Incidence of multiorgan dysfunction in perinatal asphyxia

Abstract

INTRODUCTIONBirth asphyxia refers to condition of hypoxemia, hypercapnia and insufficient blood perfusion of new born during labour and birth. NNPD defines moderate birth asphyxia as APGAR score of 4-6 at 1minute and severe birth asphyxia as APGAR score of <3 at 1 minute.1 AAP defines it as APGAR score of less than 3 at 5minutes associated with cord pH of less than 7.0, presence of neurologic dysfunction and evidence of multiorgan dysfunction. 2Perinatal Asphyxia (PA) is a major public health problem. As per the latest estimates, PA accounts for 9% (i.e. 0·8 million) of total under-5 mortality (i.e. 8.8 millions) worldwide, being one of the three most common causes of neonatal deaths along with prematurity and bacterial infections. Of a total of 2.7 million stillbirths globally, approximately 1.2 million occur during intrapartum period, largely owing to asphyxia.3 As per NNPD, 9.5% of babies require some form of resuscitation. Manifestations of Hypoxic Ischaemic Encephalopathy (HIE) were seen in approximately 1.4% of all babies. PA was responsible for 28.8% of all neonatal deaths. Apart from neonatal deaths, asphyxia is responsible for life-long neuromotor disability in a large number of children. 1 ABSTRACTBackground: Objectives of current study was to study the incidence of multiorgan dysfunction in babies with perinatal asphyxia and its effect on the outcome. Methods: All term babies admitted to NICU of S. Nijalingappa Medical College and Hanagal Shri Kumareshwara Hospital, Bagalkot in the period January 2013 to December 2013 with perinatal asphyxia and HIE were included in the study. Detailed history and thorough examination was done using predesigned and prestructured proforma. Necessary investigations were done as indicated to identify organ dysfunction. Results: 80.8% of babies with perinatal asphyxia had evidence of multiorgan dysfunction with HIE alone seen in 19.2% of cases. Respiratory failure was the most common organ dysfunction after CNS seen in 63.1% of cases. CVS involvement was seen in 54.3% (31) of babies, out of which the mortality was seen in 22.5% (7 cases), renal involvement was seen in 29.8% (17) of babies, out of which the mortality was seen in 29.4% (5 cases). Increased mortality in babies who had cardiovascular dysfunction and in babies with renal dysfunction was statistically significant. Mortality was higher in babies with multiorgan dysfunction which increased proportionately with increase in number of organs involved. Conclusions: Multiorgan dysfunction is common in babies with perinatal asphyxia. Cardiovascular involvement and renal involvement are associated with poor outcome. Mortality is directly proportional to the number of organs involved.

Spectrum of multi-organ system involvement in perinatal asphyxia in neonatal intensive care unit department of Pediatrics, King George hospital, Visakhapatnam, Andhra Pradesh, India

“…Similar studies with respiratory system being second most common system was seen in studies by Pattar RS et al, (63%), Shah P et al, (86%), and Shankaran S et al, (85%). 11,14,15 In the present study, renal involvement was seen in 26.5% of neonates with perinatal asphyxia and was associated with a mortality of 51% in present study. This was the third most common system affected next to pulmonary system in present study.…”

“…Chisty AL observed hypoglycemia in 27.6%, metabolic acidosis in 77%, hyperbilirubinemia in 24% and hypocalcemia in 12% of infants. 15 In the present study, authors observed hematological involvement in 14% of asphyxiated neonates. Hematological abnormalities are prominently seen in preterm babies and less commonly in term and as the present study evaluated only term infants, this could be the reason for the difference in the result compared to by Shankaran S et al, who showed hematologic involvement in 35% of babies with severe perinatal asphyxia.…”

Prevalence and Associated Factors of Perinatal Asphyxia in Neonates Admitted to Ayder Comprehensive Specialized Hospital, Northern Ethiopia: A Cross-Sectional Study

“…Most of the neonates with stage III perinatal asphyxia (84.6%) died. This is higher than the reported 66.7% from Enugu, southeast Nigeria [25], and 44.4% from Karnataka, India [27]. The reason could be due to the difference in the health facility setup and the presence of multiorgan failure associated with hypoxic-ischemic encephalopathy.…”

Prevalence of perinatal asphyxia in East and Central Africa: systematic review and meta-analysis

“…From the rest 94 articles, 48 were excluded as a result of not fulfilling our inclusion criteria by reviewing their titles and abstracts. Therefore, 46 full-text articles were accessed and assessed for eligibility based on the inclusion criteria [3,15,17,20,21,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71]. Finally, 13 studies that fulfilled the eligibility criteria were included in the meta-analysis (Figure 1).…”