Risk factors for mortality in birth asphyxia of outborn neonates: A prospective observational study

Abstract

Background: Birth asphyxia accounts for around 23% of annual neonatal deaths in the developing world. Objective: To assess the risk factors for death in outborn neonates with birth asphyxia. Method: A one year prospective observational cohort study was undertaken in a tertiary care teaching government hospital in India. All outborn referral neonates diagnosed with birth asphyxia were included. Demographic, maternal and neonatal factors were included and analysed. Results: Incidence of birth asphyxia was 17.3% with a male: female ratio of 1.3:1. Ninety five percent mothers received antenatal care and 98% were delivered at either primary or secondary health care level institutes. Mean distance travelled by baby was 89.42±69.36 km. One hundred and twenty two (68%) mothers were anaemic, 45 (25%) had systemic hypertension and 75 (42%) had preeclampsia/eclampsia. One hundred and forty (78%) babies were term and 103 (57%) had average birth weights. A history of not crying at birth was available in 95% neonates who were resuscitated by paramedical person and medical officers. Case fatality rate was 40.6%. Average duration of hospital stay of non-survivors was 4.35±2.98 days compared to 9.07±4.85 days in surviving neonates (P < 0.0001). Most deaths were in HIE stage III. Unbooked mothers (p=0.01), maternal anaemia (OR 3.07, CI 1.12-8.41, p=0.02), neonates requiring resuscitation (OR 0.26, CI 0.10-0.68, p=0.006), neonates presenting with convulsions (OR 4.46, CI 1.46- 12.16, p=0.003) or cyanosis (p < 0.008), prolonged capillary refill time (OR 0.32, CI 0.47-0.82, p=0.004) and neonates in HIE stage III (OR 1.60, CI 1.04-2.46, p=0.03) were the risk factors for mortality in asphyxiated neonates. Conclusions: The case fatality rate was 40.6% among outborn referral neonates with birth asphyxia in this study. Unbooked mothers, maternal anaemia, neonates requiring resuscitation, neonates presenting with convulsions or cyanosis, prolonged capillary refill time and neonates in HIE stage III were risk factors for mortality in asphyxiated outborn neonates.