Birth asphyxia and its associated factors among newborns in public hospital, northeast Amhara, Ethiopia

A cost-effectiveness analysis of using umbilical cord blood pH for the diagnosis and management of neonatal asphyxia in term high-risk pregnancy

OBJECTIVE

The objective was to evaluate the cost-effectiveness of using umbilical cord blood pH (UC-pH) in combination with APGAR score for neonatal asphyxia, in terms of high-risk pregnancies, compared to using the APGAR score only. Neonatal outcomes and the proportions of patients admitted to the neonatal intensive care unit (NICU) were evaluated.

METHODS

A cost-effectiveness ambispective analysis study was carried out, comparing (i) UC-pH combined with APGAR score and (ii) APGAR score only in 399 term pregnancies with a high risk for neonatal asphyxia. Costs included implementation, medical, and admission costs. Incremental cost-effectiveness ratios (ICER) were calculated. The proportions of patients admitted to the NICU were evaluated.

RESULTS

UC-pH combined with APGAR score demonstrated a cost-effective outcome (3990.64 USD vs 5545.11 USD) and an ICER shown as saving 103.66 USD compared to the APGAR score alone. The need for NICU admission was less in the umbilical cord blood collection group (18 vs 33 cases).

CONCLUSION

A combination of UC-pH with APGAR score assessment for neonatal asphyxia in a high-risk term pregnancy can effectively reduce costs and requirement for NICU admission.

Neonatal birth asphyxia and associated factors among newborns delivered and admitted to NICU in selected public hospitals, under Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia, A cross-sectional study

BACKGROUND

In developing countries birth asphyxia is a major cause of neonatal morbidity and mortality. Despite the implementation of various strategies and interventions to combat neonatal mortality rates, birth asphyxia remains the main public health concern in Ethiopia. Moreover, limited studies have been conducted, especially in the study area and there are no multicenter analyses available to generate evidence for action. Therefore, this study aimed to assess the burden and associated factors of birth asphyxia among newborns in the selected public hospitals of the Addis Ababa City Administration Health Bureau.

METHODS

Three hundred forty-three mother-child pairs who used delivery services and gave birth in the selected public hospitals were included in the study, and institution based cross sectional study design was employed. A systematic random sampling technique was used to select the study participants. A pretested, structured interviewer administered questionnaire was used to collect the data. The physician's/health care professionals diagnosis of an Apgar score less than 7 within the first five minutes of life led to the confirmation of the diagnosis of birth asphyxia. SPSS version 24 was used for analysis after the data were exported from Epi Info version 7.2. Multivariate logistic regression analysis included variables which had P-values less than 0.25 in the bivariable logistic regression analysis. The study findings were expressed using adjusted odds ratio with a 95% confidence interval, and P-value less than 0.05 was used to declare the statistical significance.

RESULTS

The magnitude of birth asphyxia was found to be 17.1% [95% CI; (13.2-21.5)] at the first 5 min. In the multivariable logistic regression analysis cord accident [AOR = 6.24: 95% CI; (1.24-31.32)], prolonged duration of labor [AOR = 2.49: 95% CI; (1.93-10.89)], and meconium-stained amniotic fluid [AOR = 3.33: 95% CI; (1.73-6.41)] were the predictors of birth asphyxia.

CONCLUSIONS

The findings of this research indicate that birth asphyxia is a prevalent neonatal problem at the study area. Therefore, the Addis Ababa Health Bureau must prioritize integrated mitigation interventions targeting high-risk pregnancies to achieve national and international commitment to sustainable changes in newborn health.

Incidence, predictors and immediate neonatal outcomes of birth asphyxia in Nigeria

OBJECTIVE

To determine the incidence and sociodemographic and clinical risk factors associated with birth asphyxia and the immediate neonatal outcomes of birth asphyxia in Nigeria.

DESIGN

Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme.

SETTING

Fifty-four consenting referral-level hospitals (48 public and six private) across the six geopolitical zones of Nigeria.

POPULATION

Women (and their babies) who were admitted for delivery in the facilities between 1 September 2019 and 31 August 2020.

METHODS

Data were extracted and analysed on prevalence and sociodemographic and clinical factors associated with birth asphyxia and the immediate perinatal outcomes. Multilevel logistic regression modelling was used to ascertain the factors associated with birth asphyxia.

MAIN OUTCOME MEASURES

Incidence, case fatality rate and factors associated with birth asphyxia.

RESULTS

Of the available data, 65 383 (91.1%) women and 67 602 (90.9%) babies had complete data and were included in the analysis. The incidence of birth asphyxia was 3.0% (2027/67 602) and the case fatality rate was 16.8% (339/2022). The risk factors for birth asphyxia were uterine rupture, pre-eclampsia/eclampsia, abruptio placentae/placenta praevia, birth trauma, fetal distress and congenital anomaly. The following factors were independently associated with a risk of birth asphyxia: maternal age, woman's education level, husband's occupation, parity, antenatal care, referral status, cadre of health professional present at the birth, sex of the newborn, birthweight and mode of birth. Common adverse neonatal outcomes included: admission to a special care baby unit (SCBU), 88.4%; early neonatal death, 14.2%; neonatal sepsis, 4.5%; and respiratory distress, 4.4%.

CONCLUSIONS

The incidence of reported birth asphyxia in the participating facilities was low, with around one in six or seven babies with birth asphyxia dying. Factors associated with birth asphyxia included sociodemographic and clinical considerations, underscoring a need for a comprehensive approach focused on the empowerment of women and ensuring access to quality antenatal, intrapartum and postnatal care.

Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia

BACKGROUND

Despite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the top 10 nations with the highest number of neonatal deaths in 2020 alone. This staggering amount makes it difficult to achieve the SDG (Sustainable Development Goals) target that calls for all nations to work hard to meet a neonatal mortality rate target of ≤ 12 deaths per 1,000 live births by 2030. We evaluated neonatal mortality and it's contributing factors among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Hawassa University Comprehensive Specialized Hospital (HUCSH).

METHODS

A hospital-based retrospective cross-sectional study on neonates admitted to the NICU from May 2021 to April 2022 was carried out at Hawassa University Comprehensive Specialized Hospital. From the admitted 1044 cases over the study period, 225 babies were sampled using a systematic random sampling procedure. The relationship between variables was determined using bivariate and multivariable analyses, and statistically significant relations were indicated at p-values less than 0.05.

RESULTS

The magnitude of neonatal death was 14.2% (95% CI: 0.099-0.195). The most common causes of neonatal death were prematurity 14 (43.8%), sepsis 9 (28.1%), Perinatal asphyxia 6 (18.8%), and congenital malformations 3 (9.4%). The overall neonatal mortality rate was 28 per 1000 neonate days. Neonates who had birth asphyxia were 7.28 times more probable (AOR = 7.28; 95% CI: 2.367, 9.02) to die. Newborns who encountered infection within the NICU were 8.17 times more likely (AOR = 8.17; 95% CI: 1.84, 36.23) to die.

CONCLUSION

The prevalence of newborn death is excessively high. The most common causes of mortality identified were prematurity, sepsis, perinatal asphyxia and congenital anomalies. To avert these causes, we demand that antenatal care services be implemented appropriately, delivery care quality be improved, and appropriate neonatal care and treatment be made available.

Magnitude of neonatal asphyxia and its predictors among newborns at public hospitals of Wolaita Zone in Southern Ethiopia, 2023

BACKGROUND

Neonatal asphyxia is one of preventable causes of neonatal mortality throughout the world. It could be improved by early detection and control of the underlying causes. However, there was lack of evidence on it in the study setting. Thus, the aim of this study was to assess the magnitude and predictors of neonatal asphyxia among newborns at public hospitals of Wolaita Zone in Southern Ethiopia.

METHOD

A facility-based cross-sectional study was done among 330 mothers with neonates in selected public hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through an interviewer-administered questionnaire and checklist. The collected data were entered into EpiData version 4.6 and exported to SPSS version 26 for analysis. Logistic regression was fitted to examine the association between explanatory variables and outcome variable. In multivariable logistic regression, AOR with 95% CI was reported, and p < 0.05 was used to declare statistically significant variables.

RESULTS

The magnitude of neonatal asphyxia was 26.4% with 95% CI: (21.8, 30.9). In multivariable logistic regression analysis primiparity (AOR = 2.63 95%CI 1.47, 4.72), low-birth-weight (AOR = 3.45 95%CI 1.33, 8.91), preterm birth (AOR = 3.58 95%CI 1.29, 9.92), and premature rupture of membranes (AOR = 5.19 95%CI 2.03, 13.26) were factors significantly associated with neonatal asphyxia.

CONCLUSIONS

In this study, the magnitude of neonatal asphyxia was high. From the factors, premature rapture of the membrane, parity, birth weight of the newborn, and gestational age at birth were significantly associated with neonatal asphyxia. Attention should be given to early detection and prevention of neonatal asphyxia from complicated labor and delivery.

Determinants of birth asphyxia among neonates admitted to neonatal intensive care units in hospitals of the Wolaita zone, Southern Ethiopia: A case-control study

Background

Birth asphyxia, according to the World Health Organization (WHO), is the inability of breathing to start and continue automatically at birth. Blood-gas exchange is impaired, which results in increased hypoxia, hyperapnea, and substantial metabolic acidosis. The aim of this study was to determine the factors contributing to birth asphyxia in infants admitted to neonatal intensive care units in hospitals in the Wolaita Zone.

Methods

An institution-based, unmatched case-control study among neonates admitted to neonatal intensive care units in Wolaita Zone hospitals was conducted from March 1 to April 15, 2021. With 148 cases and 294 controls and a case-to- control ratio of 1:2, a sample size of 442 was determined. The pre-tested and structured Open Data Kit collect mobile application (v1.26.1) was used to collect the data, and SPSS version 25 was used for analysis. Using adjusted odd ratios and their corresponding 95 % confidence intervals, bivariate and multivariable logistic regression analyzes were performed.

Results

A total of 143 cases and 286 controls were included making. the response rate 97 %. Meconium or blood-stained amniotic fluid (AOR = 5.43, 95%CI:3.10-9.50), mothers who experienced any of dangerous symptom during pregnancy (AOR = 3.71, 95%CI: 1.56-8.65), premature rupture of membrane (AOR = 3.12, 95%CI: 1.42-6.83), hypothermic newborn (AOR = 4.57, 95CI: 1.77-11.81), labor not supported by Basic Emergency Obstetric and Neonatal Care (BEMONC) trained health professional (AOR = 3.23, 95%CI: 1.83-5.71), birth weight of less than 2500 gm (AOR = 2.68, 95%CI: 1.04-6.92), sub-standard filling of partograph (AOR = 4.03, 95%CI: 2.19-7.41), not filling on partograph during follow-up (AOR = 8.16, 95%CI: 2.24-29.66) and assisted vaginal delivery (AOR = 1.87, 95%CI:1.03-3.39) were identified as determinants of birth asphyxia.

Conclusion

In this study, fetal conditions such as hypothermia and low birth weight, changes in the color of amniotic fluid, dangerous pregnancy symptoms, membrane rupture, standard filling of the partograph, and BEMONC training were factors that predicted birth asphyxia. Therefore, prompt and effective management of fetal and maternal problems and as well as the development of health professionals' BEMONC competence are crucial.

Risk Factors for Birth Asphyxia in Hospital-Delivered Newborns in Dodoma, Tanzania: A Case-Control Study

Introduction

Asphyxia at birth remains the leading cause of neonatal morbidity and mortality worldwide, accounting for ∼23% of all neonatal deaths. Although the causes vary from country to country, early identification and treatment of risk factors can improve the situation.

Objectives

To determine the risk factors of birth asphyxia in hospital-delivered neonates in Dodoma, Tanzania.

Methods

A matched case-control study was conducted from May to July 2017 at Dodoma Region Referral Hospital. Data were collected using a semistructured questionnaire and a standard antenatal care index card. Cases were neonates diagnosed with asphyxia at birth ( N  =  100), while controls were neonates not diagnosed with asphyxia at birth ( N  =  300). A binary logistic regression model was used to assess the independent variables associated with birth asphyxia and reported as crude and adjusted odds ratios along with their 95% confidence intervals.

Results

A total of 400 newborns and their birth mothers were involved in the study. The average age of the case mothers was 26.9 years ( SD  =  7.85) and that of the control mothers was 27.24 years ( SD  =  6.08). Place of residence, anemia, maternal age, prenatal visits attended, use of herbs during labor, previously complicated pregnancy, duration of labor, meconium-stained amniotic fluid, and mode of delivery were predictors of birth asphyxia.

Conclusion

The study showed that most predictors of birth asphyxia can be prevented. The results suggest appropriate health education before conception, effective follow-up through prenatal care, early identification and treatment of high-risk pregnant women, and proper monitoring of labor and delivery.

Risk Factors for Birth Asphyxia in Hospital-Delivered Newborns in Dodoma, Tanzania: A Case-Control Study

Introduction

Asphyxia at birth remains the leading cause of neonatal morbidity and mortality worldwide, accounting for ∼23% of all neonatal deaths. Although the causes vary from country to country, early identification and treatment of risk factors can improve the situation.

Objectives

To determine the risk factors of birth asphyxia in hospital-delivered neonates in Dodoma, Tanzania.

Methods

A matched case-control study was conducted from May to July 2017 at Dodoma Region Referral Hospital. Data were collected using a semistructured questionnaire and a standard antenatal care index card. Cases were neonates diagnosed with asphyxia at birth (N  =  100), while controls were neonates not diagnosed with asphyxia at birth (N  =  300). A binary logistic regression model was used to assess the independent variables associated with birth asphyxia and reported as crude and adjusted odds ratios along with their 95% confidence intervals.

Results

A total of 400 newborns and their birth mothers were involved in the study. The average age of the case mothers was 26.9 years (SD  =  7.85) and that of the control mothers was 27.24 years (SD  =  6.08). Place of residence, anemia, maternal age, prenatal visits attended, use of herbs during labor, previously complicated pregnancy, duration of labor, meconium-stained amniotic fluid, and mode of delivery were predictors of birth asphyxia.

Conclusion

The study showed that most predictors of birth asphyxia can be prevented. The results suggest appropriate health education before conception, effective follow-up through prenatal care, early identification and treatment of high-risk pregnant women, and proper monitoring of labor and delivery.

The determinants of neonatal asphyxia in the tropical province of China: A case-control study

As the major public health problem among under-5 children in the world, neonatal asphyxia (NA) contributes to 24% of the main causes of neonatal death. The effects of NA is not only limited to death but also has a long-term brain injury with lifelong adverse effects. Therefore, the goal of this study was to identify determinants of NA among newborns in the tropical province of China to guide early interventions and improve the survival and quality of life of these infants. A case control study was conducted at Hainan Women and Children's Medical Center from January 1 to December 31, 2021. A total of 255 newborns (85 cases and 170 controls, 1:2 case to control ratio) were enrolled in the study. A systematic random sampling approach was adopted based on hospital delivery registration. Structured questionnaires were used to collected data. The data was entered into statistical software SPSS version 20.0 for analysis. In the bivariable analysis, variables with P values less than .1 were entered into multivariable logistic regression analysis. At a P value of .05, a statistically significant level was reported. Amniotic fluid stained by meconium/blood (AOR = 3.19, 95% confidence interval [CI]: 1.47-6.95), primiparity, fetal presentation of malpresentation (AOR = 3.89, 95% CI: 1.25-12.09), and low birth weight (AOR = 10.51, 95% CI: 3.02-36.55) were to be significantly associated with NA. This study identified that amniotic fluid stained by meconium/blood, primiparity, low birth weight were determinants of NA. Thus, preventive solutions such as close monitoring of fetus presentation, meliorating the obstetric care setup during antenatal care consultations should be stressed in China.

Predictors of Birth Asphyxia Among Newborns in Public Hospitals of Eastern Amhara Region, Northeastern Ethiopia, 2022

Background

Ethiopia ranked fourth in the world in terms of neonatal mortality rates, with birth asphyxia accounting for the majority of neonatal deaths.

Objective

This study aimed to determine the prevalence of birth asphyxia and associated factors among newborns delivered in government hospitals of the Eastern Amhara region, Northeastern Ethiopia, 2022.

Methods

A hospital-based cross-sectional study was conducted in 4 government hospitals between March 10, 2022, and May 8, 2022. The subjects in the study were selected using a systematic random sampling technique. Face-to-face interviews and chart reviews were used to collect the data. The association was discovered through multivariate logistic regression analysis.

Result

In this study, the prevalence of birth asphyxia was 13.1% (48) of the total 367 newborns. Mothers who could not read and write (AOR = 9.717; 95% CI = 3.06, 10.857); infants born with low birth weight (AOR = 2.360; 95% CI = 1.004, 5.547); primipara mothers (AOR = 5.138; 95% CI = 1.060, 26.412); mothers with less than 37 weeks of gestation (AOR = 4.261; 95% CI = 1.232, 14.746); and caesarian section delivery (AOR = 2.444; 95% CI = 1.099, 5.432) were predictors of birth asphyxia.

Conclusion

The magnitude of birth asphyxia has managed to remain a health concern in the study setting. As a result, special attention should be paid to uneducated and primi-mothers during antenatal care visits, and prematurity and caesarian section delivery complication reduction efforts should be bolstered to prevent birth asphyxia and its complications.

Associations between low birth weight and perinatal asphyxia: A hospital-based study

To investigate the associations between low birth weight (LBW) and perinatal asphyxia by a hospital-based study. The participants of this study were mothers who gave birth at our hospital in 2018. They were divided into case group and control group according to their children's asphyxia status. The bivariable and multivariable logistics regression were used to identify maternal and newborn factors with perinatal asphyxia. A total of 150 participants were enrolled in this study, including 50 participants in the case group and 100 participants in the control groups. The bivariate logistic regression analysis showed the significant relationship of LBW, the mother's age which was less than 20 years, and the gestational age with perinatal asphyxia (P < .05). The multivariate analysis was shown that LBW, male newborns, mothers who had preeclampsia/eclampsia, or mothers who were primipara or whose gestational age more than 37 weeks had higher risks of perinatal asphyxia (P < .05). However, there were no significant relationships of the age of mother or history of antenatal care with perinatal asphyxia. LBW of infants contributes to the higher risk of perinatal asphyxia.

Application of machine learning to identify risk factors of birth asphyxia

BACKGROUND

Developing a prediction model that incorporates several risk factors and accurately calculates the overall risk of birth asphyxia is necessary. The present study used a machine learning model to predict birth asphyxia.

METHODS

Women who gave birth at a tertiary Hospital in Bandar Abbas, Iran, were retrospectively evaluated from January 2020 to January 2022. Data were extracted from the Iranian Maternal and Neonatal Network, a valid national system, by trained recorders using electronic medical records. Demographic factors, obstetric factors, and prenatal factors were obtained from patient records. Machine learning was used to identify the risk factors of birth asphyxia. Eight machine learning models were used in the study. To evaluate the diagnostic performance of each model, six metrics, including area under the receiver operating characteristic curve, accuracy, precision, sensitivity, specificity, and F1 score were measured in the test set.

RESULTS

Of 8888 deliveries, we identified 380 women with a recorded birth asphyxia, giving a frequency of 4.3%. Random Forest Classification was found to be the best model to predict birth asphyxia with an accuracy of 0.99. The analysis of the importance of the variables showed that maternal chronic hypertension, maternal anemia, diabetes, drug addiction, gestational age, newborn weight, newborn sex, preeclampsia, placenta abruption, parity, intrauterine growth retardation, meconium amniotic fluid, mal-presentation, and delivery method were considered to be the weighted factors.

CONCLUSION

Birth asphyxia can be predicted using a machine learning model. Random Forest Classification was found to be an accurate algorithm to predict birth asphyxia. More research should be done to analyze appropriate variables and prepare big data to determine the best model.

Prevalence of birth injuries and associated factors among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Crossectional study

BACKGROUND

Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021.

METHODS

Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant.

RESULT

The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59-32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81-12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45-34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9-35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05-0.68), male sex (AOR = 3.84, 95% CI: 1.30-11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58-17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38-18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52-9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45-32.7) and night time birth (AOR = 4.82, 95% CI: 1.84-12.6).

CONCLUSION

The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.

Cause and risk factors of early neonatal death in Ethiopia

Background

Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death.

Methods

The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI.

Result

More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period.

Conclusion

The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.

Mapping research evidence on perinatal asphyxia within the sustainable development era in sub-Saharan Africa: a scoping review protocol

BACKGROUND

Approximately 45% of all under-five child deaths are among newborn infants, babies in their first 28 days of life, or the neonatal period every year in the World Health Organization (WHO) Africa Region. To facilitate the achievement of Sustainable Development Goal (SDG) 3.2, innovative interventions are needed to address this challenge. Thus, this scoping review aims to map research evidence on perinatal asphyxia among neonates in the WHO Africa Region.

METHODS

This scoping review will be guided by the Arksey and O'Malley framework, Levac et al. recommendations, and the Joanna Briggs Institute checklist for scoping reviews. Relevant published literature will be searched using a combination of keywords, Boolean terms, and Medical Subject Headings in the following databases: PubMed, SCOPUS, CINAHL, and Web of Science from January 2016 onwards. We will further search the World Health Organization and government websites, as well as the reference list of included studies for potentially eligible studies. This scoping review will include research evidence involving countries in the WHO Africa Region, with a focus on the burden of perinatal asphyxia, contributory/associated factors of perinatal asphyxia, clinical interventions for perinatal asphyxia, and interventions/strategies for the prevention of perinatal asphyxia in the SDGs era. Two reviewers will independently sort the studies to include and exclude, guided by the eligibility criteria. Also, the data from the included studies will be extracted and any discrepancies resolved using a third reviewer. Thematic analysis will be conducted, and the findings reported using both qualitative tables and figures. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) will be followed to report this study's results. Quality appraisal of the included studies will be done utilising the mixed methods appraisal tool version 2018.

CONCLUSION

This scoping review results may reveal research evidence gaps to inform future primary studies, systematic reviews and meta-analyses; and possibly contribute towards the realisation of the SDG 3.2 by countries in the WHO Africa Region. The finding of this review will be disseminated using multiple channels such as workshops, peer review publications, conferences, and social media.

Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study

BACKGROUND

Apgar score is used to evaluate the neonates' overall status and response to resuscitation, as well as its prognosis beyond the neonatal period. Low fifth minute Apgar scores is more frequent and is associated with markedly increased risks of neonatal mortality and morbidity. In Ethiopia, the prevalence of birth asphyxia is high (22.52%). Birth asphyxia contributes to significant neonatal morbidities and mortalities due to severe hypoxic-ischemic multi-organ damage, mainly brain damage. Therefore, this study was aimed to identify determinants of low fifth minute Apgar score among newborns delivered by cesarean section.

METHODS

An unmatched case control study design was conducted. The Apgar score is based on measures of heart rate, respiratory effort, skin color, muscle tone, and reflex irritability. The data collection tool or checklist was adapted from previous study done at Addis Ababa, Ethiopia. In this study, cases were all newborns with Apgar score < 7 whereas controls were all newborns with Apgar score >  = 7. The study participants were selected by simple random sampling technique. Data was into Epidata version 4.6 and exported to SPSS software version 24. Multivariable logistic regression was used to identify the independent effect of different factors at P < 0.05.

RESULT

Factors associated with low Apgar score were fetal birth weight < 2.5 kg [adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI): 1.03 ‒ 64.59] P = 0.046, skin incision to delivery time (AOR = 5.27; 95% CI: 2.20 ‒ 12.60) P = 0.001, pregnancy induced hypertension (AOR = 4.58, 95% CI: 1.75 ‒ 11.92) P = 0.002, antepartum hemorrhage (AOR = 3.96; 95% CI: 1.75 ‒ 8.94) 0.001, general anesthesia (AOR = 3.37, 95% CI: 1.72 ‒ 6.62) P = 0.001, meconium stained amniotic fluid (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) P = 0.009 and emergency cesarean section (AOR = 2.17, 95% CI: 1.13 ‒ 4.15) P = 0.019.

CONCLUSIONS

Fetal birth weight < 2.5 kg, skin incision to delivery time, pregnancy induced hypertension, antepartum hemorrhage, type of anesthesia, meconium stained amniotic fluid and type of cesarean section were factors independently associated with Apgar score. Therefore, it is important to work on identified risk factors to reduce the impacts low fifth minute Apgar score in the in early adulthood..

Perinatal maternal characteristics predict a high risk of neonatal asphyxia: A multi-center retrospective cohort study in China

Objective

This study aimed to identify various perinatal maternal characteristics that contributed to neonatal asphyxia (NA) in term and late-preterm newborns based on the data obtained from a Chinese birth registry cohort and to establish an effective model for predicting a high risk of asphyxia.

Method

We retrospectively reviewed and analyzed the birth database from July 1, 2016, to June 30, 2017, in the main economically developed regions of China. Asphyxia was defined as an Apgar score <7 at 5 min post-delivery with umbilical cord arterial blood pH < 7.2 in the infant born after 34weeks. We compared the perinatal maternal characteristics of the newborns who developed asphyxia (NA group, n = 1,152) and those who did not (no NA group, n = 86,393). Candidate predictors of NA were analyzed using multivariable logistic regression. Subsequently, a prediction model was developed and validated by an independent test group.

Result

Of the maternal characteristics, duration of PROM ≥ 48 h, a gestational week at birth <37, prolonged duration of labor, hypertensive disorder, nuchal cord, and birth weight <2,500 or ≥4,000 g, abnormal fetal heart rate, meconium-stained amniotic fluid, and placenta previa were included in the predicting model, which presented a good performance in external validation (c-statistic of 0.731).

Conclusion

Our model relied heavily on clinical predictors that may be determined before or during birth, and pregnant women at high risk of NA might be recognized earlier in pregnancy and childbirth using this methodology, allowing them to avoid being neglected and delayed. Future studies should be conducted to assess its usefulness.

Magnitude of birth asphyxia and its associated factors among live birth in north Central Ethiopia 2021: an institutional-based cross-sectional study

Background

The leading cause of neonatal death worldwide is birth asphyxia. Yearly, in the first month of life, 2.5 million children died around the world. Birth asphyxia is a major problem, particularly in developing nations like Ethiopia. The goal of this study was to determine the magnitude of birth asphyxia and the factors that contributed to it among neonates delivered at the Aykel Primary Hospital in north-central Ethiopia.

Methods

From August 1 to August 31, 2021, a hospital-based cross-sectional study was conducted on 144 live births. An Apgar score less than 7 in the fifth minute of birth authorized the diagnosis of birth asphyxia. Variable contention (P < 0.250) for multivariable analysis was determined after data examination and cleaning. Then, to identify important factors of birth asphyxia, a multivariable logistic regression model with a p-value of 0.05 was developed. Finally, a significant relationship between a dependent variable and independent factors was defined as a p-value less than 0.05 with a 95% confidence interval.

Results

The majority of the mothers, 71.53%, received at least one Antenatal care visit, and more than half of the newborns were male (62.50%). The percentage of neonates that had asphyxia at delivery was 11.11% (95% CI: 6.3 -16.9%). Male newborns were 5.02 times more probable than female newborns to asphyxiate [AOR: 5.02, 95% CI (1.11–22.61)]. Mothers who have not had at least one Antenatal Care visit were 3.72 times more likely to have an asphyxiated newborn than those who have at least one Antenatal Care visit [AOR: 3.72, 95%CI (1.11–12.42)]. Similarly, mothers who had an adverse pregnancy outcome were 7.03 times more likely to have an asphyxiated newborn than mothers who had no such history [AOR: 7.03, 95% CI (2.17–22.70)].

Conclusion

Birth asphyxia in newborn has come to a standstill as a major public health issue. The sexual identity of the newborn, Antenatal Care visits, and a history of poor pregnancy outcomes were all found to be significant risk factors for birth asphyxia. These findings have great importance for various stakeholders who are responsible for reducing birth asphyxia; in addition, policymakers should establish and revise guidelines associated to newborn activities and workshops.

The effect of gestational age, low birth weight and parity on birth asphyxia among neonates in sub-Saharan Africa: systematic review and meta-analysis: 2021

BACKGROUND

Despite simple and proven cost-effective measures were available to prevent birth asphyxia; studies suggested that there has been limited progress in preventing birth asphyxia even in healthy full-term neonates. In Sub-Saharan Africa, Inconsistency of magnitude of birth asphyxia and its association gestational age, Low birth Weight and Parity among different studies has been observed through time.

OBJECTIVE

This study aimed to estimate the Pooled magnitude of birth asphyxia and its association with gestational age, Low birth Weight and Parity among Neonates in Sub-Saharan Africa.

METHOD

PubMed, Cochrane library and Google scholar databases were searched for relevant literatures. In addition, reference lists of included studies were retrieved to obtain birth asphyxia related articles. Appropriate search term was established and used to retrieve studies from databases. Searching was limited to cohort, cross-sectional, and case-control studies conducted in Sub-Saharan africa and published in English language. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. Heterogeneity across the included studies was evaluated by using the inconsistency index (I2) test. Funnel plot and the Egger's regression test were used to test publication bias. A weighted inverse variance random effects- model was used to estimate the pooled prevalence of birth asphyxia among neonates in Sub-Saharan Africa. STATA™ version 11softwarewasused to conduct the meta-analysis.

RESULT

A total of 40 studies with 176,334 study participants were included in this systematic review and meta-analysis. The overall pooled magnitude of birth asphyxia in Sub-Saharan Africa was 17.28% (95% CI; (15.5, 19.04). low birth weight (AOR = 2.58(95% CI: 1.36, 4.88)), primigravida (AOR = 1.15 (95% CI: 0.84, 1.46) andMeconium-stained amniotic fluid (AOR = 6(95% CI: 3.69, 9.74)) werevariables significantly associated with the pooled prevalence of birth asphyxia.

CONCLUSION

The pooled magnitude of birth asphyxia was found to be high in Sub-Saharan Africa. Low birthweight and Meconium-stained amniotic fluid were variables significantly associated with birth asphyxia in Sub-Saharan Africa. Hence, it is better to develop early detection and management strategies for the affected neonates with low birth weight and born from mothers intrapartum meconium stained amniotic fluid.

Determinants of birth asphyxia among newborns in Debre Berhan referral hospital, Debre Berhan, Ethiopia: a case-control study

Background

Birth asphyxia is the major public health problem in the world. It is estimated that around 23% of all newborn deaths are caused by birth asphyxia worldwide. Birth asphyxia is the top three causes of newborn deaths in sub-Saharan Africa and more than one-third of deaths in Ethiopia. Therefore, the aim of this study was to identify determinants of birth asphyxia which can play a crucial role to decrease the death of newborns.

Methods

Unmatched case-control study design was implemented among 276 (92 cases and 184 controls) newborns from January 1st to March 30th, 2020. A systematic sampling technique was used to select the study participants. Data were collected by using a semi-structured interviewer-administered questionnaire and document review by trained nurses and midwives who work at the delivery ward of the hospitals. Bivariate logistic regression analysis was done to identify determinants of birth asphyxia. Adjusted odds ratios with 95% confidence intervals and p-value less than and equal to 0.05 were used to assess the level of significance.

Results

In this study, maternal education of being can’t read & write [AOR = 4.7, 95% CI: (1.2, 11.9)], ante-partum hemorrhage [AOR = 7.7, 95% CI: (1.5, 18.5)], prolonged labor [AOR =13.5, 95% CI: (2.0, 19.4)], meconium stained amniotic fluid [AOR = 11.3, 95% CI: (2.7, 39.5)], breech fetal presentation [AOR = 4.5, 95% CI: (2.0, 8.4)] and preterm birth [AOR: 4.1, 95% CI: (1.8, 9.2)] were factors which showed significantly associated with birth asphyxia among newborns.

Conclusions

In this study, maternal education can’t read & write, antepartum hemorrhage, prolonged labor, stained amniotic fluid, breech fetal presentation, preterm birth were significantly associated with birth asphyxia. So, educating mothers to enhance health-seeking behaviors and close monitoring of the labor and fetus presentation were recommended to reduce birth asphyxia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03223-3.

The evaluation of the antepartum and intrapartum risk factors in predicting the risk of birth asphyxia

PURPOSE

This study aimed to determine the related antepartum and intrapartum factors of birth asphyxia among neonates born in a tertiary referral hospital.

METHODS

A total of 45 singleton pregnant women who delivered live births with a gestational age of ≥35 weeks and their neonates who suffered from birth asphyxia from June 2016 to June 2021 were included in this retrospective study. Data regarding maternal demographic features, maternal laboratory values, pregnancy complications, and obstetric and neonatal outcomes were collected.

RESULTS

Significant risk factors associated with birth asphyxia were nulliparity (odds ratio [OR] = 5.357, 95% confidence interval [CI] = 2.169-24.950, p = 0.001), placental abruption (OR = 8.667, 95% CI = 2.223-33.784, p = 0.002), intrauterine growth restriction (OR = 1.394, 95% CI = 1.109-8.631, p = 0.012), the prolonged second stage of labor (OR = 6.121, 95% CI = 2.120-17.595, p = 0.001), meconium-stained amniotic fluid (OR = 7.615, 95% CI = 2.394-24.223, p = 0.001), bloody amniotic fluid (OR = 9.423, 95% CI = 2.885-35.232, p = 0.001), the presence of FHR category II (OR = 12.083, 95% CI = 7.081-48.849, p <0.001) and FHR category III before labor (OR = 15.500, 95% CI = 8.394-56.176, p <0.001).

CONCLUSION

We identified that nulliparity, placental abruption, intrauterine growth restriction, the prolonged second stage of labor, meconium-stained or bloody amniotic fluid, and FHR tracings categories II and III were significantly associated with birth asphyxia.

Determinants of birth asphyxia among preterm newborns in Ethiopia: a systematic review and meta-analysis of observational studies protocol

BACKGROUND

Birth asphyxia accounted for nearly 50% of neonatal mortality in Sub-Saharan African countries. This scenario has been worst in Ethiopia where every two out of three deaths attributed to birth asphyxia. Moreover, studies conducted in Ethiopia were highly variable and inconclusive to estimate the pooled prevalence and determinants of perinatal birth asphyxia among preterm babies.

OBJECTIVE

This study aimed to estimate the pooled prevalence of birth asphyxia and its determinants among preterm newborns in Ethiopia.

METHODS

The protocol for this review is registered at PROSPERO with registration number CRD42020158224. A comprehensive online databases (PubMed, HINARI, Scopus, EMBASE, Science direct, and Cochrane library database), Google Scholar, African Journals online, other gray and online repository accessed studies will be searched using different search engines. In addition, maternity and infant care databases uploaded at Ethiopian Health Development Journal and Ethiopian Journal of Health Sciences will be searched until 30 June 2020. Newcastle-Ottawa Quality Assessment Scale (NOS) will be used for critical appraisal of studies. Three reviewers will screen all retrieved articles, conduct data extraction, and then critically appraise all identified studies. All identified observational studies reporting the prevalence of birth asphyxia and associated factors among neonates in Ethiopia will be considered. The analysis of data will be done using STATA 11.0. We will demonstrate pooled estimates and determinants of birth asphyxia with effect size and 95% confidence interval. Heterogeneity among the included studies will be assessed through the Cochrane Q test statistics and I² test. Publication bias will be checked using funnel plot and Egger's test. Finally, statistical significance level will be declared at a p value of less than 0.05.

DISCUSSION

The result from this systematic review will inform and guide health policy planners to invest limited resources on maternal and neonatal health. Furthermore, it will be a stimulus for future cumulative meta-analysis researchers in developing nations.

Perinatal asphyxia and associated factors among neonates admitted to a specialized public hospital in South Central Ethiopia: A retrospective cross-sectional study

Introduction

Perinatal asphyxia continues to be a significant clinical concern around the world as the consequences can be devastating. World Health Organization data indicates perinatal asphyxia is encountered amongst 6–10 newborns per 1000 live full-term birth, and the figures are higher for low and middle-income countries. Nevertheless, studies on the prevalence of asphyxia and the extent of the problem in poorly resourced southern Ethiopian regions are limited. This study aimed to determine the magnitude of perinatal asphyxia and its associated factors.

Methods

A retrospective cross-sectional study design was used from March to April 2020. Data was collected from charts of neonates who were admitted to NICU from January 2016 to December 31, 2019.

Result

The review of 311 neonates’ medical records revealed that 41.2% of the neonates experienced perinatal asphyxia. Preeclampsia during pregnancy (AOR = 6.2, 95%CI:3.1–12.3), antepartum hemorrhage (AOR = 4.5, 95%CI:2.3–8.6), gestational diabetes mellitus (AOR = 4.2, 95%CI:1.9–9.2), premature rupture of membrane (AOR = 2.5, 95%CI:1.33–4.7) fetal distress (AOR = 3,95%CI:1.3–7.0) and meconium-stained amniotic fluid (AOR = 7.7, 95%CI: 3.1–19.3) were the associated factors.

Conclusion

Substantial percentages of neonates encounter perinatal asphyxia, causing significant morbidity and mortality. Focus on early identification and timely treatment of perinatal asphyxia in hospitals should, therefore, be given priority.

Preparedness for neonatal emergencies at birth and associated factors among healthcare providers working at hospitals in northwest Ethiopia: A multi-center cross-sectional study

BACKGROUND

Neonatal mortality remains a public health concern, especially in Southern Asia and Sub-Saharan Africa. Despite substantial efforts, the neonatal mortality rate is increasing from 29 per 1000 live births in 2016 to 33 per 1000 live births in 2019 in Ethiopia. To avert this unacceptably high mortality, the healthcare provider's readiness for neonatal emergencies at birth is crucial. Hence, this study aimed to assess healthcare providers' preparedness for neonatal emergencies at birth in northwest Ethiopia.

METHODS

A multicenter cross-sectional study was conducted at hospitals in northwest Ethiopia from November 15/2020 to March 10/2021. A simple random sampling technique was used to select 406 study participants. Data were collected through face-to-face interviews using a structured questionnaire, and direct observation and chart review using standardized checklists. The data were then entered into EPI INFO version 7.1.2 and exported to SPSS version 25 for analysis. Both bivariable and multivariable logistic regression analyses were undertaken. The level of significance was claimed based on the adjusted odds ratio (AOR) with a 95 % confidence interval (CI) at a p-value of ≤0.05.

RESULTS

The proportion of healthcare providers having adequate preparedness for neonatal emergencies was 60.1% (95% CI: 55.3, 64.8). The final model analysis illustrates that healthcare providers who received neonatal resuscitation training (AOR = 2.87; 95% CI: 1.74, 7.74) and working at the general hospital (AOR = 5.2; 95% CI: 1.96, 13.8) were adequately prepared for neonatal emergencies. On the other hand, healthcare providers who complained about workload or shortage of staff (AOR = 0.41; 95% CI: 0.26, 0.66) were poorly prepared for neonatal emergencies.

CONCLUSION

In this study, about two-fifths of the healthcare providers were inadequately prepared for neonatal emergencies at birth. Strengthening the provision of neonatal resuscitation training, deploying adequate healthcare professionals, and reducing the healthcare provider's workload would improve healthcare providers' preparedness for neonatal emergencies.

Perinatal Asphyxia and Its Associated Factors among Live Births in the Public Health Facilities of Bahir Dar City, Northwest Ethiopia, 2021

BACKGROUND

Birth asphyxia is a serious clinical problem of newborn babies, which occurs due to impaired blood-gas exchange and results in hypoxemia. Despite improvements in the diagnosis and management of perinatal asphyxia, it has become the leading cause of admission and neonatal mortality, especially in developing countries.

OBJECTIVE

This study was aimed at assessing factors associated with perinatal asphyxia among live births in the public health facilities of Bahir Dar city, Northwest Ethiopia, 2021.

METHOD

Health facility-based cross-sectional study was employed from April 1-30/2021 in the public health facilities of Bahir Dar city among 517 mother-newborn pairs. The data were collected by systematic random sampling technique, entered by using Epi data 3.1, and analyzed using SPSS 25.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P value of less than 0.05 considered statistically significant. Frequency tables, figures, and descriptive summaries were used to describe the study variables.

RESULT

In this study, 21.7% (95% CI: 18.2%-25.5%) of the newborns had perinatal asphyxia. Malpresentation (AOR = 4.06, 95%CI = 2.08-7.94), uterotonic drug administration (AOR = 2.78, 95%CI = 1.67-4.62), meconium-stained amniotic fluid (AOR = 4.55, 95%CI = 2.66, 7.80), night time delivery (AOR = 1.91, 95%CI = 1.17, 3.13), and preterm delivery (AOR = 3.96, 95%CI = 1.98, 7.89) were significantly associated with perinatal asphyxia. Conclusion and Recommendation. In the present study, the proportion of perinatal asphyxia was high. To mitigate this problem, there is a need to focus on early identification of the risk factors like fetal malpresentation, preterm labor/delivery, and managing them appropriately. Administering uterotonic drugs should be based on indication with close supervision.

Prevalence and risk factors associated with birth asphyxia among neonates delivered in Ethiopia: A systematic review and meta-analysis

BACKGROUND

A number of primary studies in Ethiopia address the prevalence of birth asphyxia and the factors associated with it. However, variations were seen among those studies. The main aim of this systematic review and meta-analysis was carried out to estimate the pooled prevalence and explore the factors that contribute to birth asphyxia in Ethiopia.

METHODS

Different search engines were used to search online databases. The databases include PubMed, HINARI, Cochrane Library and Google Scholar. Relevant grey literature was obtained through online searches. The funnel plot and Egger's regression test were used to see publication bias, and the I-squared was applied to check the heterogeneity of the studies. Cross-sectional, case-control and cohort studies that were conducted in Ethiopia were also be included. The Joanna Briggs Institute checklist was used to assess the quality of the studies and was included in this systematic review. Data entry and statistical analysis were carried out using RevMan 5.4 software and Stata 14.

RESULT

After reviewing 1,125 studies, 26 studies fulfilling the inclusion criteria were included in the meta-analysis. The pooled prevalence of birth asphyxia in Ethiopia was 19.3%. In the Ethiopian context, the following risk factors were identified: Antepartum hemorrhage(OR: 4.7; 95% CI: 3.5, 6.1), premature rupture of membrane(OR: 4.0; 95% CI: 12.4, 6.6), primiparas(OR: 2.8; 95% CI: 1.9, 4.1), prolonged labor(OR: 4.2; 95% CI: 2.8, 6.6), maternal anaemia(OR: 5.1; 95% CI: 2.59, 9.94), low birth weight(OR = 5.6; 95%CI: 4.7,6.7), meconium stained amniotic fluid(OR: 5.6; 95% CI: 4.1, 7.5), abnormal presentation(OR = 5.7; 95% CI: 3.8, 8.3), preterm birth(OR = 4.1; 95% CI: 2.9, 5.8), residing in a rural area (OR: 2.7; 95% CI: 2.0, 3.5), caesarean delivery(OR = 4.4; 95% CI:3.1, 6.2), operative vaginal delivery(OR: 4.9; 95% CI: 3.5, 6.7), preeclampsia(OR = 3.9; 95% CI: 2.1, 7.4), tight nuchal cord OR: 3.43; 95% CI: 2.1, 5.6), chronic hypertension(OR = 2.5; 95% CI: 1.7, 3.8), and unable to write and read (OR = 4.2;95%CI: 1.7, 10.6).

CONCLUSION

According to the findings of this study, birth asphyxia is an unresolved public health problem in the Ethiopia. Therefore, the concerned body needs to pay attention to the above risk factors in order to decrease the country's birth asphyxia.

REVIEW REGISTRATION

PROSPERO International prospective register of systematic reviews (CRD42020165283).

Predictors of mortality among newborns admitted with perinatal asphyxia at public hospitals in Ethiopia: a prospective cohort study

Introduction

Perinatal asphyxia is a complicated newborn health problem and applies a high contribution to the increased proportion of newborn mortality. It occurs in newborns due to altered breathing or inadequate inhalation and exhalation resulting in reduced oxygen perfusion to certain body tissues and organs. Irrespective of the increased progress in health care towards newborns and implementations in reductions in under-five, infant, and neonatal mortality in the past 10 years, perinatal asphyxia remained as the most common severe newborn health challenge that causes a high number of morbidity and mortality.

Methods

A prospective cohort longitudinal study was implemented among 573 newborns admitted with perinatal asphyxia at public hospitals in Southern Ethiopia from 1st March 2018 to 28th February 2020. The perinatal survival time was determined using Kaplan Meier survival curve together with a log-rank test. The dependent variable was time to death and the independent variables were classified as socio-demographic factors, obstetrics related factors, newborn related factors and maternal medical related factors. The study subjects were entered in to the cohort during admission with perinatal asphyxia in the hospital and followed until 7 days of life.

Results

The cumulative proportion of survival among the newborns admitted with perinatal asphyxia was 95.21% (95%CI:91.00,97.48), 92.82% (95%CI:87.95,95.77), 92.02%(95%CI:86.84,95.22) and 90.78%(95%CI:84.82,94.48) at the end of first, second, third and fourth follow-up days respectively. The mean survival date was 6.55(95%CI: 6.33, 6.77) and cord prolapse (AHR:6.5;95%CI:1.18,36.01), pregnancy induced hypertension (AHR:25.4;95%CI:3.68,175.0), maternal iron deficiency anemia (AHR:5.9;95%CI:1.19,29.5) and having convulsion of the newborn (AHR:10.23;95%CI:2.24,46.54) were statistically significant in multivariable cox proportional hazard model.

Conclusion

The survival status among newborns with perinatal asphyxia was low during the early follow-up periods after admission to the hospital and the survival status increased after fourth follow up days. In addition, cord prolapse, history of PIH, maternal iron deficiency anemia and newborns history of convulsion were the independent predictors of mortality.

Factors associated with mortality among asphyxiated newborns in a low-resource setting

Objective: Neonatal asphyxia accounts for a quarter of neonatal deaths. We aimed to assess factors associated with mortality among asphyxiated neonates in a low-resource setting.Methods: A retrospective observational study evaluating all neonates who were admitted for asphyxia to the Neonatal Intensive Care Unit (NICU) at Tosamaganga Hospital (Tanzania) in 2017-2018. Inclusion criteria were: Apgar score <7 at 5 min and/or failure to initiate spontaneous breathing and/or presence of sentinel events and/or clinical signs suggesting encephalopathy not explained by other obvious factors or early convulsions. Newborns with congenital malformations, birth weight <2000 g or those who died in the delivery room were excluded.Results: NICU admission for perinatal asphyxia was 17.5%. In 169 neonates, mortality rate was 23% and was associated with being outborn, low 5-minute Apgar score, depressed clinical status at NICU admission, occurrence of infection or seizures within 24 h from admission, and receiving aminophylline during the hospital stay.Conclusions: Perinatal asphyxia was responsible for a relevant proportion of NICU admissions and neonatal deaths in a low-resource setting. Appropriate clinical examination remains the main asset in settings with limited availability of diagnostic tools. Improvements in antenatal and perinatal care are needed to reduce mortality in asphyxiated newborns. Future studies should assess long-term outcome in survivors.