Prevalence, case fatality rate and risk factors for mortality among neonates admitted with perinatal asphyxia at a tertiary hospital in northern Nigeria

Submitted: 6 April 2022
Accepted: 15 September 2022
Published: 29 December 2022
Abstract Views: 382
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Documenting the burden and the risk factors for perinatal asphyxia-related mortality is key to its prevention. The goal was to document the factors associated with mortality in perinatal asphyxia in a tertiary health facility in Nigeria. Records of consecutive neonatal admissions (between January 2016 and January 2017) underwent a retrospective analysis. Data were analyzed using Stata statistical software version 16 (Statacorp® Texas, USA). 102 (12.1%) of 841 admitted neonates had perinatal asphyxia; the median age (inter quartile range [IQR]) was 6 (0-168) hours. The mean admission weight ±(SD) was 2.96kg±(0.66) kg. Among inborn neonates, the incidence was 9.7 per 1000 live births. In 49% (50/102) pregnancies the amniotic fluid was clear; in 42% (43/102) it was meconium-stained; and 9 staining was unreported. Case fatality rate was 20.6% (21 of 102). 77(75%) neonates had no HIE, while 24 (24.5%) did. When compared to neonates without HIE, those with HIE II had about 7000 times higher odds of mortality (aOR = 68132.19, P0.01, 95% CI 3 to 1.4X 109). The adjusted odds of mortality for neonate with meconium-stained liquor were about 1900 times higher compared to clear meconium (aOR =1895, P = 0.02, 95%CI = 2.7 to 13072). Neonates with higher mean admission lengths (49.4cm [range = 48.8 to 50]) had 88 times lower odds of death compared to shorter neonates (aOR of 0.12 (95% CI: 0.17 to 0.85; p = 0.03).

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Wang H, Bhutta ZA, Coates MM, et al. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1725-74. DOI: https://doi.org/10.1016/S0140-6736(16)31575-6
Lawn JE, Lee ACC, Kinney M, et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done? Int J Gynecol Obstetr 2009;107:S5-S19 0020-7292. DOI: https://doi.org/10.1016/j.ijgo.2009.07.016
Hug L, Alexander M, You D, et al. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Global Health 2019;7:e710-e20. DOI: https://doi.org/10.1016/S2214-109X(19)30163-9
Antonucci R, Porcella A, Pilloni MD. Perinatal asphyxia in the term newborn. J Pediatr Neonatal Individual Med 2014;3:e030269
Mota-Rojas D, Villanueva-García D, Solimano A, et al. Pathophysiology of Perinatal Asphyxia in Humans and Animal Models. Biomed 2022;10:347. DOI: https://doi.org/10.3390/biomedicines10020347
Kumar A, Ramakrishna SV, Basu S, Rao GR. Oxidative stress in perinatal asphyxia. Pediatr Neurol 2008;38:181-5. DOI: https://doi.org/10.1016/j.pediatrneurol.2007.10.008
Nakao M, Iwashita M, Ikeda T. Looking at the data in the right perspective. Am J Obstet Gynecol 2021;225:106-107. DOI: https://doi.org/10.1016/j.ajog.2021.02.025
Committee Opinion No. 644: The Apgar Score. Obstet Gynecol 2015;126:e52-e55. DOI: https://doi.org/10.1097/AOG.0000000000001108
Lie K K, Grøholt E, Eskild A. Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study. BMJ 2010;341:c4990. DOI: https://doi.org/10.1136/bmj.c4990
World Health Organization. Guidelines on basic newborn resuscitation.
Krishnan V, Kumar V, Variane GFT, et al. 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. DOI: https://doi.org/10.1016/j.siny.2021.101271
Almeida MFBD, Kawakami MD, Moreira LMO, et al. Early neonatal deaths associated with perinatal asphyxia in infants≥ 2500 g in Brazil. Jornal de pediatria 2017;93:576-84. DOI: https://doi.org/10.1016/j.jped.2016.11.008
Velaphi S, Pattinson R. Avoidable factors and causes of neonatal deaths from perinatal asphyxia-hypoxia in South Africa: national perinatal survey. Ann Trop Paediatr 2007;27:99-106. DOI: https://doi.org/10.1179/146532807X192462
World Health Organization (WHO). World Health Report 2005: make every mother and child count. Geneva, Switzerland: World Health Organization; 2005.
Idris U. Perinatal asphyxia in term neonates seen in Federal Medical Centre, Birnin Kudu, Nigeria. Int J Health Allied Sci 2019;8:44-7.
Ochoga M, Ejeliogu E, Michael A, et al. Prevalence, risk factors and outcomes of perinatal asphyxia in newborns at Benue State University Teaching Hospital Makurdi. Jo Res Basic Clin Sci 2021;2:17-24. DOI: https://doi.org/10.46912/jrbcs.95
Ogunkunle TO, Odiachi H, Chuma JR, et al. 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. DOI: https://doi.org/10.5334/aogh.2884
Usman F, Imam A, Farouk ZL, Dayyabu AL. Newborn mortality in Sub-Saharan Africa: Why is perinatal asphyxia still a major cause? Ann Glob Health 2019;85:112. DOI: https://doi.org/10.5334/aogh.2541
Enweronu-Laryea CC, Andoh HD, Frimpong-Barfi A, Asenso-Boadi FM. Parental costs for in-patient neonatal services for perinatal asphyxia and low birth weight in Ghana. PLoS One 2018;13:e0204410. DOI: https://doi.org/10.1371/journal.pone.0204410
National Population Commission (NPC). Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF; 2019.
World Health Organization. Basic newborn resuscitation: a practical guide. No. WHO/RHT/MSM/98.1. World Health Organization, 1998.
Mrelashvili A, Russ JB, Ferriero DM, Wusthoff CJ. The Sarnat score for neonatal encephalopathy: looking back and moving forward. Pediatr Res 2020;88:824-5. DOI: https://doi.org/10.1038/s41390-020-01143-5
Audu LI, Otuneye AT, Mairami AB, et al. Determination of neonatal case-specific fatality rates in a tertiary health institution in North Central Nigeria. BMC Pediatr. 2021;21:302. DOI: https://doi.org/10.1186/s12887-021-02778-x
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. DOI: https://doi.org/10.1371/journal.pone.0262619
Ilah B, Aminu M, Musa A, et al. Prevalence and risk factors for perinatal asphyxia as seen at a specialist hospital in Gusau, Nigeria. Sub-Saharan Afri J Med 2015;2:64-9. DOI: https://doi.org/10.4103/2384-5147.157421
Locatelli A, Lambicchi L, Incerti M, et al. Is perinatal asphyxia predictable? BMC Pregnancy Childbirth 2020;20:186. DOI: https://doi.org/10.1186/s12884-020-02876-1
Aliyu I, Lawal T, Onankpa B. Prevalence and outcome of perinatal asphyxia: Our experience in a semi-urban setting. Tropical J Med Res 2017;20:161. DOI: https://doi.org/10.4103/tjmr.tjmr_42_16
Idris U. Perinatal asphyxia in term neonates seen in Federal Medical Centre, Birnin Kudu, Nigeria. Int J Health Allied Sci 2019;8:44. DOI: https://doi.org/10.4103/ijhas.IJHAS_11_18
Bogdanovic G, Babovic A, Rizvanovic M, et al. Cardiotocography in the prognosis of perinatal outcome. Med Arch 2014;68:102-5. DOI: https://doi.org/10.5455/medarh.2014.68.102-105
Lain J, Schoch M, Vishwanath T. (Forthcoming). Estimating a poverty trend for Nigeria between 2009 and 2019. Washington DC: World Bank.
Farquhar CM, Armstrong S, Masson V, et al. Clinician identification of birth asphyxia using intrapartum cardiotocography among neonates with and without encephalopathy in New Zealand. JAMA Netw Open 2020;3:e1921363. DOI: https://doi.org/10.1001/jamanetworkopen.2019.21363
Ray C, Ray A. Intrapartum cardiotocography and its correlation with umbilical cord blood pH in term pregnancies: a prospective study. Int J Reprod Contracept Obstetr Gynecol 2017;6:2745-53. DOI: https://doi.org/10.18203/2320-1770.ijrcog20172555
Yatham SS, Whelehan V, Archer A, Chandraharan E. Types of intrapartum hypoxia on the cardiotocograph (CTG): do they have any relationship with the type of brain injury in the MRI scan in term babies? J Obstetr Gynaecol 2020;40:688-93. DOI: https://doi.org/10.1080/01443615.2019.1652576
Lorenz U, Kubli F. Abnormal antepartum cardiotocogram and neuromotor dysfunction in term and preterm babies. Perinatal events and brain damage in surviving children. Springer; 1988: p. 117-29. DOI: https://doi.org/10.1007/978-3-642-72850-1_14
Al Wattar BH, Honess E, Bunnewell S, et al. Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis. Can Med Assoc J 2021;193:E468-e77. DOI: https://doi.org/10.1503/cmaj.202538
Neldam S. Fetal movements as an indicator of fetal well-being. Danish Med Bull 1983;30:274-8.
Usman F, Tsiga-Ahmed FI, Abdulsalam M, et al. Facility and care provider emergency preparedness for neonatal resuscitation in Kano, Nigeria. PLoS One 2022;17:e0262446. DOI: https://doi.org/10.1371/journal.pone.0262446
Ekwochi U, Asinobi NI, Osuorah CD, et al. Incidence and predictors of mortality among newborns with perinatal asphyxia: a 4-year prospective study of newborns delivered in health care facilities in Enugu, South-East Nigeria. Clinical Medicine Insights: Pediatrics. 2017;11:1179556517746646. DOI: https://doi.org/10.1177/1179556517746646
Ezenwa BN, Olorunfemi G, Fajolu I, et al. Trends and predictors of in-hospital mortality among babies with hypoxic ischaemic encephalopathy at a tertiary hospital in Nigeria: A retrospective cohort study. PLoS One 2021;16:e0250633. DOI: https://doi.org/10.1371/journal.pone.0250633
Perlman JM. Intrapartum asphyxia and cerebral palsy: is there a link? Clinics Perinatol 2006;33:335-53. DOI: https://doi.org/10.1016/j.clp.2006.03.004
Draper ES, Kurinczuk JJ, Lamming CR, et al. A confidential enquiry into cases of neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed 2002;87:F176-80. DOI: https://doi.org/10.1136/fn.87.3.F176
Ogunfowora O, Ogunlesi T. Socio-clinical correlates of the perinatal outcome of severe perinatal asphyxia among referred newborn babies in Sagamu. Nigerian J Paediatr 2020;47:110-8. DOI: https://doi.org/10.4314/njp.v47i2.10
Forster AJ, Fung I, Caughey S, et al. Adverse events detected by clinical surveillance on an obstetric service. Obstetr Gynecol 2006;108:1073-83. DOI: https://doi.org/10.1097/01.AOG.0000242565.28432.7c
Issa A, Abdulkadir MB, Adesiyun OO, et al. Relationships between cardiovascular signs and neurological signs in asphyxiated neonates in Ilorin, North Central Nigeria. African Health Sci 2021;21:743-52. DOI: https://doi.org/10.4314/ahs.v21i2.33
Thayyil S. Cooling therapy for the management of hypoxic-ischaemic encephalopathy in middle-income countries: we can, but should we? Paediatrics and International Child Health 2019;39:231-3. DOI: https://doi.org/10.1080/20469047.2019.1596586
Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar Score for the assessment of newborn infants. New Engl J Med 2001;344:467-71. DOI: https://doi.org/10.1056/NEJM200102153440701
American Academy of Pediatrics, Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists and Committee on Obstetric Practice. The Apgar score. Pediatrics 2006;117:1444-7. DOI: https://doi.org/10.1542/peds.2006-0325
Rasheed N, Arshad M, Siddique S. Neonatal outcome of meconium stained liquor. J Sheikh Zayed Med Coll 2010;6:836-8.
Shrestha A, Singh SD, Tamrakar D. Associated factors and outcome of babies born through meconium stained amniotic fluid. Kathmandu University Med J 2018;16:65-8.
Mehta, Vidhi, Hassan M. Meconium-stained amniotic fluid as a risk factor for perinatal asphyxia. Int J Contemp Pediatr 2019;6:325-8. DOI: https://doi.org/10.18203/2349-3291.ijcp20190678
Monfredini C, Cavallin F, Villani PE, et al. Meconium aspiration syndrome: a narrative review. Children (Basel) 2021;8:230. DOI: https://doi.org/10.3390/children8030230
Lindqvist PG, Molin J. Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstetr Gynecol 2005;25:258-64. DOI: https://doi.org/10.1002/uog.1806

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How to Cite

Farouk, Zubaida Ladan, Mahmud Jahun Gambo, Fatima Usman, Hauwa Musa Abdullahi, Abdulazeez Imam, Mohammed Abdussalam, and Labaran Dayyabu Aliyu. 2022. “Prevalence, Case Fatality Rate and Risk Factors for Mortality Among Neonates Admitted With Perinatal Asphyxia at a Tertiary Hospital in Northern Nigeria”. Pyramid Journal of Medicine 5 (2). https://doi.org/10.4081/pjm.2022.202.