Birth asphyxia related mortality in Northwest Ethiopia: A multi-centre cohort study

Background Birth asphyxia is the second leading cause of neonatal death in Ethiopia, next to preterm-associated infections. Understanding the causes of death in asphyxiated newborns will help to design appropriate care. This study identifies predictors of neonatal mortality in asphyxiated newborns in selected hospitals in Northwest Ethiopia. Methods An institution-based prospective cohort study of 480 newborns with birth asphyxia was conducted at Debre Markos Comprehensive Specialized Hospital, Shegaw Motta District Hospital, and Injibara General Hospital. All newborns with asphyxia admitted to the neonatal critical care unit from the first of November 2018 to the first of November 2019 were included. Data were obtained prospectively from mothers using an interviewer’s administered questionnaire. The Kaplan-Meier survival curve was used to estimate survival time, and Log rank test was used to compare the survival curves. Bivariable and multivariable Cox proportional hazards models were fitted to identify the independent predictors of mortality in asphyxiated newborns. Adjusted hazard Ratios (AHRs) with 95% Cis (Confidence Intervals) were used to measure the strength of association and test statistical significance. Results The overall cumulative incidence of mortality among asphyxiated newborns was 42.29% (95% CI: 38%, 46). Asphyxiated neonates with other comorbidities (sepsis, neonatal anemia) (AHR = 2.63, 95% CI:1.69, 4.10), oxygen saturation of 50–69 (AHR = 4.62, 95% CI:2.55, 8.37), oxygen saturation of 70–89 (AHR = 2.82, 95% CI: 1.80, 4.42), severe Apgar score at one minute (AHR = 1.59, 95% CI:1.12, 2.25), neonates with Hypoxic Ischemic Encephalopathy (HIE) (AHR = 6.12, 95% CI:2.23, 16.75) were at higher risk of mortality. Conclusions The mortality rate among asphyxiated neonates remains high, and slightly higher than previous studies. Asphyxiated newborns with other comorbidities, severe Apgar score at one minute, who develop HIE, and low oxygen saturation were at higher risk of death. Therefore, designing appropriate interventions and prevention methods should be considered for identified variables.

[1]  G. Putoto,et al.  Factors associated with mortality among asphyxiated newborns in a low-resource setting , 2020, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[2]  L. Zeng,et al.  Neonatal mortality and associated factors in the specialized neonatal care unit Asmara, Eritrea , 2020, BMC Public Health.

[3]  Gebreamlak Gidey,et al.  Risk Factors of Neonatal Deaths Among Asphyxiated Neonates in Ayder Referral Hospital, Mekelle, Ethiopia: A Case Control Study , 2019 .

[4]  R. Meshram,et al.  Risk factors for mortality in birth asphyxia of outborn neonates: A prospective observational study , 2019, Sri Lanka Journal of Child Health.

[5]  E. Aniwada,et al.  Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, South East, Nigeria , 2019, African health sciences.

[6]  T. Berheto,et al.  Predictors of Neonatal mortality in Neonatal intensive care unit at referral Hospital in Southern Ethiopia: a retrospective cohort study , 2019, BMC Pregnancy and Childbirth.

[7]  S. Alikah,et al.  Perinatal asphyxia in a rural Nigerian hospital: Incidence and determinants of early outcome. , 2018, Journal of neonatal-perinatal medicine.

[8]  C. Osuorah,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 , 2017, Clinical medicine insights. Pediatrics.

[9]  S. Radhika,et al.  Clinical profile and short-term outcome of perinatally asphyxiated term neonates in a tertiary hospital in Southern Kerala , 2017 .

[10]  S. Yadav,et al.  Treatment and outcome of neonates with hypoxic ischaemic encephalopathy at B.P. Koirala Institute of Health Sciences , 2017 .

[11]  Théoneste Ndayisenga Maternal and Newborn Risk Factors associated With Neonatal Mortality in Gitwe District Hospital in Ruhango District, Rwanda , 2016 .

[12]  O. P. Mishra,et al.  Risk factors for adverse outcome in asphyxiated new born in Eastern Nepal , 2016 .

[13]  J. Lawn,et al.  Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions , 2015, BMC Pregnancy and Childbirth.

[14]  O. Adebami Maternal and fetal determinants of mortality in babies with birth asphyxia at Osogbo, Southwestern Nigeria , 2015 .

[15]  Vimal Kumar,et al.  Clinical profile and short-term outcome of hypoxic ischemic encephalopathy among birth asphyxiated babies in Katihar medical college hospital , 2014 .

[16]  E. Mercuri,et al.  Antepartum and Intrapartum Factors Preceding Neonatal Hypoxic-Ischemic Encephalopathy , 2013, Pediatrics.

[17]  D. Ballot,et al.  Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa , 2013 .

[18]  G. Naulaers,et al.  A descriptive study of perinatal asphyxia at the University Hospital of Kinshasa (Democratic Republic of Congo). , 2013, Journal of tropical pediatrics.

[19]  B. Schmidt,et al.  Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial. , 2013, JAMA.

[20]  D. Jamison,et al.  The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival , 2013, BMC Medicine.

[21]  M. Morelli,et al.  Birth asphyxia as the major complication in newborns: moving towards improved individual outcomes by prediction, targeted prevention and tailored medical care , 2011, EPMA Journal.

[22]  H. Trotman,et al.  Predictors of outcome of neonates with hypoxic ischaemic encephalopathy admitted to the neonatal unit of the University Hospital of the West Indies. , 2011, Journal of tropical pediatrics.

[23]  S. Shrestha,et al.  Clinical Profile of Birth Asphyxia in Dhulikhel Hospital: A Retrospective Study , 2010 .

[24]  A. Ali,et al.  WHO midwifery education module 3 Managing prolonged and obstructed labour , 2010 .

[25]  L. Wright,et al.  Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. , 2009, Bulletin of the World Health Organization.

[26]  A. Hanif,et al.  Factors Related to Adverse Outcome in Asphyxiated Babies , 2009 .

[27]  J. Butera,et al.  Making EmOC a reality—CARE's experiences in areas of high maternal mortality in Africa , 2006, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[28]  T. Tadesse,et al.  The FIGO Save the Mothers Initiative: the Ethiopia–Sweden collaboration , 2003, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.