Clinico laboratory determinants of outcome among babies with perinatal asphyxia in Osogbo, Southwestern Nigeria

Abstract

Background: Many clinical, pathological, biochemical and metabolic changes occur as a result of perinatal asphyxia. These changes affect many organ and systems like central nervous system, cardiovascular system, pulmonary, renal, adrenal, gastrointestinal tract, skin and haemopoetic systems. The aim of the study was to identify various clinical and biochemical determinants of outcome in perinatal asphyxia so as to institute proactive the management of such babies. Methods: All newborn infants with birth asphyxia over 5 year period (2009)(2010)(2011)(2012)(2013) were retrospectively studied. The data studied included place of birth, gestational age, Apgar score, mode of resuscitation, details of complete physical examination especially as regard each of the system. Results of investigations like haematocrit, serum electrolytes and urea, blood glucose done in the first 24 hours of life and also other investigations like lumbar puncture, full blood count, cultures were noted. The outcome studied was survival and death of the babies. Results: One thousand, six hundred and seven babies were admitted into special care baby"s unit over the 5 year period, between 2009 and 2013. Nine hundred and seventy nine (60.9%) of them were males while 628 (39.1%) were females, M:F ratio was 1.6:1. Of the 1607 babies, 563 (35.0%) were asphyxiated. Of 1607 admitted during the period of study, 304 (18.9%) died while 128 (22.7%) of 563 babies with perinatal asphyxia died. Therefore, perinatal asphyxia accounted for 42.1% of the total mortality. 22 (7.8%) of the 280 babies who suffered moderate asphyxia compared with 106 (37.9%) of 283 babies who suffered severe asphyxia died. (χ2 = 72.4, p=0.000). Many of the asphyxiated babies had multisystemic adverse features. Significantly more babies who were out born, low birth weight, macrosomic and hypothermic than otherwise died. Also more babies with cyanosis, respiratory distress, apnoea, abdominal distension, feed intolerance, oliguria/anuria, bleeding disorder, abnormal muscle tone, seizures, bulging frontannel, and coma died, p ≥ 0.001. Also, mean haematocrit, plasma potassium and urea was significantly lower while plasma sodium was significantly higher among the babies who survived (p ≥0.001). Conclusions: Our findings have highlighted the major role of asphyxia in neonatal mortality and multisystemic morbidities or complications which contributed to death. It is therefore, likely that efforts at preventing perinatal asphyxia will be more rewarding. Such efforts include free and compulsory antenatal care, training of more skilled labour attendants and women empowerment.

Incidence and Predictors of Mortality Among Newborns With Perinatal Asphyxia: A 4-Year Prospective Study of Newborns Delivered in Health Care Facilities in Enugu, South-East Nigeria

“…This finding corroborates the observation of a similar study in Osogbo, Southwestern Nigeria. 18 This difference in mortality rate seen in our study between newborns delivered within the study facility and those referred from outside may be accounted for by several factors. First, being a tertiary hospital with relatively higher number of well-trained medical personnel and better facilities, it is expected that birth delivery services would be superior compared with services provided in most private hospitals, by TBAs and in home deliveries.…”

Determinants of outcome in newborns with respiratory distress in Osogbo, Nigeria

“…[14][15][16] Globally, about one quarter of all neonatal deaths are caused by birth asphyxia. 13 Perinatal asphyxia readily cause respiratory distress through multiorgan dysfunction, theorized to be secondary to the "diving reflex," hypoxia, acidosis and its attendant complications.…”

“…It also show findings of respiratory acidosis, metabolic acidosis and mixed acidosis as laboratory findings. 6,14 The main stay of management is sulfactant administration, respiratory support and management of systemic complications or associated findings. Prognosis is determined based on severity of diseases, management viz a vis immediate sulfactant administration and respiratory support available; associated systemic complications.…”

Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study

“…Twenty-three percent of the deaths each year around the world[ 7 ] and 31.6% in Ethiopia are attributed to birth asphyxia[ 8 ]. Studies conducted in Osogbo, Southwestern Nigeria[ 9 ], Southern Nepal[ 10 ], and Khulna Urban Slum, Bangladesh[ 11 ] also suggest that birth asphyxia is responsible for about 23.9%, 30%, and 39% of the deaths, respectively.…”