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Yehouala SG, Tesfahun E, Dejene TM, Gebreegziabher ZA. Time to recovery of asphyxiated neonates and its' predictors among newborns admitted to neonatal intensive care unit at Debre Berhan Comprehensive Specialized Hospital, Ethiopia. BMC Public Health 2024; 24:2006. [PMID: 39061048 PMCID: PMC11282753 DOI: 10.1186/s12889-024-19520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Neonatal asphyxia is a leading cause of early neonatal mortality, accounting for approximately 900,000 deaths each year. Assessing survival rates, recovery time and predictors of mortality among asphyxiated neonates can help policymakers design, implement, and evaluate programs to achieve the sustainable development goal of reducing neonatal mortality to 12/1,000 live births by 2030. The current study sought to ascertain the survival status, recovery time, and predictors of neonatal asphyxia. METHODS A retrospective follow-up study conducted in Debre Berhan Comprehensive Specialized Hospital, which carried out from May 20th to June 20th, 2023 using records of asphyxiated babies in NICUs from January 1st, 2020 to December 31st, 2022, involving a sample size of 330. Pre-structured questionnaires created in Google Form were used to collect data, and STATA Version 14.0 was utilized for data entry and analysis, respectively. The Kaplan-Meier survival curve, log rank test, and median time were calculated. A multivariable Cox proportional hazards regression model was fitted in order to determine the predictors of time to recovery. Variables were statistically significant if their p-value was less than 0.05. RESULTS Three hundred thirty admitted asphyxiated neonates were followed a total of 2706 neonate -days with a minimum of 1 day to 18 days. The overall incidence density rate of survival was 9.9 per 100 neonates' days of observation (95% CI: 8.85-11.24) with a median recovery time of 9 days (95% CI: 0.82-0.93). Prolonged labor (Adjusted hazard ratio (AHR: 0.42,95%CI:0.21-0.81), normal birth weight (AHR:2.21,95% CI: 1.30-3.70),non-altered consciousness (AHR:2.52,CI:1.50-4.24),non-depressed moro reflex of the newborn (AHR:2.40,95%CI: 1.03-5.61), stage I HIE (AHR: 5.11,95% CI: 1.98-13.19),and direct oxygen administration via the nose (AHR: 4.18,95% CI: 2.21-7.89) were found to be independent predictors of time to recovery of asphyxiated neonates.. CONCLUSION In the current findings, the recovery time was prolonged compared to other findings. This implies early diagnosis, strict monitoring and provision of appropriate measures timely is necessary before the babies complicated into the highest stage of hypoxic -ischemic encephalopathy(HIE) and managing complications are the recommended to hasten recovery time and increase the survival of neonates.
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Affiliation(s)
- Sisay Girma Yehouala
- Department of Pediatrics and Child Health, Debre Berhan Comprehensive Specialized Hospital, Debre Berhan, Ethiopia.
| | - Esubalew Tesfahun
- Department of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tadesse Mamo Dejene
- Department of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Gedefaw GD, Abuhay AG, Endeshaw YS, Birhan MA, Ayenew ME, Genet GB, Tilahun DW, Mekonnen HS, Legesse BT, Daka DT, Wondie WT, Abate AT. Incidence and predictors of acute kidney injury among asphyxiated neonates in comprehensive specialized hospitals, northwest Ethiopia, 2023. Sci Rep 2024; 14:16480. [PMID: 39013957 PMCID: PMC11252324 DOI: 10.1038/s41598-024-66242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/28/2024] [Indexed: 07/18/2024] Open
Abstract
Acute kidney injury (AKI) is characterized by a sudden decline in the kidneys' abilities to remove waste products and maintain water and electrolyte homeostasis. This study aims to determine the incidence and predictors of acute kidney injury among neonates with perinatal asphyxia admitted at the neonatal intensive care unit of West Amhara Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Multicentred institution-based retrospective follow-up study was conducted from October 1, 2021, to September 30, 2023, among 421 perinatal asphyxia neonates. A simple random sampling technique was used. The data were collected using a data extraction checklist from the medical registry of neonates. The collected data were entered into EPI-DATA V.4.6.0.0. and analyzed using STATA V.14. The Kaplan-Meier failure curve and log-rank test were employed. Bivariable and multivariable Cox regression was carried out to identify predictors of Acute kidney injury. Statistical significance was declared at a p ≤ 0.05. The overall incidence of AKI was 54 (95% CI 47.07-62.51) per 100 neonate days. C/S delivery (AHR = 0.64; (95% CI 0.43-0.94), prolonged labor (AHR = 1.43; 95% CI 1.03-1.99) low-birth weight times (AHR = 1.49; (95% CI 1.01-2.20), stage three HIE(AHR: 1.68; (95% CI (1.02-2.77), No ANC follow up (AHR = 1.43; 95% CI 1.9 (1.07-3.43) and Hyperkalemia (AHR = 1.56; 95% CI 1.56 (1.05-2.29); 95% CI) were significant predictors. The incidence rate of acute kidney injury was higher than in other studies conducted on other groups of neonates. Cesarean section delivery, prolonged low birthweight, no Anc follow-up, stage 3 HIE, and neonatal hyperkalemia were predictors of acute kidney injury. However, it needs further prospective study. Therefore, the concerned stakeholders should give due attention and appropriate intervention to these predictors.
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Affiliation(s)
- Gezahagn Demsu Gedefaw
- Department of Neonatal Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia.
| | - Abere Gebru Abuhay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yaregal Semanew Endeshaw
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Collage of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Marta Adugna Birhan
- Department of Neonatal Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Endalamaw Ayenew
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Geta Bayu Genet
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Degalem Worku Tilahun
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Sewunet Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollaga University, Nekemte, Ethiopia
| | | | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences and referral hospital, Ambo University, Ambo, Ethiopia
| | - Asnake Tadesse Abate
- Department of Neonatal Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Zakerihamidi M, Hassan B, Samin A. The prooxidant-antioxidant balance in diagnosis and developmental prognosis of premature neonates with asphyxia. ASIAN BIOMED 2024; 18:116-124. [PMID: 39175955 PMCID: PMC11338270 DOI: 10.2478/abm-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Background The antioxidant system in a preterm neonate is premature. The imbalance between the prooxidant and antioxidant systems can make these neonates prone to oxidative stress. Birth asphyxia is one of the factors that can disturb this balance. Objective We studied the prooxidant-antioxidant balance (PAB) in the diagnosis and developmental prognosis of preterm neonates with asphyxia. Methods This cohort study has been conducted between 2016 and 2022 with 2 years follow-up on 183 premature neonates admitted to Ghaem Hospital Mashhad, by using a convenience sampling method. The data-collection tool and the researcher-made checklist included the mothers' and the neonate's information, and the third segment included laboratory information. PAB was studied by using standard solutions and the Enzyme immunoassays (ELISA) method. After discharging the newborns from the hospital, they were under follow-up at 6 months, 12 months, 18 months, and 24 months, by using the Denver II test. PAB was compared among newborns with asphyxia, those without asphyxia, and also newborns with normal and abnormal outcomes in both groups. Results The mean ± standard deviation of the PAB factor reported is as follows: in newborns without asphyxia (21.00 ± 18.14 HK), those with asphyxia (31.00 ± 45.42 HK), in newborns with asphyxia having abnormal outcomes (40.00 ± 60.84 HK), and those having normal outcomes (21.00 ± 18.67 HK) (P ≤ 0.05). PAB results >25 HK have been used for the diagnosis of asphyxia prognosis in newborns, with 83.3% sensitivity and 81% specificity. Conclusion The PAB index showed a significant increase after asphyxia. It can be used as a diagnostic marker for the prognosis of premature newborns with asphyxia. Thus, diagnosis and prognosis of asphyxia in premature newborns can be predicted by using the PAB index.
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Affiliation(s)
- Maryam Zakerihamidi
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon46617-34666, Iran
| | - Boskabadi Hassan
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad91778-96149, Iran
| | - Amirkhani Samin
- Department of Midwifery, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon46617-34666, Iran
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Msisiri LS, Kibusi SM, Kimaro FD. Risk Factors for Birth Asphyxia in Hospital-Delivered Newborns in Dodoma, Tanzania: A Case-Control Study. SAGE Open Nurs 2024; 10. [DOI: https:/doi.org/10.1177/23779608241246874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
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.
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Affiliation(s)
- Laidi S. Msisiri
- Department of Clinical Nursing, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
- Department of Pediatrics and Child Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Stephen M. Kibusi
- Department of Public Health, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Franisca D. Kimaro
- Department of Pediatrics and Child Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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Msisiri LS, Kibusi SM, Kimaro FD. Risk Factors for Birth Asphyxia in Hospital-Delivered Newborns in Dodoma, Tanzania: A Case-Control Study. SAGE Open Nurs 2024; 10:23779608241246874. [PMID: 38665876 PMCID: PMC11044786 DOI: 10.1177/23779608241246874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 12/20/2023] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Laidi S. Msisiri
- Department of Clinical Nursing, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
- Department of Pediatrics and Child Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Stephen M. Kibusi
- Department of Public Health, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Franisca D. Kimaro
- Department of Pediatrics and Child Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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Li X, Bu W, Hu X, Han T, Xuan Y. The determinants of neonatal asphyxia in the tropical province of China: A case-control study. Medicine (Baltimore) 2023; 102:e35292. [PMID: 37747010 PMCID: PMC10519517 DOI: 10.1097/md.0000000000035292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
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.
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Affiliation(s)
- Xiaohua Li
- Department of Neonatology, Hainan Women and Children’s Medical Center, Haikou, China
| | - Weizhen Bu
- Department of Pediatric Surgery, Hainan Women and Children’s Medical Center, Haikou, China
| | - Xiaojing Hu
- Department of Nursing, Hainan Women and Children’s Medical Center, Haikou, China
| | - Tianhong Han
- Department of Nursing, Hainan Women and Children’s Medical Center, Haikou, China
| | - Yan Xuan
- Department of Nursing, Hainan Women and Children’s Medical Center, Haikou, China
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Tang Z, Jia J. PM 2.5-related neonatal encephalopathy due to birth asphyxia and trauma: a global burden study from 1990 to 2019. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:33002-33017. [PMID: 36472743 DOI: 10.1007/s11356-022-24410-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Long-term exposure to fine particulate matter (PM2.5) may increase the risk of neonatal encephalopathy due to birth asphyxia and trauma. However, little is known about the trends of PM2.5-related neonatal encephalopathy burden under different levels of social and economic development. We studied the burden of PM2.5-related neonatal encephalopathy due to birth asphyxia and trauma measured by the age-standardized mortality rate (ASMR) and the age-standardized disability-adjusted life years rate (ASDR), and its trends with the socio-demographic index (SDI) in 192 countries and regions from 1990 to 2019. This is a retrospective study using the Global Burden of Disease Study 2019 (GBD2019) database. The age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR) are used to measure the burden of PM2.5-related neonatal encephalopathy in different countries and regions. The mortality rate (per 100 thousand) is used to evaluate the differences of PM2.5-related neonatal encephalopathy burden in sex and age. The annual percentage changes (APCs) and the average annual percentage changes (AAPCs) are used to reflect the trends of PM2.5-related neonatal encephalopathy burden over years (1990-2019) and are calculated using a Joinpoint model. The relationship of the socio-demographic index with the ASMR and ASDR is calculated using Gaussian process regression. In summary, the global burden of PM2.5-related neonatal encephalopathy increased since 1990, especially in boys, early neonates, and regions with low-middle SDI. Globally, the ASMR and ASDR of PM2.5-related neonatal encephalopathy burden in 2019 were 0.59 (95% CI: 0.40, 0.83) per 100,000 people and 52.59 (95% CI: 35.33, 73.67) per 100,000 people, respectively. From 1990 to 2019, the ASMR and ASDR of PM2.5-related neonatal encephalopathy increased by 44.39% and 44.19%, respectively. The global average annual percentage changes of ASMR and ASDR were 1.3 (95% CI: 1.0, 1.6). The relationship between the socio-demographic index and the burden of PM2.5-related neonatal encephalopathy presented negative correlation when the socio-demographic index was more than 0.60. Middle, high-middle, and high SDI regions had decreasing trends of PM2.5-related neonatal encephalopathy, of which the AAPCs for both ASMR and ASDR ranged from - 0.3 to - 3.1. Besides improving the progress in national policy and the coverage rate of maternal and neonatal health care and facility-based delivery, air pollution control may also be a better way for countries with large and increasing amounts of exposure to PM2.5 pollution to reduce neonatal encephalopathy. And our results also suggest that low and low-middle SDI countries should appropriately pay more attention to early newborns and boys.
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Affiliation(s)
- Zeyu Tang
- Department of Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Beijing, 100191, China
| | - Jinzhu Jia
- Department of Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Beijing, 100191, China.
- Center for Statistical Science, Peking Universeity, 5 Summer Palace Road, Beijing, 100191, China.
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Mensah MK, Tano Kofi FK, Ansu-Mensah M, Bawontuo V, Kuupiel D. Mapping research evidence on perinatal asphyxia within the sustainable development era in sub-Saharan Africa: a scoping review protocol. Syst Rev 2022; 11:182. [PMID: 36042525 PMCID: PMC9429632 DOI: 10.1186/s13643-022-02058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Michael K Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University, College of Ghana, Fiapre, Sunyani, Ghana
| | - Franky K Tano Kofi
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University, College of Ghana, Fiapre, Sunyani, Ghana
| | | | - Vitalis Bawontuo
- Department of Health Services Management and Administration, School of Business, SD Dombo University of Business and Integrated Development Studies (SDD-UBIDS), Bamahu, Ghana
| | - Desmond Kuupiel
- Faculty of Health Sciences, Durban University of Technology, Durban, 4001, South Africa.
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Yu Y, Gao J, Liu J, Tang Y, Zhong M, He J, Liao S, Wang X, Liu X, Cao Y, Liu C, Sun J. Perinatal maternal characteristics predict a high risk of neonatal asphyxia: A multi-center retrospective cohort study in China. Front Med (Lausanne) 2022; 9:944272. [PMID: 36004371 PMCID: PMC9393324 DOI: 10.3389/fmed.2022.944272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Yi Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics & Gynecologic Diseases, Peking Union Medical College Hospital (CAMS), Beijing, China
| | - Jinsong Gao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics & Gynecologic Diseases, Peking Union Medical College Hospital (CAMS), Beijing, China
- *Correspondence: Jinsong Gao
| | - Juntao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics & Gynecologic Diseases, Peking Union Medical College Hospital (CAMS), Beijing, China
- Juntao Liu
| | - Yabing Tang
- Department of Obstetrics and Gynecology, Hunan Maternal and Child Health Care Hospital, Changsha, China
| | - Mei Zhong
- Department of Obstetrics and Gynecology, Nanfang Hospital Southern Medical University, Guangzhou, China
| | - Jing He
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Shixiu Liao
- Department of Obstetrics and Gynecology, Henan Provincial People's Hospital Zhengzhou, Henan, China
| | - Xietong Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, Sichuan University West China Second Hospital, Chengdu, China
| | - Yinli Cao
- Department of Obstetrics and Gynecology, Northwest Women and Children's Hospital, Xi'an, China
| | - Caixia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, China
| | - Jingxia Sun
- Department of Obstetrics and Gynecology, The First Clinical Hospital Affiliated to Harbin Medical University, Harbin, China
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Techane MA, Alemu TG, Wubneh CA, Belay GM, Tamir TT, Muhye AB, Kassie DG, Wondim A, Terefe B, Tarekegn BT, Ali MS, Fentie B, Gonete AT, Tekeba B, Kassa SF, Desta BK, Ayele AD, Dessie MT, Atalell KA, Assimamaw NT. 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. Ital J Pediatr 2022; 48:114. [PMID: 35841063 PMCID: PMC9288040 DOI: 10.1186/s13052-022-01307-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/22/2022] [Indexed: 12/05/2022] Open
Abstract
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.
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Affiliation(s)
- Masresha Asmare Techane
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tewodros Getaneh Alemu
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getaneh Mulualem Belay
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addis Bilal Muhye
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Destaye Guadie Kassie
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Wondim
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Department of Community health Nursing, School of Nursing, College of Medicine and health science, University of Gondar, Gondar, Ethiopia
| | - Bethelihem Tigabu Tarekegn
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beletech Fentie
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Selam Fisiha Kassa
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bogale Kassahun Desta
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Demsie Ayele
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tilahun Dessie
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kendalem Asmare Atalell
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Usman F, Tsiga-Ahmed FI, Farouk ZL, Gambo MJ, Mohammed AD, Mohammed AM, Salihu HM, Aliyu MH. Perinatal factors associated with admission to neonatal intensive care unit following cesarean delivery in Kano, northern Nigeria. J Perinat Med 2022; 50:493-502. [PMID: 35038815 DOI: 10.1515/jpm-2021-0409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cesarean section is the most common obstetric surgical procedure, with associated risks for adverse neonatal outcomes. The interplay of perinatal factors associated with neonatal admissions following cesarean delivery remains poorly understood in developing countries. We examined how perinatal and facility-based factors affect Neonatal Intensive Care Unit (NICU) admission after cesarean delivery in northern Nigeria. METHODS A prospective cohort study involving 200 women undergoing cesarean section were consecutively enrolled with subsequent follow-up of their infants in the post-natal period. Data were abstracted from the medical record using an interviewer-administered questionnaire. The primary outcomes were NICU admission and intrauterine or early neonatal deaths. Binary logistic regression modelling was used to identify variables independently associated with the outcomes. RESULTS Over the study period (six months), there were 200 cesarean sections. A total of 30 (15.0%) neonates were admitted into the NICU following the procedure. No stillbirths or early neonatal deaths were recorded. NICU admission was associated with gestational age (preterm vs. term [adjusted odds ratio, aOR: 18.9, 95% confidence interval (CI): 4.0-90.4]), birth weight (small vs. appropriate [aOR: 6.7, 95% CI 1.9-22.7] and large vs. appropriate birth weight [aOR: 20.3, 95% CI 2.9-143.7]) and the number of indications for cesarean section (≥2 vs. one [aOR: 0.2, 95% 0.1-0.8]). CONCLUSIONS Prematurity, small and large for gestational age neonates; and indications for cesarean section were associated with increased likelihood of neonatal admission following cesarean delivery. These findings could inform ongoing quality enhancement initiatives to improve NICU admission outcomes at the study site, and other similar settings.
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Affiliation(s)
- Fatima Usman
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Fatimah I Tsiga-Ahmed
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Zubaida L Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Mahmoud J Gambo
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Alhassan D Mohammed
- Department of Anesthesiology & Intensive Care, Kano & Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Abdullahi M Mohammed
- Department of Anesthesiology & Intensive Care, Kano & Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Becker J, Becker C, Oprescu F, Wu CJJ, Moir J, Shimwela M, Gray M. Silent voices of the midwives: factors that influence midwives' achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry. BMC Pregnancy Childbirth 2022; 22:39. [PMID: 35034616 PMCID: PMC8761383 DOI: 10.1186/s12884-021-04339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery). METHODS This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes. RESULTS Thematic analysis of the midwives' responses revealed three factors that influence successful resuscitation: 1. Hands-on training ("HOT") with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother's bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research. CONCLUSIONS Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of "HOT" real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife's beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.
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Affiliation(s)
- Jan Becker
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia. .,University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD, 4556, Australia. .,General Division of the Order of Australia, Office of the Official Secretary to the Governor-General, Government House, ACT, 2600, Canberra, Australia.
| | - Chase Becker
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia.,University of Nicosia Medical School in Partnership with St George's University of London, Makedonitissis 46, Nicosia, 2417, Cyprus
| | - Florin Oprescu
- School of Health and Behavioural Sciences, University of Sunshine Coast (USC), 90 Sippy Downs Dr, Sippy Downs, QLD, 4556, Australia
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), 1 Morton Bay Parade, Petrie, QLD, 4502, Australia.,Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia
| | - James Moir
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia.,Clinical Director, QLD Fertility Group Sunshine Coast, 44 Clarkes Road, Diddillibah, QLD, 4559, Australia
| | - Meshak Shimwela
- Internal Medicine, Temeke Regional Referral Hospital, Temeke Road, Adjacent Sterio Market, Dar es Salaam, Tanzania
| | - Marion Gray
- Centre for Health Research/School of Health and Wellbeing; Associate Dean (Clinical), Faculty of Health, Engineering and Sciences, University of the Southern Queensland, Sinnathamby Blvd, Springfield Central, Queensland, 4300, Australia
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13
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Mamo SA, Teshome GS, Tesfaye T, Goshu AT. Perinatal asphyxia and associated factors among neonates admitted to a specialized public hospital in South Central Ethiopia: A retrospective cross-sectional study. PLoS One 2022; 17:e0262619. [PMID: 35025979 PMCID: PMC8758104 DOI: 10.1371/journal.pone.0262619] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Seifu Awgchew Mamo
- Department of Pediatric Nursing, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Girum Sebsibie Teshome
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Tesfaye
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abel Tibebu Goshu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- * E-mail:
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14
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Zewdie R, Getachew L, Dubele G, Oluma A, Israel G, Dese K, Simegn GL. Treatment device for neonatal birth asphyxia related Hypoxic Ischemic Encephalopathy. BMC Pediatr 2021; 21:487. [PMID: 34732165 PMCID: PMC8564992 DOI: 10.1186/s12887-021-02970-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background Birth asphyxia is a leading cause of neonatal brain injury, morbidity, and mortality globally. It leads to a multi-organ dysfunction in the neonate and to a neurological dysfunction called Hypoxic Ischemic Encephalopathy (HIE). Cooling therapy is commonly used to slow or stop the damaging effects of birth asphyxia. However, most of the cooling devices used in the healthcare facility do not have a rewarming functionality after cooling therapy. A separate rewarming device, usually a radiant warmer or incubator is used to rewarm the infant after therapy, causing additional burden to the healthcare system and infant families. The objective of this project was, therefore, to design and develop a cost-effective and efficient total body cooling and rewarming device. Methods Our design includes two water reservoirs that operate by pumping cold and warm sterile water to a mattress. After decreasing the infant’s core body temperature to 33.5 °C, the system is designed to maintain it for 72 h. Feedback for temperature regulation is provided by the rectal and mattress temperature sensors. Once the cooling therapy is completed, the system again rewarms the water inside the mattress and gradually increases the neonate temperature to 36.5–37 °C. The water temperature sensors’ effectiveness was evaluated by adding 1000 ml of water to the reservoir and cooling and warming to the required level of temperature using Peltier. Then a digital thermometer was used as a gold standard to compare with the sensor’s readings. This was performed for five iterations. Results The prototype was built and gone through different tests and iterations. The proposed device was tested for accuracy, cost-effectiveness and easy to use. Ninety-three point two percent accuracy has been achieved for temperature sensor measurement, and the prototype was built only with a component cost of less than 200 USD. This is excluding design, manufacturing, and other costs. Conclusion A device that can monitor and regulate the neonate core body temperature at the neuroprotective range is designed and developed. This is achieved by continuous monitoring and regulation of the water reservoirs, mattress, and rectal temperatures. The device also allows continuous monitoring of the infant’s body temperature, mattress temperature, reservoir temperature, and pulse rate. The proposed device has the potential to play a significant role in reducing neonatal brain injury and death due to HIE, especially in low resource settings, where the expertise and the means are scarce.
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Affiliation(s)
- Rediet Zewdie
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia.,Bilham Pharmaceutical Private Limited Company, Addis Ababa, Ethiopia
| | - Lidet Getachew
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia.,Medicure Medicine and Medical Device Importer, Addis Ababa, Ethiopia
| | - Geremew Dubele
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia.,Wolaita Sodo University Teaching Referral Hospital, Wolaita Sodo, Ethiopia
| | - Ababo Oluma
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia.,Medicure Medicine and Medical Device Importer, Addis Ababa, Ethiopia
| | - Gedion Israel
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Kokeb Dese
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
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15
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Krishnan V, Kumar V, Variane GFT, Carlo WA, Bhutta ZA, Sizonenko S, Hansen A, Shankaran S, Thayyil S. Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action. Semin Fetal Neonatal Med 2021; 26:101271. [PMID: 34330679 PMCID: PMC8650826 DOI: 10.1016/j.siny.2021.101271] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although low- and middle-income countries (LMICs) shoulder 90 % of the neonatal encephalopathy (NE) burden, there is very little evidence base for prevention or management of this condition in these settings. A variety of antenatal factors including socio-economic deprivation, undernutrition and sub optimal antenatal and intrapartum care increase the risk of NE, although little is known about the underlying mechanisms. Implementing interventions based on the evidence from high-income countries to LMICs, may cause more harm than benefit as shown by the increased mortality and lack of neuroprotection with cooling therapy in the hypothermia for moderate or severe NE in low and middle-income countries (HELIX) trial. Pooled data from pilot trials suggest that erythropoietin monotherapy reduces death and disability in LMICs, but this needs further evaluation in clinical trials. Careful attention to supportive care, including avoiding hyperoxia, hypocarbia, hypoglycemia, and hyperthermia, are likely to improve outcomes until specific neuroprotective or neurorestorative therapies available.
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Affiliation(s)
- Vaisakh Krishnan
- Centre of Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK.
| | - Vijay Kumar
- Centre of Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK.
| | | | - Waldemar A Carlo
- Division of Neonatology, University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, USA.
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | | | - Anne Hansen
- Division of Newborn Medicine, Boston Children's Hospital, Boston, USA.
| | | | - Sudhin Thayyil
- Centre of Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK.
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16
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Kebede E, Kekulawala M. Risk factors for stillbirth and early neonatal death: a case-control study in tertiary hospitals in Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2021; 21:641. [PMID: 34548064 PMCID: PMC8456546 DOI: 10.1186/s12884-021-04025-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births. METHODS This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher's exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death. RESULTS During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098-2.780), previous stillbirth (aOR 9.447, 95%CI 6.245-14.289), previous preterm birth (aOR 3.620, 95%CI 2.363-5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228-3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523-7.031). CONCLUSION Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.
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Affiliation(s)
- Eskinder Kebede
- Department of Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Melani Kekulawala
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA.,College of Medicine and Life Sciences, University of Toledo, Toledo, USA
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17
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Pu Y, Zhu Z, Yang Q, Zhang Y, Zhao J, Liu M, Yu X. Significance of amplitude integrated electroencephalography in early stage of neonatal hypoxic-ischemic encephalopathy and cerebral function monitoring in Neonatal Intensive Care Units. Am J Transl Res 2021; 13:9437-9443. [PMID: 34540063 PMCID: PMC8430076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/26/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the role of amplitude integrated electroencephalography (aEEG) diagnosis in early stage of neonatal hypoxic-ischemic encephalopathy (HIE), and to evaluate the feasibility of aEEG in cerebral function monitoring in Neonatal Intensive Care Units (NICU). METHODS 60 cases of term infants with neonatal HIE were included in the observation group, and 50 healthy term infants were enrolled as the control group. Both groups received aEEG monitoring within 6 hours after birth, and the results were analyzed. RESULTS The correlation coefficient between the degree of asphyxia, SWC, SA and aEEG background activity was r = 0.571 (P<0.001); r = 0.512 (P<0.001) and r = 0.293 (P<0.001), respectively. The correlation coefficient between HIE degree and aEEG background activity, SWC was r = 0.742 (P<0.001) and r = 0.763 (P<0.001), respectively. The Gessell scores of the control group at 1, 3, 6, 9, and 12 months after birth were higher than those of the mild asphyxia group and the severe asphyxia group, and the mild asphyxia group showed higher Gessell scores than the severe asphyxia group (P<0.001). The predicted ROC curve of aEEG monitoring on the occurrence of neonatal HIE showed the area under the curve (AUC) = 0.6354, Std. Error = 0.05668 (95% CI: 0.5243-0.7465, P = 0.0209). CONCLUSION aEEG had obvious diagnostic value in brain injury in the early stage of full-term neonates with asphyxia, and could be used to monitor the cerebral function of NICU, which is helpful for early clinical detection of brain injury of full-term neonates with asphyxia, so as to improve early diagnosis and treatment.
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Affiliation(s)
- Yuanlin Pu
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshi 445000, Hubei Province, China
| | - Zeyu Zhu
- College of Medicine, Hubei University for NationalitiesEnshi 445000, Hubei Province, China
| | - Qian Yang
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshi 445000, Hubei Province, China
| | - Yongfang Zhang
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshi 445000, Hubei Province, China
| | - Jihua Zhao
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshi 445000, Hubei Province, China
| | - Meiling Liu
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshi 445000, Hubei Province, China
| | - Xinqiao Yu
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshi 445000, Hubei Province, China
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18
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Ogunkunle TO, Gabriel TY, Bello SO, Abdullahi Y, Bulus J, Ozhe SI, Imam A. Facility-Based Newborn Deaths at a Referral Tertiary Hospital in North-Central Nigeria during the Sustainable Development Goal Era: A Retrospective Cohort Analysis. J Trop Pediatr 2021; 67:6076725. [PMID: 33421090 DOI: 10.1093/tropej/fmaa126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nigeria has the largest number of global under-five deaths and almost half of these occur in the newborn period in an almost 50:50 ratio across hospital facilities and communities. We examine and describe risk factors for newborn mortality at a busy neonatal unit of a referral tertiary hospital in North-central Nigeria. METHODS We conducted a retrospective cohort analysis of all newborn admissions to the Dalhatu Araf Specialist Hospital between September 2018 and March 2020. We determined the newborn mortality rate (NMR) and case fatality rates (CFRs) for individual diagnostic categories and determined risk predictors for mortality using cox-proportional hazard models. RESULTS Of 1171 admitted newborn infants, 175 (14.9%) died with about half of these occurring within 24 h of admission. Extremely low birth weight infants and those with congenital anomalies had the highest CFRs. Identified risk factors for mortality were age at admission [adjusted hazard ratio (AHR): 0.996, 95% CI: 0.993-0.999], admitting weight (AHR: 0.9995, 95% CI: 0.9993-0.9997) and home delivery (AHR: 1.65, 95% CI: 1.11-to 2.46). CONCLUSIONS Facility-based newborn mortality is high in North-central Nigeria. Majority of these deaths occur within the first 24 h of admission, signifying challenges in acute critical newborn care. To improve the current situation and urgently accelerate progress to meet the sustainable development goal NMR targets, there is an urgent need to develop human and material resources for acute critical newborn care while encouraging facility-based delivery and decentralizing existing newborn care. Lay summaryNigeria now has the greatest number of deaths in children below the age of five globally. Almost half of these occurred in the newborn period and these deaths occur within hospital facilities and also in communities in an almost 50:50 ratio. As such, the country might not attain global newborn mortality rates that were set as targets for the sustainable development goals (SDGs). In this article, we examine and describe the risk factors for newborn deaths occurring at a typical newborn unit in North-central Nigeria. During the period under review, we found that about 175 (14.9%) died and about half of these deaths occurred within 24 h of admission. Extremely small babies and those who were born with physical defects had the highest death rates. Older babies and those who weighed more at admission had decreased risks of dying while being delivered at home increased the risk of death. Hospital newborn deaths remain high in North-central Nigeria and the pattern of early admission deaths signifies challenges in stabilizing critically ill newborn infants. There is an urgent need to develop human and material resources for acute critical newborn care while encouraging institutional delivery and decentralizing of existing newborn care.
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Affiliation(s)
| | - Tiya Yohanna Gabriel
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, 950101 Lafia, Nassarawa, Nigeria
| | | | - Yakubu Abdullahi
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, 950101 Lafia, Nassarawa, Nigeria
| | - Joel Bulus
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, 950101 Lafia, Nassarawa, Nigeria
| | - Sunday Ikukpla'si Ozhe
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, 950101 Lafia, Nassarawa, Nigeria
| | - Abdulazeez Imam
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, PO Box 273 Banjul, Fajara, Gambia
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Tadesse M, Hally S, Rent S, Platt PL, Eusterbrock T, Gezahegn W, Kifle T, Kukora S, Pollack LD. Effect of a Low-Dose/High-Frequency Training in Introducing a Nurse-Led Neonatal Advanced Life Support Service in a Referral Hospital in Ethiopia. Front Pediatr 2021; 9:777978. [PMID: 34900877 PMCID: PMC8656416 DOI: 10.3389/fped.2021.777978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11-31% of deaths among neonates delivered in healthcare facilities that have breathing difficulty at birth. This study aimed to examine the impact of low-dose, high-frequency (LDHF) training for introducing a nurse-led neonatal advanced life support (NALS) service in a tertiary care hospital in Ethiopia. Methods: Through a retrospective cohort study, a total of 12,001 neonates born post-implementation of the NALS service (between June 2017 and March 2019) were compared to 2,066 neonates born before its implementation (between June 2016 and September 2016). Based on when the neonates were born, they were divided into six groups (groups A to F). All deliveries occurred in the inpatient Labor and Delivery Unit (LDU) at St. Paul's Hospital Millennium Medical College. The number of neonatal deaths in the LDU, neonatal intensive care unit (NICU) admission rate, and proportion of neonates with normal axillary temperature (36.5-37.5°C) within the first hour of life were evaluated. Data were analyzed using the χ2 test, and p-values < 0.05 were considered statistically significant. Following the implementation of the NALS service, semi-structured interviews with key stakeholders were conducted to evaluate their perception of the service; the interviews were recorded, transcribed, and coded for thematic analysis. Results: There was a decrease in the proportion of neonates who died in the LDU (from 3.5 to 1%) during the immediate post-implementation period, followed by a sustained decrease over the study period (p < 0.001). The change in the NICU admission rate (from 22.8 to 21.2%) was insignificant (p = 0.6) during this initial period. However, this was followed by a significant sustained decrease (7.8% in group E and 9.8% in group F, p < 0.001). The proportion of newborns with normal axillary temperature improved from 46.2% during the initial post-implementation period to 87.8% (p < 0.01); this proportion further increased to 99.8%. The program was perceived positively by NALS team members, NICU care providers, and hospital administrators. Conclusion: In resource-limited settings, LDHF training for neonatal resuscitation improves the neonatal resuscitation skills and management of delivery room attendants.
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Affiliation(s)
- Misrak Tadesse
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Suzanne Hally
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States.,School of Nursing, Endicott College, Boston, MA, United States
| | - Sharla Rent
- Division of Neonatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Phillip L Platt
- Wax & Gold Inc., Amarillo, TX, United States.,Pediatrix Medical Group, Department of Neonatology, Baptist St Anthony's Hospital, Amarillo, TX, United States
| | - Thomas Eusterbrock
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Alta Bates Summit Medical Center, Berkeley, CA, United States
| | | | - Tsinat Kifle
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie Kukora
- Division of Neonatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Louis D Pollack
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Alta Bates Summit Medical Center, Berkeley, CA, United States
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20
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Postnatal Outcomes and Risk Factors for In-Hospital Mortality among Asphyxiated Newborns in a Low-Resource Hospital Setting: Experience from North-Central Nigeria. Ann Glob Health 2020; 86:63. [PMID: 32587813 PMCID: PMC7304451 DOI: 10.5334/aogh.2884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Birth asphyxia accounts for a third of global newborn deaths and 95 percent of these occur in low-resource settings. A key to reducing asphyxia-related deaths in these settings is improving care of these newborns and this requires an understanding of factors associated with adverse outcomes. Objectives: In this study, we report outcomes and risk factors for mortality among newborn infants with birth asphyxia admitted to a typical low-resource hospital setting. Methods: We prospectively followed up 191 asphyxiated newborn infants admitted to a referral tertiary hospital in North-central Nigeria. At baseline, care-givers completed a structured questionnaire. Using univariable analysis, we compared baseline characteristics between participants who died and those who survived till discharge. We also fitted a multivariable logistic regression model to identify risk factors for mortality among the cohort. Results: Majority (60.7%) of the study participants presented to the hospital within the first six hours of life. Despite this, mortality among the cohort was 14.7% with a third dying within the first 24 hours of admission. The presence of respiratory distress at admission increased the risk for mortality (AOR = 3.73, 95% CI 1.22 to 11.35) while higher participant weight at admission decreased the risk (AOR = 0.11, 95% CI 0.03 to 0.40). Intrapartum factors such as duration of labour and maternal age, although significant on univariable analysis, were not significant on multivariable analysis. Conclusions: Hospital mortality among newborns with birth asphyxia is high in North-central Nigeria and majority of deaths occur during acute care. Respiratory distress at presentation and admission weights were identified as key risk factors for asphyxia mortality. Intrapartum factors on the other hand might have indirect effects on mortality through an increased risk for neonatal complications.
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Cavallin F, Menga A, Brasili L, Maziku D, Azzimonti G, Putoto G, Trevisanuto D. Factors associated with mortality among asphyxiated newborns in a low-resource setting. J Matern Fetal Neonatal Med 2020; 35:1178-1183. [PMID: 32212882 DOI: 10.1080/14767058.2020.1743670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
| | - Alessandra Menga
- Doctors with Africa CUAMM, Iringa, Tanzania.,Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | | | | | - Gaetano Azzimonti
- Doctors with Africa CUAMM, Iringa, Tanzania.,Tosamaganga Hospital, Iringa, Tanzania
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