Incidence of and Risk Factors for Neonatal Respiratory Depression and Encephalopathy in Rural Sarlahi, Nepal

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Intrapartum-related (IPR) hypoxic events ("birth asphyxia") result in an estimated 2 million fetal/neonatal deaths and 1 million impaired survivors each year, primarily in low-and middle-income countries. Limited data on the incidence, risk factors, and morbidity associated with IPR events are available from these settings. WHAT THIS STUDY ADDS:In Sarlahi, 20% of newborns experienced respiratory depression at birth; the incidence of neonatal encephalopathy was 28 to 33 cases per 1000 live births. The case fatality rate for IPR neonatal encephalopathy was 46%. Long-term implications for survivors are poorly understood. abstract OBJECTIVES: To characterize the incidence of, risk factors for, and neonatal morbidity and mortality associated with respiratory depression at birth and neonatal encephalopathy (NE) among term infants in a developing country. METHODS:Data were collected prospectively in 2002-2006 during a community-based trial that enrolled 23 662 newborns in rural Nepal and evaluated the impact of umbilical-cord and skin cleansing on neonatal morbidity and mortality rates. Respiratory depression at birth and NE were defined on the basis of symptoms from maternal reports and study-worker observations during home visits. RESULTS:Respiratory depression at birth was reported for 19.7% of live births, and 79% of cases involved term infants without congenital anomalies. Among newborns with probable intrapartum-related respiratory depression (N ϭ 3465), 112 (3%) died before their first home visit (presumed severe NE), and 178 (5%) eventually developed symptoms of NE. Overall, 629 term infants developed NE (28.1 cases per 1000 live births); 2% of cases were associated with congenital anomalies, 25% with infections, and 28% with a potential intrapartum event. The incidence of intrapartum-related NE was 13.0 cases per 1000 live births; the neonatal case fatality rate was 46%. Infants with NE more frequently experienced birth complications and were male, of multiple gestation, or born to nulliparous mothers. CONCLUSIONS:In Sarlahi, the incidence of neonatal respiratory depression and NE, associated neonatal case fatality, and morbidity prevalence are high. Action is required to increase coverage of skilled obstetric/neonatal care in this setting and to evaluate long-term impairments. Pediatrics 2011;128:e915-e924