Clinical Study of Etiological Factors and Its Outcome in Birth Asphyxia

Abstract

ABSTRACT:A prospective and descriptive clinical study was done to study etiological factors of birth asphyxia and its outcome. Total 150 newborn babies were included in this study and 1190 normal babies were taken as control to study etiological factors for birth asphyxia. Data analysis was done by Z test, chi square test, univariate and ultivariate logistic regression analysis of risk factors. In this study statistically significant association between severity of perinatal asphyxia and severity of HIE was seen. In this study, significant proportion of neonates develop HIE following asphyxia insult. The identification of HIE following perinatal hypoxic insult is important because of the predictive significance for future motor and cognitive deficits. KEYWORDS: Birth asphyxia, HIE, predictive significance. INTRODUCTION:Perinatal asphyxia, neonatal asphyxia or birth asphyxia is a medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the process to cause physical harm, usually to the brain. Hypoxic damage can occur to most of the infants organs (Heart, lungs, liver, gut, kidney), but brain damage is of most concern and perhaps the least likely to completely heal. (1) Birth asphyxia is one of the major causes of early neonatal mortality in India. Among the institutional births, incidence is 5% and accounts for 24.3% of neonatal deaths. (2) The greatest risk of adverse outcome is seen in newborn infants with fetal acidosis (pH <5), a five minute apgar score of 0-3, hypoxic ischemic encephalopathy (HIE) or multi organ malfunctions. (3) Sarnat and Sarnat described their HIE grading in 21 infants in 1976 (4) in a study relating electroen-cephalographic findings to the clinical conditions of infants. Later on this classification was modified by Levene based on clinical observation. HIE was classified as mild HIE (Stage I) in which the infant was hyper alert with normal muscle tone, reflexes were normal and seizures were absent. Moderate HIE (Grade II) presented with an infant being lethargic, decreased muscle tone, weak or absent reflexes and seizures were present. In severe HIE (Grade III) the level of consciousness was very much depressed (Stuporose) with flaccid muscle tone, absent reflexes and seizures were either too frequent or difficult to control.The common worry of health professional and parents is the permanent brain damage that birth asphyxia can cause and the common aim is to reduce the number of newborns affected. Improving women's' health and health care will reduce the risk factors and decrease the number of newborns needing resuscitation.Nevertheless, there is one single intervention for dealing ith asphyxia when it occursResuscitation. Therefore, every birth attendant must be both skilled and equipped to resuscitate newborns that don't start breathing spontaneously.So, appropriate and effective resuscitation at birth is a cornerstone of optimal neonatal care. The new guidelines provide for a uniform, systematic and action oriented approach to the neo...