Stillbirths and neonatal encephalopathy in Kathmandu, Nepal: an estimate of the contribution of birth asphyxia to perinatal mortality in a low‐income urban population

Abstract

We describe a prospective cross-sectional survey over a 12-month period in the principal maternity hospital of Kathmandu, Nepal, where over 50% of the local population deliver. The study aim was to estimate the contribution of birth asphyxia to perinatal mortality in this setting. During 1995, there were 14,371 livebirths and 400 stillbirths, a total stillbirth rate of 27 per 1000 total births. The fresh term (2000 g or more) stillbirth rate was 8.5 per 1000 total births [95% CI 7.1, 10.1]. Ninety-two cases of neonatal encephalopathy (NE) affecting term infants were detected (excluding those due to congenital malformations, hypoglycaemia and early neonatal sepsis). The birth prevalence of NE was 6.4 per 1000 livebirths [95% CI 5.2, 7.8]. There was evidence of intrapartum compromise in 63 (68%) of the cases of NE and 65 (76%) of the stillbirths, but only in 12 (12%) of controls. The cause-specific early neonatal mortality rate for NE was 2.1 per 1000 livebirths [95% CI 1.4, 3.0]. Combining the NE deaths and fresh stillbirths gives an upper estimate for term birth asphyxia perinatal mortality rate of 10.8 per 1000 total births [95% CI 9.2, 12.6], 24% of all perinatal deaths before hospital discharge. This study suggests that birth asphyxia remains an important cause of perinatal mortality in developing countries. The paper discusses the pros and cons of different strategies to reduce birth asphyxia in low-income countries.

Risk factors for adverse outcome in asphyxiated new born in Eastern Nepal

“…A Hospital based studies in Nepal estimated that birth asphyxia accounted for 24% of perinatal mortality. 4 Similarly another study from Southern Nepal documented 30% of neonatal mortality due to birth asphyxia. This study also showed maternal fever, prematurity, multiple birth and poor socio-economy as a risk factor for high mortality in asphyxiated newborn.…”

Sonographic Changes in Hypoxic-Ischaemic Encephalopathy

“…The duration and severity of HIE depend of the severity of asphyxia. Neonatal asphyxial encephalopathy occurs in 1-2 per 1000 births in the high income countries (Marlow & Budge, 2005;Pierrat et al, 2005;Barkovich, 2005), in low-income countries, the incidence is much higher (Ellis et al, 2000;Black et al, 2010).…”

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

“…[27][28][29] The incidence of NE in Sarlahi (ϳ28 cases per 1000 live births) was Ͼ4 times the rate of NE reported from a maternity hospital in Kathmandu, Nepal (6 cases per 1000 live births). 30 Incidence rates have been reported from other hospital-based studies in low-and middle-income countries, ranging from 9.4 cases per 1000 live births in Kuwait 31 to 14 cases per 1000 live births in India 32 and 22 to 26 cases per 1000 live births in Uganda and Nigeria. 33,34 Hospital-based data are subject to selection biases that may result in overestimation or underestimation of population-based incidence rates.…”

“…With the assumption of a 30% disability rate among survivors of NE, 16,17 the impair- (14) 42 (10) 12 (11) 1385 (7) Hypoxic-ischemic intrapartum events may contribute to 30% to 80% of cases of NE. 30,[35][36][37] In Perth, Australia, 30% of NE cases had evidence of intrapartum hypoxia, defined on the basis of abnormal fetal heart rates, meconium staining, and low Apgar scores. 35 In a hospital-based study in Kathmandu, Nepal, 60% of NE cases had evidence of intrapartum compromise with the use of similar criteria.…”