Incidence and Risk Factors Associated with Birth Asphyxia in South Indian Newborns—Part I

Abstract

Birth asphyxia is the leading cause of preventable proportion of neonatal morbidity and mortality, has a high incidence in many Asian countries. The objective of the study was to determine the incidence and influence of various antepartum, intrapartum and neonatal risk factors associated with birth asphyxia in Ethnic Asian-South Indian newborns and to formulate appropriate Asian guideline as preventive strategy. The study comprised of 2,750 consecutive singleton live births, with 583 "Cases" of birth asphyxia and 2,167 "Controls" without asphyxia. Analysis was done using SPSS Version 21 for various risk factors associated with birth asphyxia presented at different intensity levels as odds ratio (OR), mean difference (95% CI), number or percent (%) by binary logistic regression and statistical significance set at 0.05. Incidence of birth asphyxia was 21.2%, peak births of asphyxiated cases occurred at 39 weeks, contrasted to 38 weeks in controls. High risk factors included primigravida OR 1.1 [CI 95%] 0.89-1.29, pregnancy induced hypertension OR 1.37, [CI 95%] 0.92-2.04, P=0.0001, breech presentation OR 20.6 [CI95%] 4.5-94.3, P=0.0001, meconium staining of liquor OR 29 [CI 95%] 19.78-42.65, P=0.0001, oligohydraminos OR 29 [CI 95%] 19.78-42.65, P=0.0001 and cord abnormalities OR 2.9 [CI 95%] 2.18-3.88, P=0.0001. Most asphyxiated cases were delivered by emergency lower segment cesarean section OR 4.91 [CI 95%] 3.94-6.10, P=0.0001, while elective or planned LSCS had low risk of birth asphyxia, Neonatal factors include prematurity < 37 weeks OR 1.36 [CI 95%] 1.03-1.79, P=0.032 and Low Birth Weight (LBW) < 2500g OR 1.51 [CI 95%] 1.21-1.98, P=0.0001. Thus judicious intervention in high risk pregnancy with delivery at 38 weeks, preferably by planned section, obviating intrapartum events will result in reduction of birth asphyxia, thus improving quality of life in survivors.

Lalana Newborn Resuscitation

“…The main cause of death was severe birth asphyxia 30% (n=74/248), lethal malformation (LM) 24% (n=59/248) and Respiratory Distress Syndrome (RDS) 21% (n=52/248) ranked as second and third causes respectively, followed by intracranial haemorrhage (ICH) 7.6% (n=19/248), neonatal infections 3.2% (n=8/248) and 'miscellaneous' 14.5% (n=36/248) which included extreme prematurity, pulmonary haemorrhage, liquor aspiration and Rh iso immunization, constituted the remaining first day deaths [9]. Time of death among 248 first day deaths, nearly half 48% (n=119/248) took place within two hours of birth and 29% (n=72/248) >2-12 hours with less than a quarter 23% (n=57/248) within 12-24 hours [9]. Other studies have noted that more than half, 57 % of neonatal mortality occurred within 24 hours [102].…”

“…Seven out of every eight stillbirths is due to severe birth asphyxia, with stillbirth rate figuring one and a half times that of early neonatal mortality rate, reveals the magnitude of asphyxiated stillbirths [21,103]. Emphasizing that birth asphyxia continues to be a major cause of preventable proportion perinatal and neonatal and that the neonatal period, more so the first one week, especially within the first 24 hours of life being critical for survival in the life of a child with prevailing high mortality rates predominately in developing Asian countries [5][6][7][8][9][10].…”

“…Nearly 20-40 percent of perinatal deaths are attributed to birth asphyxia especially in Asian countries [5][6][7][8][9][10][11][12]16,17]. Strictly speaking stillbirths are fetal deaths nevertheless even live born neonate who is apneic and cyanotic with pulse is set aside after birth and left to initiate respiration, or are inadequately resuscitated and die are classified as stillbirths as unskilled birth attendants may not be able to distinguish between the two conditions with inaccuracy of recording these fatalities, often termed stillbirth with high stillbirth rates.…”

“…Globally of 2.5 million children who die in the first month of life, about one-third dies within 24 hours with similar intrapartum 1.2 million stillbirths, occurring predominantly in Asian countries, it is estimated that 4 to 9 million babies per year experience birth asphyxia with only 1 to 2 million successfully resuscitated [1,4]. Incidence varies from 2 to 28 per 1000 live births with three-fold higher risk of asphyxiated infants dying in the neonatal period compared to non-asphyxiated infants; however the major impact is on larger and more mature babies, who otherwise have a good chance of survival [5][6][7][8][9][10]. During 2020, 36.3% of 7,000 neonatal deaths took place within the first 24 hours comprising 47% of all child deaths under five years, up from 40% in 1990.…”

Incidence and predictors of mortality among neonates admitted with perinatal asphyxia at west Oromia region referral hospitals, Ethiopia, 2022

“…Despite improvements in the management of perinatal care, ANC follow up strategies and the accessibility of NICU (Neonatal intensive care unit) care perinatal asphyxia continues to account for the majority of neonatal intensive care unit (NICU) admissions and is one of the leading causes of neonatal deaths in underdeveloped countries (18)(19)(20). A study conducted in Vietnam identi ed that prematurity, asphyxia and designated congenital malformations are underestimated because of most of the researches were not considered the comorbidities (21,22).…”