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

Abstract

Fatalities from perinatal asphyxia remain high in developing countries, and continually assessing its risk factors will help improve outcomes in these settings. We explored how some identified risk factors predict mortality in asphyxiated newborns, to assist clinicians in prioritizing interventions. This was a 4-year prospective study conducted at the Enugu State University Teaching Hospital, Enugu, Nigeria. All newborns who met the study criteria that were admitted to this facility in this period were enrolled and monitored. Data collected were analysed with SPSS Version 18. A total of 161 newborns with perinatal asphyxia were enrolled into the study with an in-hospital incidence rate of 12.81 per 1000 birth and a case fatality rate of 18%. Overall, the APGAR scores were severe in 10%, moderate in 22%, mild to normal in 68%, whereas the SARNAT stages were III in 24%, II in 52%, and I in 25%. In terms of mortality, 66.7%, 22.2%, and 11.1% mortalities were, respectively, observed with SARNAT scores III, II, and I (P = .003), whereas the findings with APGAR were 31.2% (severe), 25.0% (moderate), 25.0% (mild), and 18.8% (normal) (P = .030). Fatality outcome was more correlated with SARNAT (R = .280; P = .000) than APGAR (R = −.247; P = .0125). The SARNAT score significantly differentiated between the degrees of asphyxia in newborns based on gestational age at delivery (P = .010), place of delivery (P = .032), and mode of delivery (P = .042). Finally, it was noted that newborns that were female (P = .007), or born outside the hospital (P = .010), or with oxygen saturations <60% (P = .001), or with heart rate <120 (P = .000), and those with respiratory rate <30 (P = .003), all have significantly higher likelihood of deaths from asphyxia. Therefore, predictors of neonatal mortality from perinatal asphyxia in our centre include being female and being born outside the hospital, as well as low oxygen saturations, heart rates, and respiratory rates at presentation.

Postnatal Outcomes and Risk Factors for In-Hospital Mortality among Asphyxiated Newborns in a Low-Resource Hospital Setting: Experience from North-Central Nigeria

“…The in-hospital case fatality rate for asphyxia in this study was 14.7% and about a third of these newborn infants died within 24 hours of admission, and this was despite early presentation to hospital. These asphyxia case fatality rates are similar to those previously described in studies from other low-resource settings [16][17]. In contrast, mortality prevalence was significantly higher in a previous North-western Nigerian study were rates of 25.5% were described [8].…”

“…We have conducted a prospective study and have used multivariable logistic regression to address possible confounders for risk estimates. This study thus improves on previous studies that have not adjusted for the effect of confounding or have been retrospective case analysis [16].…”

Gender Differences Involved in the Pathophysiology of the Perinatal Hypoxic-Ischemic Damage

“…However, this study suffers from some limitations, as e.g. more male than female neonates were incorporated in this study (Ekwochi et al 2017).…”

Factors associated with clinical outcomes among neonates admitted with acute bilirubin and hypoxic-ischaemic encephalopathies at a tertiary hospital in south-west Nigeria

“…It is not strange in this setting for a parturient to first seek obstetric care during labour at non-orthodox facilities (traditional and spiritual birth homes) and thereafter to resort to orthodox facilities when emergencies occur or progress could not be made, by which time foetal compromise might have occurred. 16 Despite the pressure for early discharge from the nursery, babies should be screened for the risk of significant hyperbilirubinaemia using the various recommended tools (such as the normogram for plotting six-hour serum bilirubin level as a predictor of severe hyperbilirubinaemia within the first week of life). 29 Mothers should be taught how to check their babies for jaundice in bright light and be encouraged to seek care promptly when jaundice is detected.…”

“…[5][6][7][8][9][10][11][12] The odds of mortality among babies with these conditions have been variously reported to be higher among outborn babies. 6,7,[13][14][15] On a general note, studies in the developing world have suggested that babies delivered outside the hospital are at worse risk of complications such as hypoxic-ischaemic encephalopathy (HIE), 13,16 and acute bilirubin encephalopathy (ABE). 15,17 This higher tendency for complications occurs for various reasons ranging from inappropriate and ineffective home care, and delay in seeking effective care outside home, to seeking care at inappropriate places and non-availability of desired quality care, even at the appropriate health facilities.…”