based study was designed to investigate the association between consanguineous status and neonatal asphyxia measured measured as low APGAR scores after birth in 879 newborns.The data regarding consanguineous status was obtained retrospectively. Potential covariates were incorporated for finding confounding effects. Data was analyzed in SPSS version 26.0 as mean ± standard deviation, unadjusted & adjusted odds ratios by logistic regression at P-values ≤ 0.05 significance for associations. Over 36.1% newborns were consanguineous, delivered with APGAR < 6 at 1-minute compared to 5.2% born to non-consanguineous parents. Premature birth was the single most important factor associated with neonatal asphyxia and low APGAR at 1 & 5-minute after birth. After adjusting for confounding variables, first cousin couples' offsprings showed OR of 9.1 & 4.1 for APGAR score ≤ 6 at 1 & 5-minutes after birth, respectively (P < 0.001 & P =0.001). We conclude that consanguinity is a strong determinant for neonatal asphyxia reported as low APGAR scores in this population of new borns.

Effects of season, daytime, sex, and stress on the incidence, latency, frequency, severity, and duration of neonatal seizures in a rat model of birth asphyxia.

Neonatal seizures are common in newborn infants after birth asphyxia. They occur more frequently in male than female neonates, but it is not known whether sex also affects seizure severity or duration. Furthermore, although stress and diurnal, ultradian, circadian, or multidien cycles are known to affect epileptic seizures in adults, their potential impact on neonatal seizures is not understood. This prompted us to examine the effects of season, daytime, sex, and stress on neonatal seizures in a rat model of birth asphyxia. Seizures monitored in 176 rat pups exposed to asphyxia on 40 experimental days performed over 3 years were evaluated. All rat pups exhibited seizures when exposed to asphyxia at postnatal day 11 (P11), which in terms of cortical development corresponds to term human babies. A first examination of these data indicated a seasonal variation, with the highest seizure severity in the spring. Sex and daytime did not affect seizure characteristics. However, when rat pups were subdivided into animals that were exposed to acute (short-term) stress after asphyxia (restraint and i.p. injection of vehicle) and animals that were not exposed to this stress, the seizures in stress-exposed rats were more severe but less frequent. Acute stress induced an increase in hippocampal microglia density in sham-exposed rat pups, which may have an additive effect on microglia activation induced by asphyxia. When seasonal data were separately analyzed for stress-exposed vs. non-stress-exposed rat pups, no significant seasonal variation was observed. This study illustrates that without a detailed analysis of all factors, the data would have erroneously indicated significant seasonal variability in the severity of neonatal seizures. Instead, the study demonstrates that even mild, short-lasting postnatal stress has a profound effect on asphyxia-induced seizures, most likely by increasing the activity of the hypothalamic-pituitary-adrenal axis. It will be interesting to examine how postnatal stress affects the treatment and adverse outcomes of birth asphyxia and neonatal seizures in the rat model used here.

Adverse Maternal and Perinatal Outcomes of Meconium-Stained Amniotic Fluid in Term Labor at Hospitals in South Gondar Zone, Northwest Ethiopia: A Prospective Cohort Study.

Background: The passage of meconium during labor increased the chance of undesirable birth outcomes. The adverse effects of meconium are worsening in resource-limited countries. In Ethiopia, there is an argument concerning meconium's negative effects and management on pregnant women and their babies. Therefore, this study was intended to assess the adverse maternal and perinatal outcomes of meconium in term labor in the South Gondar Zone, Ethiopia. Methods: A prospective cohort study was conducted using 580 laboring mothers (145 exposed and 435 nonexposed groups). A two-stage sampling method was implemented to get study subjects. The data were collected using an interviewer-administered structured questionnaire and a medical chart review. SPSS version 25 was used for data analysis. Chi-squared and Fisher's exact tests were used to compare the two groups' differences. The strength of the association was measured using relative risk with a 95% CI. Result: There was more operative delivery (28.3% versus 5.3%), puerperal sepsis (79.54% versus 2.06%), nonreassuring fetal heart rate pattern (29.7% versus 2.1%), meconium aspiration syndrome (7.58% versus 0.68%), neonatal sepsis (9% versus 4.1%), perinatal asphyxia (13.8% versus 7.6%), admission to the neonatal intensive care unit (23.4% versus 3.2%), and early neonatal deaths (4.8% versus 1.4%) among meconium stained groups as compared to the clear amniotic fluid groups. Conclusion: Meconium-stained amniotic fluid significantly increased adverse maternal and perinatal outcomes in Ethiopia. The risk of perinatal asphyxia, nonreassuring fetal heart rate pattern, neonatal sepsis, meconium aspiration syndrome, admission to the NICU, early neonatal death, operative delivery, and puerperal sepsis were significantly higher in meconium-exposed groups. Special attention should be given to meconium-exposed mothers during the intrapartum period and in postnatal follow-up.

Contributing factors of birth asphyxia in Thailand: a case-control study.

BACKGROUND: Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia. METHODS: A case-control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software. RESULTS: The odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal-fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia. CONCLUSION: Birth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.

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OBJECTIVES: To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia. METHODS: A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively. RESULTS: Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia. CONCLUSIONS: The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.

Serum magnesium levels of term neonates with birth asphyxia and relationship to severity of asphyxia.

Background and Aims: Birth asphyxia is one of the three main causes of neonatal mortality in Nigeria. Hypomagnesaemia has been reported amongst severely asphyxiated babies. Despite this, the prevalence of hypomagnesaemia amongst newborns with birth asphyxia has not been well researched in Nigeria. This study set out to determine the prevalence of hypomagnesaemia in term neonates with birth asphyxia and the relationship (if any) between magnesium levels and the severity of birth asphyxia or encephalopathy. Methods: In this cross-sectional analytical study, the serum magnesium levels of consecutive cases of birth asphyxia were compared to that of gestational age-matched healthy term neonates. Babies with Apgar scores <7 in the 5th minute of life were recruited into the study. Blood samples were taken from each baby at birth and 48 h. Serum magnesium was measured using spectrophotometry. Results: Hypomagnesaemia was found in 36 (35.3%) babies with birth asphyxia and 14 (13.7%) healthy controls; this difference was statistically significant (χ2 = 18.098, P = 0.001), with an odds ratio of 3.4 (95% confidence interval = 1.7, 6.9). The median (interquartile range) levels of serum magnesium in babies with mild, moderate and severe asphyxia were 0.7 mmol/L (0.5-1.1), 0.7 mmol/L (0.4-0.9) and 0.7 mmol/L (0.5-1.0), respectively (P = 0.316), while those of babies with mild (stage 1), moderate (stage 2) and severe (stage 3) encephalopathy were 1.2 mmol/L (1.0-1.3), 0.7 mmol/L (0.5-0.8) and 0.8 mmol/L (0.6-1.0), respectively (P = 0.789). Conclusion: This study has shown that hypomagnesaemia was more common in babies with birth asphyxia and there was no relationship between magnesium levels and the severity of asphyxia or encephalopathy.

Multi-organ dysfunction in infants with acidosis at birth in the absence of moderate to severe hypoxic ischemic encephalopathy.

INTRODUCTION: Infants with perinatal asphyxia are at risk for organ failure aside from the brain, regardless of the severity of the asphyxial insult. We aimed to evaluate the presence of organ dysfunction other than the brain in newborns with moderate to severe acidosis at birth, in the absence of moderate to severe hypoxic ischemic encephalopathy. MATERIALS AND METHODS: Data of 2 years were retrospectively recorded. Late preterm and term infants admitted to the intensive care unit with ph < 7.10 and BE < -12 mmol/l in the first hour were included in the absence of moderate to severe hypoxic ischemic encephalopathy. Respiratory dysfunction, hepatic dysfunction, renal dysfunction, myocardial depression, gastrointestinal problems, hematologic system dysfunction, and circulatory failure were evaluated. RESULTS: Sixty-five infants were included [39 (37-40) weeks, 3040 (2655-3380) grams]. Fifty-six (86 %) infants had one or more dysfunction in any system [respiratory: 76.9 %, hepatic: 20.0 %, coagulation: 18.5 %, renal: 9.2 %, hematologic: 7.7 %, gastrointestinal: 3.0 %, and cardiac: 3.0 %]. Twenty infants had at least two affected systems. The incidence of coagulation dysfunctions was higher in the infants with severe acidosis (n = 25, ph < 7.00) than the infants with moderate acidosis (n = 40: pH = 7.00-7.10); 32 % vs 10 %; p = 0.03. CONCLUSIONS: Moderate to severe fetal acidosis is associated with the development of extra-cranial organ dysfunctions in infants who do not require therapeutic hypothermia. A monitoring protocol is needed for infants with mild asphyxia in order to identify and manage potential complications. Coagulation system should be carefully evaluated.

Effect of birth asphyxia on neonatal blood glucose during the early postnatal life: A multi-center study in Hubei Province, China.

BACKGROUND: Birth asphyxia causes hypoxia or inadequate perfusion to the organs of newborns, leading to metabolism dysfunctions including blood glucose disorders. METHODS: Neonates with and without birth asphyxia were retrospectively recruited from 53 hospitals in Hubei Province from January 1 to December 31, 2018. In summary, 875, 1139, and 180 cases in the control group, the mild asphyxia group, and the severe asphyxia group were recruited, respectively. Neonatal blood glucose values at postnatal 1, 2, 6, and 12 h (time error within 0.5 h was allowed) were gathered from the medical records. RESULTS: The incidence rates of hyperglycemia in the control group, the mild asphyxia group and the severe asphyxia group were 2.97%, 7.90%, and 23.33%, respectively (p < 0.001). Additionally, the incidence rates of hypoglycemia in the three groups above were 3.66%, 4.13%, and 7.78%, respectively (p = 0.042). The blood glucose values of neonates with hypoglycemia in the asphyxia group were lower than in the control group (p = 0.003). Furthermore, the blood glucose values of neonates with hyperglycemia were highest in the severe asphyxia group (p < 0.001). There were 778 and 117 cases with blood glucose records at four predefined time points in the mild and severe asphyxia group, respectively. The incidence of blood glucose disorders in the mild asphyxia group significantly decreased from postnatal 6 h (p＜0.05). However, we found no obvious changes of the incidence of glucose disorders within postnatal 12 h in the severe asphyxia group (p = 0.589). CONCLUSION: Birth asphyxia is likely to cause neonatal blood glucose disorders, both hypoglycemia and hyperglycemia, during the early postnatal life. The neonates with severe asphyxia have higher incidence, worse severity and longer duration of blood glucose disorders than neonates with mild asphyxia.

Machine learning models based on clinical indices and cardiotocographic features for discriminating asphyxia fetuses-Porto retrospective intrapartum study.

Introduction: Perinatal asphyxia is one of the most frequent causes of neonatal mortality, affecting approximately four million newborns worldwide each year and causing the death of one million individuals. One of the main reasons for these high incidences is the lack of consensual methods of early diagnosis for this pathology. Estimating risk-appropriate health care for mother and baby is essential for increasing the quality of the health care system. Thus, it is necessary to investigate models that improve the prediction of perinatal asphyxia. Access to the cardiotocographic signals (CTGs) in conjunction with various clinical parameters can be crucial for the development of a successful model. Objectives: This exploratory work aims to develop predictive models of perinatal asphyxia based on clinical parameters and fetal heart rate (fHR) indices. Methods: Single gestations data from a retrospective unicentric study from Centro Hospitalar e Universitário do Porto de São João (CHUSJ) between 2010 and 2018 was probed. The CTGs were acquired and analyzed by Omniview-SisPorto, estimating several fHR features. The clinical variables were obtained from the electronic clinical records stored by ObsCare. Entropy and compression characterized the complexity of the fHR time series. These variables' contribution to the prediction of asphyxia perinatal was probed by binary logistic regression (BLR) and Naive-Bayes (NB) models. Results: The data consisted of 517 cases, with 15 pathological cases. The asphyxia prediction models showed promising results, with an area under the receiver operator characteristic curve (AUC) >70%. In NB approaches, the best models combined clinical and SisPorto features. The best model was the univariate BLR with the variable compression ratio scale 2 (CR2) and an AUC of 94.93% [94.55; 95.31%]. Conclusion: Both BLR and Bayesian models have advantages and disadvantages. The model with the best performance predicting perinatal asphyxia was the univariate BLR with the CR2 variable, demonstrating the importance of non-linear indices in perinatal asphyxia detection. Future studies should explore decision support systems to detect sepsis, including clinical and CTGs features (linear and non-linear).

Maximizing the detection rate of hypoglycemia among preterm neonates admitted in Neonatal intensive care unit in Ethiopia, 2021.

The burden of hypoglycemia is high in resource limited countries, such as Ethiopia. However, there are no sufficient studies conducted in Ethiopia in general and in the study setting in particular in the previous era. Hence, this study aims to assess the proportion of hypoglycemia and associated factors among preterm neonates admitted to the neonatal intensive care unit at Debre Tabor Comprehensive Specialized Hospital, Ethiopia, in 2021. A hospital-based cross-sectional study was conducted from October 1 to December 30, 2021, at Debre Tabor Comprehensive Specialized Hospital in the neonatal intensive care unit ward. The data was entered in Epi-info 7 and exported to STATA version 14. A binary and multivariable logistic regression was computed at 95% confidence interval (CI). During bivariable analysis, variables having a p-value of less than 0.25 were chosen for multivariable logistic regression analysis, and variables having a p-value of less than 0.05 in multivariable analysis, were significant associations with the dependent variable. The study included 267 preterm neonates, and 23.59% (95% CI 18.9-29.1) were develop hypoglycemia. Moreover, 49 (18.35%) preterm neonates died during the study period. In this study, preterm neonates with hypothermia [Adjusted Odds Ratio (AOR = 4.5; 95 CI 3.4, 7.2)], birth asphyxia (AOR = 5.1; 95 CI 3.9, 27.1), seizure (AOR = 4.7; 95 CI 2.8, 17.8), and also preterm neonates born from diabetic mothers (AOR = 6.7; 95 CI 3.3, 27.2) were significantly associated with the occurrence of hypoglycemia in the neonatal intensive care. The proportion of hypoglycemia and associated factors among preterm neonates admitted to the neonatal intensive care unit at Debre Tabor Comprehensive Specialized Hospital was found to be high. The associated factors for the occurrence of hypoglycemia were discovered to be neonates with hypothermia, birth asphyxia, seizure, and neonates born with a diabetes mother. Thus, recognizing and treating the above associated factors is essential to preventing, and controlling hypoglycemia.

Birth asphyxia related mortality in Northwest Ethiopia: A multi-centre cohort study.

BACKGROUND: Birth asphyxia is the second leading cause of neonatal death in Ethiopia, next to preterm-associated infections. Understanding the causes of death in asphyxiated newborns will help to design appropriate care. This study identifies predictors of neonatal mortality in asphyxiated newborns in selected hospitals in Northwest Ethiopia. METHODS: An institution-based prospective cohort study of 480 newborns with birth asphyxia was conducted at Debre Markos Comprehensive Specialized Hospital, Shegaw Motta District Hospital, and Injibara General Hospital. All newborns with asphyxia admitted to the neonatal critical care unit from the first of November 2018 to the first of November 2019 were included. Data were obtained prospectively from mothers using an interviewer's administered questionnaire. The Kaplan-Meier survival curve was used to estimate survival time, and Log rank test was used to compare the survival curves. Bivariable and multivariable Cox proportional hazards models were fitted to identify the independent predictors of mortality in asphyxiated newborns. Adjusted hazard Ratios (AHRs) with 95% Cis (Confidence Intervals) were used to measure the strength of association and test statistical significance. RESULTS: The overall cumulative incidence of mortality among asphyxiated newborns was 42.29% (95% CI: 38%, 46). Asphyxiated neonates with other comorbidities (sepsis, neonatal anemia) (AHR = 2.63, 95% CI:1.69, 4.10), oxygen saturation of 50-69 (AHR = 4.62, 95% CI:2.55, 8.37), oxygen saturation of 70-89 (AHR = 2.82, 95% CI: 1.80, 4.42), severe Apgar score at one minute (AHR = 1.59, 95% CI:1.12, 2.25), neonates with Hypoxic Ischemic Encephalopathy (HIE) (AHR = 6.12, 95% CI:2.23, 16.75) were at higher risk of mortality. CONCLUSIONS: The mortality rate among asphyxiated neonates remains high, and slightly higher than previous studies. Asphyxiated newborns with other comorbidities, severe Apgar score at one minute, who develop HIE, and low oxygen saturation were at higher risk of death. Therefore, designing appropriate interventions and prevention methods should be considered for identified variables.

Prevalence of birth injuries and associated factors among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Crossectional study.

BACKGROUND: Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. METHODS: Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant. RESULT: The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59-32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81-12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45-34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9-35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05-0.68), male sex (AOR = 3.84, 95% CI: 1.30-11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58-17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38-18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52-9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45-32.7) and night time birth (AOR = 4.82, 95% CI: 1.84-12.6). CONCLUSION: The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.