Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country

Abstract

Background It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. Methods Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. Results Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks. Conclusions There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.

Incidence and Predictors of Mortality Among Neonates with Perinatal Asphyxia, Northwest Ethiopia, 2021: An Institution Based Retrospective Cohort Study.

“…Previous studies conducted on predictors of mortality found maternal age less than 20 years (29,30), mothers who did not attend ANC (20,21,31), primipara (20,32), maternal anemia (21), pregnancyinduced hypertension (30), delivered out of the hospital (33)(34)(35), premature rupture of the membrane (PROM) (20,30,32), spontaneous vaginal delivery (29,(33)(34)(35), instrumental delivery (23), multiple births (32), prolonged labour (23,32), Obstructed labour (30), meconium-stained amniotic (20), preterm birth (32,35,36), low birth weight (35)(36)(37)(38)(39), Hypoxic-ischemic encephalopathy (HIE) stage II and III (20,21,23,40), respiratory distress at admission (21,39), neonatal sepsis (32,40,41), hypoglycemia (20), neonatal anemia (21) and hypothermia (20) were independent predictors of mortality among neonat...…”

Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study

“…Several studies have documented on the short and long term adverse effects of HIE in infants such as increased requirements for supportive care in the perinatal period, severe long-lasting neurological sequelae, cerebral palsy, epilepsy and cognitive impairments [6][7][8]. In most high-income countries, the incidence of HIE has reduced significantly following improvements in obstetric and neonatal care unlike in lower and middleincome countries (LMICs) [8,9]. In Sub-Saharan Africa and indeed in Nigeria, the real burden of HIE is difficult to determine due to the paucity of data [10].…”

“…Thus, the Sarnat and Sarnat staging of HIE has been identified as a predictive tool in prognosticating severe perinatal asphyxia. However, this scoring tool requires a certain level of medical expertise [9,10,13,14].…”

Role of Nucleated Red Blood Cells in Diagnosis of Neonatal Asphyxia in Neonate with Meconium Stained and Clear Amniotic Fluid

“…According to the World Health Organization (WHO) in 2000, of the 130 million infants born globally each year, approximately 4 million babies die before they reach the age of 1 month. Furthermore, of 1.2 million neonatal deaths in India, 300,000-350,000 babies die due to perinatal asphyxia mostly within first 3 days of life (1) .Hypoxic ischemic encephalopathy (HIE) after prenatal asphyxia is an important cause of neonatal morbidity, neurological disability and mortality. The early prediction of hypoxic ischemic encephalopathy is particularly important because of the brief therapeutic window and possible side effects of neuroprotective intervention (2) .…”