INTRODUCTIONBirth asphyxia refers to condition of hypoxemia, hypercapnia and insufficient blood perfusion of new born during labour and birth. NNPD defines moderate birth asphyxia as APGAR score of 4-6 at 1minute and severe birth asphyxia as APGAR score of <3 at 1 minute.1 AAP defines it as APGAR score of less than 3 at 5minutes associated with cord pH of less than 7.0, presence of neurologic dysfunction and evidence of multiorgan dysfunction. 2Perinatal Asphyxia (PA) is a major public health problem. As per the latest estimates, PA accounts for 9% (i.e. 0·8 million) of total under-5 mortality (i.e. 8.8 millions) worldwide, being one of the three most common causes of neonatal deaths along with prematurity and bacterial infections. Of a total of 2.7 million stillbirths globally, approximately 1.2 million occur during intrapartum period, largely owing to asphyxia.3 As per NNPD, 9.5% of babies require some form of resuscitation. Manifestations of Hypoxic Ischaemic Encephalopathy (HIE) were seen in approximately 1.4% of all babies. PA was responsible for 28.8% of all neonatal deaths. Apart from neonatal deaths, asphyxia is responsible for life-long neuromotor disability in a large number of children. 1 ABSTRACTBackground: Objectives of current study was to study the incidence of multiorgan dysfunction in babies with perinatal asphyxia and its effect on the outcome. Methods: All term babies admitted to NICU of S. Nijalingappa Medical College and Hanagal Shri Kumareshwara Hospital, Bagalkot in the period January 2013 to December 2013 with perinatal asphyxia and HIE were included in the study. Detailed history and thorough examination was done using predesigned and prestructured proforma. Necessary investigations were done as indicated to identify organ dysfunction. Results: 80.8% of babies with perinatal asphyxia had evidence of multiorgan dysfunction with HIE alone seen in 19.2% of cases. Respiratory failure was the most common organ dysfunction after CNS seen in 63.1% of cases. CVS involvement was seen in 54.3% (31) of babies, out of which the mortality was seen in 22.5% (7 cases), renal involvement was seen in 29.8% (17) of babies, out of which the mortality was seen in 29.4% (5 cases). Increased mortality in babies who had cardiovascular dysfunction and in babies with renal dysfunction was statistically significant. Mortality was higher in babies with multiorgan dysfunction which increased proportionately with increase in number of organs involved. Conclusions: Multiorgan dysfunction is common in babies with perinatal asphyxia. Cardiovascular involvement and renal involvement are associated with poor outcome. Mortality is directly proportional to the number of organs involved.

Background: Respiratory distress in newborn due to varied aetiology is one of the common causes for new born admission to NICU, new born morbidity and mortality. Bubble CPAP is a simple, cost effective and gentle mode of respiratory support in newborns with respiratory distress. It reduces the need for mechanical ventilation in appropriately selected cases. In this paper we review our institute experience of using very low cost indigenous CPAP as primary way of respiratory support and its outcome. Objectives: Effectiveness of indigenous CPAP as a low cost measure in treatment of respiratory distress in newborn period and its outcome. Design: Prospective observational study. Subjects and Methods: This study included 100 consecutive both term and preterm newborns admitted for respiratory distress due to varied aetiologies like respiratory distress syndrome, transient tachypnea of newborn, apnea of prematurity, birth asphyxia, meconium aspiration syndrome, etc in our NICU over a period of 1 year. Exclusion criteria being babies put on CPAP for post-extubation respiratory distress and babies with severe life threatening surgical conditions. Downe's scoring for term and Silvermann's scoring for preterm babies were used to assess the severity of respiratory distress and also to assess the response to indigenous CPAP. Results: Out of 100 newborns with respiratory distress treated with indigenous CPAP, 73% improved, 21% were further put on mechanical ventilation and 6% were discharged against medical advise. Failure of CPAP was associated with co morbidities like sepsis, congenital heart diseases, PPHN and IVH. Conclusion: Indigenous bubble CPAP is low cost equipment (Total cost Rs.301) effective in treatment of respiratory distress in newborn at resource limited neonatal intensive care units where newborn admissions are in excess.