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ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 1  |  Page : 44-47

Perinatal asphyxia in term neonates seen in Federal Medical Centre, Birnin Kudu, Nigeria


Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria

Date of Web Publication18-Feb-2019

Correspondence Address:
Dr. Umma Abdullahi Idris
Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_11_18

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  Abstract 


BACKGROUND: The World Health Organization estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic squeal. Majority of cases are in sub-Saharan Africa. This study aimed at determining the prevalence, associated factors, and hospital outcome of term neonates hospitalized for perinatal asphyxia.
METHODOLOGY: This was a descriptive cross-sectional observational study of term neonates with low Apgar scores and outborn babies with no Apgar score but with features of asphyxia admitted over a period of 12 months into the Special Care Baby Unit of the Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria. Case files of the patients were retrieved, and relevant information was obtained.
RESULTS: Forty-nine of 212 babies admitted had perinatal asphyxia giving a prevalence of 23.1%. Majority of the babies were males and presented within the first 12 h of life with a mean birth weight of 2.66 ± 0.52 kg. Most of the mothers of the asphyxiated babies were primiparous and booked and had prolonged obstructed labor. Thirty-six (73.4%) of the babies were discharged home, eight (16.3%) left against medical advice, and five died to give the case fatality rate of 10.3%.
CONCLUSION: Perinatal asphyxia is a common cause of neonatal morbidity. It was common among babies delivered through emergency cesarean section whose mothers are primiparous and had prolonged labor and/or eclampsia.

Keywords: Newborns, perinatal asphyxia, term


How to cite this article:
Idris UA. Perinatal asphyxia in term neonates seen in Federal Medical Centre, Birnin Kudu, Nigeria. Int J Health Allied Sci 2019;8:44-7

How to cite this URL:
Idris UA. Perinatal asphyxia in term neonates seen in Federal Medical Centre, Birnin Kudu, Nigeria. Int J Health Allied Sci [serial online] 2019 [cited 2019 Sep 21];8:44-7. Available from: http://www.ijhas.in/text.asp?2019/8/1/44/252446




  Introduction Top


Perinatal asphyxia is defined as the inability of the newborn to initiate and sustain adequate respiration after delivery.[1] According to the World Health Organization, between 4 and 9 million newborns develop birth asphyxia each year.[2] Of these, an estimated 1.2 million die thus ranked as the fifth largest cause of under-five child deaths (8.5%), after pneumonia, diarrhea, neonatal infections, and complications of preterm birth.[2]

The combination of hypoxemia and ischemia leads to cascades of biochemical reactions that ultimately lead to brain neuronal death and multiple organ dysfunctions early in life, whereas in the long term, childhood survivors of neonatal hypoxic-ischemic encephalopathy might develop cerebral palsy; developmental delay; visual, hearing, and intellectual impairment; epilepsy; and learning and behavioral problems.[3],[4]

Reaching the sustainable development goal of 2030 of reducing preventable neonatal mortality to <12 deaths per 1000 live births requires research and evidence interventions that target neonatal period.[5]

The incidence of birth asphyxia in developed countries has reduced significantly, and <0.1% newborn infants die from perinatal asphyxia; this was following improvements in primary and obstetric care.[6] In developing countries, however, the prevalence rate of perinatal asphyxia is still high ranging from 21.6% to 32%[7],[8],[9],[10],[11],[12],[13] and higher case fatality rates.

This study aimed to determine the prevalence, risk factors, and outcome perinatal asphyxia in term neonates admitted into this rural tertiary hospital. The findings from this study will assist policymakers in an effective health-care planning.


  Methodology Top


This cross-sectional study was carried out at the Special Care Baby Unit (SCBU) of the Federal Medical Centre, Birnin kudu. It is one of the major government hospitals that provide inpatient neonatal services in Jigawa State and its neighboring state. It serves as the secondary and tertiary health institution in the state. It was established in the year 2000 for the provision of clinical services, teaching, and research in order to cater for the needs of the local and wider community. The SCBU has a capacity of ten beds where all sick neonates are admitted. Parents or guardians bear all the cost of admissions including drugs and laboratory investigations. This study was authorized by the Research and Ethical Committee of the hospital.

All term babies with Apgar scores <7 at 1 min and whose parents/caregivers who gave consent for inclusion into the study were recruited consecutively during the period of study (January 1, 2016, to December 31, 2016). For outborn babies with no Apgar score recording and a history of poor cry from birth with either of the following, poor color, respiratory distress, floppiness, and loss of primitive reflexes were used.[14]

Exclusion criteria included neonates suffering from major congenital anomalies or syndromes and preterm babies <37 completed weeks because the Apgar scores of nonasphyxiated preterm babies are normally low due to poor neurological maturity.

Data extracted from their case files included age at presentation, sex, birth weight, gestational age, parity of mothers, booking status, mode and place of delivery, Apgar score for inborn and history of prolonging labor, pregnancy-induced hypertension and other maternal conditions, duration of hospital stay, and outcome of admission.

Data were entered into Microsoft excel then into SPSS version 16 (SPSS Inc., Chicago, IL, USA), for cleaning and analysis using standard methods. Quantitative variables were summarized using mean and standard deviation. Categorical variables were summarized using frequency and percentages.


  Results Top


A total of 212 of neonates were admitted into the SCBU during the study period, of which 49 had perinatal asphyxia giving a prevalence of 23.1%. Thirty-two (65.3%) were males and seventeen were females (34.7%) with M:F of 1.9:1.

Majority of the babies presented within the first 12 h of life (ranged from <1 h to 240 h). Mean birth weight of asphyxiated babies was 2.66 ± 0.52 kg.

Most of the mothers of the asphyxiated babies were primiparous and booked and had prolonged obstructed labor [Table 1].
Table 1: Maternal antenatal variables

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Thirteen (26.5%) of the 49 babies had an Apgar score of 0–3, 29 (59.2%) had 4–5, while 7 had no Apgar score recorded. Hypotonia (69.4%), inability to cry(53%), poor suck (51%) and convulsions (28.6%) were the commonest complaints at presentation. The mean duration of hospital stay was 5.72 ± 2.92 days with a minimum of 4 h and the longest was 17 days.

[Table 2] showed that majority of the babies were delivered in the hospital and 20 (41%) through an emergency cesarean section.
Table 2: Apgar scores, place, and mode of deliveries of the asphyxiated neonates

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Outcome of babies with perinatal asphyxia

Thirty-six (73.4%) of the babies were discharged home, eight (16.3%) left against medical advice, and five died to give the case fatality rate of 10.3% [Table 3].
Table 3: Outcome of babies with perinatal asphyxia

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  Discussion Top


The findings of this study demonstrate that perinatal asphyxia is still prevalent and is associated with significant morbidity and mortality among term neonates in our locality. The prevalence of 23.1% of perinatal asphyxia documented in this study is in keeping with the findings of authors from Northwestern Nigeria,[7],[8],[15] 22.3% from South African countries, and 26.3% from Tanzania.[10] It is lower than the 32% reported from Warri[13] and higher than 6.6% reported from India.[11] The differences observed in the study may be explained by varied methodology, different case definition of birth asphyxia, socioeconomic status, and the locality of the studied population.

More male neonates were asphyxiated than females in this study. The male predominance was also reported by West and Opara from Port Harcourt,[9] Ugwu et al.[13] from Warri, Niger Delta, Aliyu et al. from Birnin Kebbi,[8] Padayachee and Ballot[16] from Johannesburg, and Dalal and Bodar[11] from India. This, however, contrasts the findings of IIah et al. from Gusau[15] where females were the most affected. The reason for male preponderance in this study is not clearly understood, but Badawi et al. in Australia[17] reported that male sex increased the risk of asphyxia by 50% while Johnston and Hagberg[18] concluded that female sex hormones (estrogens) enhance the protection against anoxia-ischemic lesions.

In this study, asphyxia was more common among booked mothers as was reported in Port Harcourt[9] and Johannesburg[16] and Cameroon[19] unlike what was observed in Warri,[13] India,[12] Gusau,[15] and Birnin Kebbi.[8] This may be due to the fact that our hospital is a tertiary/referral center, so many high-risk pregnancies booked at the primary or secondary health facilities are been referred. Second, this may highlight the inadequacy of the antenatal services offered at those centers and perhaps delay in referral. Third, some mothers despite attending antenatal care preferred to deliver at home. Home delivery is perceived by some as the norm and act of bravery; hence, they only present to the hospital when complications arose, thereby predisposing their unborn babies to perinatal asphyxia.

Primiparity, prolonged labor, and eclampsia were the most common maternal factors found in this study which is in agreement with the findings from Gusau,[15] Birnin Kebbi,[8] and Cameron.[9] These factors led to high emergency cesarean section among the mothers of asphyxiated babies.

Most of the mothers in this study are very young and primiparous as it was reported by Kinoti[10] and Dalal and Bodar.[11] It has been shown that primiparous women are often ignorant of the demands of pregnancy, thereby neglecting early booking and regular attendance to antenatal care. This may result in complications of prolonged labor, which may subsequently end up with the delivery of asphyxiated babies.

Majority of the patients (73.5%) were successfully discharged, and 10.2% death was recorded. The case fatality rate (CFR) reported in this study is lower than what was reported from many centers in Nigeria and India. This is therefore highly commendable giving the limited resources in the facility and considering the fact that majority of the babies had severe birth asphyxia.


  Conclusion Top


Perinatal asphyxia is a common cause of neonatal morbidity. It was common among babies delivered through emergency cesarean section whose mothers are primiparous and had prolonged labor and/or eclampsia.

Limitation of the study

This study was a retrospective study from a single center. Arterial blood gas measurement of fetal or neonatal would have been one of the ideal parameters in defining asphyxia in term babies, but Apgar score is used instead, given our resource-constrained setting.

Despite these limitations, the study was able to document for the first time, the prevalence, associated factors, and admission outcome of asphyxiated term babies in this locality.

Recommendation

Informing and educating pregnant women on the need for adequate antenatal care and skilled attendants at birth will lead to a significant reduction in the prevalence of the perinatal asphyxia.

Acknowledgment

The author is grateful to the doctors, nurses, and health records of the SCBU of Federal Medical Centre, Birnin Kudu, Jigawa State.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Perinatal Mortality: A Listing of Available Information. WHO/frh/msm/96.7. Geneva: World Health Organization; 1996.  Back to cited text no. 1
    
2.
Bryce J, Boschi-Pinto C, Shibuya K, Black RE; WHO Child Health Epidemiology Reference Group. WHO estimates of the causes of death in children. Lancet 2005;365:1147-52.  Back to cited text no. 2
    
3.
Zupan-Simunek V. Definition of intrapartum asphyxia and effects on outcome. J Gynecol Obstet Biol Reprod 2008;37S: S7-15.  Back to cited text no. 3
    
4.
De Vries LS, Jongmans MJ. Long-term outcome after neonatal hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 2010;95:F220-4.  Back to cited text no. 4
    
5.
World Health Organization. Health in 2015: From Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs). Switzerland Newborn. Geneva: WHO Press; 2015.  Back to cited text no. 5
    
6.
Saving Newborn Lives. The State of the World's Newborn: A Report from Saving Newborn Lives. Washington, D.C.: SAVE the Children; 2001. p. 1-44.  Back to cited text no. 6
    
7.
Mukhtar-Yola M, Iliyasu Z. A review of neonatal morbidity and mortality in Aminu Kano teaching hospital, Northern Nigeria. Trop Doct 2007;37:130-2.  Back to cited text no. 7
    
8.
Aliyu I, Lawal TO, Onankpa B. Prevalence and outcome of perinatal asphyxia: Our experience in a semi-urban setting. Trop J Med Res 2017;20:161-5. Available from: http://www.tjmrjournal.org/text.asp?2017/20/2/161/218214. [Last accessed on 2018 Feb 03].  Back to cited text no. 8
    
9.
West BA, Opara PI. Perinatal asphyxia in a specialist hospital in Port Harcourt, Nigeria. Niger J Paediatr 2013;40:206-10.  Back to cited text no. 9
    
10.
Kinoti SN. Asphyxia of the newborn in east, central and Southern Africa. East Afr Med J 1993;70:422-33.  Back to cited text no. 10
    
11.
Dalal CA, Bodar NL. A study on birth asphyxia at a tertiary health centre. Natl J Med Res 2013;3:374-6.  Back to cited text no. 11
    
12.
Memon S, Shaikh S, Bibi S. To compare the outcome (early) of neonates with birth asphyxia in-relation to place of delivery and age at time of admission. J Pak Med Assoc 2012;62:1277-81.  Back to cited text no. 12
    
13.
Ugwu GI, Abedi HO, Ugwu EN. Incidence of birth asphyxia as seen in central hospital and GN children's clinic both in Warri Niger Delta of Nigeria: An eight year retrospective review. Glob J Health Sci 2012;4:140-6.  Back to cited text no. 13
    
14.
Stoll JB, Kliegman RM. The fetus and the neonatal infant. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Paed. 16th ed. Philadelphia: W.B Saunders Company; 2000. p. 454-9.  Back to cited text no. 14
    
15.
IIah BG, Aminu MS, Musa A, Adelakun MB, Adeniji AO, Kolawole T. Prevalence and risk factors for perinatal asphyxia as seen at a specialist hospital in Gusau, Nigeria. Sub Saharan Afr J Med 2015;2:64-9.  Back to cited text no. 15
    
16.
Padayachee N, Ballot DE. Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa. SAJCH 2013;7:89-94.  Back to cited text no. 16
    
17.
Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O'Sullivan F, Burton PR, et al. Antepartum risk factors for newborn encephalopathy: The Western Australian case-control study. BMJ 1998;317:1549-53.  Back to cited text no. 17
    
18.
Johnston MV, Hagberg H. Sex and the pathogenesis of cerebral palsy. Dev Med Child Neurol 2007;49:74-8.  Back to cited text no. 18
    
19.
Chiabi A, Nguefack S, Mah E, Nodem S, Mbuagbaw L, Mbonda E, et al. Risk factors for birth asphyxia in an urban health facility in Cameroon. Iran J Child Neurol 2013;7:46-54.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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