Risk Factors and Short-Term Outcome of Birth Asphyxiated Babies in Dhaka Medical College Hospital

Abstract

Background: Perinatal asphyxia is the most important preventable cause of cerebral
injury in the neonatal period leading to very high neonatal mortality and morbidity in
developing countries. Little can be done for a baby affected by severe perinatal
asphyxia. So, prevention is unquestionably desired.
Objective: To identify the maternal and fetal risk factors for the development of birth
asphyxiated babies and to see the short term outcome of the affected babies.
Methods: An analytical type of or observational study was done in the Special Care
Baby Unit (SCBU) of Dhaka Medical College Hospital from October 2003 to March
2004. Identification of the risk factors was done by retrospective comparison of the
cases and controls. Outcome was analyzed by cross sectional comparative study.
One hundred consecutive cases of birth asphyxia, admitted in SCBU, were enrolled
in the study. Another 30 neonates admitted during this period for other reasons (i.e.,
jaundice, septicemia, low birth weight) were taken as control. Necessary information
were collected by detailed history taking, clinical examination and close follow up of
the hospital course, using pre-designed questionnaire and recording form.
Results: Male: female ratio 3:2 both in the cases and controls. Mean age on admission
was 13.8 hours and 2.6 days for case and control respectively. Identified important
maternal risk factors were primiparity (57% in cases vs. 33.3% in control), hypertension
(16.6% vs. 3.3%), pre-eclamptic toxemia of pregnancy (24% vs. 13.3%), prolonged
rupture of membrane (33.3% vs. 6.7%), prolonged labour (34% vs. 3.3%) and use
of oxytocin during labour (16% vs. none). All these were statistically significant (p<0.05).
Serious neonatal complications noted among the asphyxiated babies were convulsion,
hypoxic ishchemic encephalopathy and necrotizing enterocolitis. These were not seen
among the control group. Mortality among the asphyxiated babies was 16% during
hospital stay, whereas no fatality was recorded among the control. Neurological
sequelae was observed in 28% of asphyxiated babies but was absent in controls.
Conclusion: All the identified risk factors as well as neonatal complications were
significantly higher in asphyxiated babies. Most of these could have been prevented
even with our limited resources.

Key words: Birth Asphyxia; risk factors; immediate outcome.

DOI: 10.3329/bjch.v33i3.5688

Bangladesh Journal of Child Health 2009; Vol.33(3): 83-89