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22-04-2012 | Cardiology | Article

Birth asphyxia accounts for substantial number of neonatal deaths


Free abstract

MedWire News: Birth asphyxia accounts for a large proportion of neonatal deaths, say researchers in Pediatrics.

The prospective observational study also showed that 5-minute Apgar score was a "poor surrogate" of birth asphyxia, report Hege Ersdal (Stavanger University, Norway) and colleagues.

The presumed causes of neonatal deaths globally have remained unchanged over the past decade and include infections, prematurity, and asphyxia, they write. However, great uncertainty surrounds these estimates and, in addition, cases are likely misclassified as stillbirths.

To investigate further, the researchers evaluated 4720 infants over 1 year for birth asphyxia, defined as failure to initiate spontaneous respiration and/or 5-minute Apgar score of more than 7, prematurity as gestational age of less than 36 weeks, and low birthweight as weight lower than the third percentile for gestational age.

Overall, 4595 (92.3%) infants were liveborn and 256 (5.6%) were admitted to the neonatal area of a rural referral hospital in Northern Tanzania. At 24 hours postpartum, 17 (0.4%) infants were still admitted to the neonatal area, 49 (1.0%) infants had died, 75 (1.6%) intrapartum stillbirths had occurred, and 50 (1.0%) antepartum stillbirths had occurred.

In addition, at 24 hours postpartum, 49 (61%) infants had died secondary to birth asphyxia, 18% due to prematurity, 8% due to low birthweight, 2% due to infection, 8% due to congenital abnormalities, and 2% due to unclear reasons.

The authors say that these data for the first time provide prospective descriptive observational information on causes of early neonatal deaths in a rural, resource-limited hospital setting.

"The findings indicate that birth asphyxia is the predominant cause [of neonatal mortality]… and low birth weight and congenital abnormalities are additional causes," comment the authors.

They note that approximately 50% of the asphyxiated infants were assigned a 5-minute Apgar score of 7 or more, "which supports a long-held notion that the Apgar score is an unreliable indicator of birth asphyxia."

Ersdal and team conclude: "Reducing early neonatal mortality requires a multifaceted approach with attention related to fetal heart rate monitoring and obstetric care, basic neonatal resuscitation including bag mask ventilation, and potential complications of prematurity and low birth weight."

By Piriya Mahendra

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