Outcomes of birth asphyxia and associated factors among newborns

Abstract

Birth asphyxia is a serious clinical problem that is associated with life-threatening complication like Hypoxic Ischemic Encephalopathy (HIE). Hypoxic Ischemic Encephalopathy carries high case fatality rates ranging between 10–60%, with 25% of survivors getting an adverse long-term neurodevelopment outcome. In Uganda, birth asphyxia has been the leading cause of neonatal deaths over the past three years at an average of 48% with the Bugisu region having the highest neonatal death rates of 55.6% as compared to the other 14 regions of the country. Despite the above, data are scarce regarding the immediate outcomes and associated factors in most developing countries, including Uganda. Therefore, this study aimed to describe the immediate outcomes of birth asphyxia and determine the factors associated with adverse outcomes among newborns admitted to the Special Care Unit (SCU) at Mbale Regional Referral Hospital (MRRH) during the first 24 hours of life. Methodology: A longitudinal prospective study was conducted on 286 newborns/mother pairs with birth asphyxia in the first 24 hours of birth admitted to SCU MRRH. We used a consecutive Sampling method to recruit our study participants and data were collected using a structured questionnaire, mother’s maternity records, pulse oximetry, Thomson scoring sheet, and participants records were used to measure the outcome variables. The data were analyzed using STATA version 15. Bivariate analysis by cross-tabulation using a Chi-square test was used to determine the existence of the association of the maternal social demographic and newborn characteristics with HIE. A binary logistic regression model was performed at a multivariable level reporting odds ratios of 95% confidence intervals. The factors with an adjusted Odds ratio of greater than one and a P-value of < 0.05 were considered statistically significant. Results: The incidence of HIE was 70.3% at admission, 45.1% at 12 hours, and 24.6% at 24 hours (AOR 5.1, CI 1.8-15.0, P<0.003) respectively. A total of 4.6% died at admission, 4.4%in 12 hours and 1.2% in 24 hours. Accordingly, HIE, deaths were significantly associated with a referral from lower health facilities (AOR 4.2, CI 1.7-10.0, P<0.001), meconium-stained liquor (AOR 2.2, CI 1.2-4.1, P<0.014) and newborns who were resuscitated at 95% CI . Conclusion: The burden of Hypoxic Ischemic Encephalopathy and mortality was high among newborns with BA in our study and a majority had HIE at admission and decreased over time. We found a significant association between HIE and meconium-stained amniotic fluid, newborns referred from peripheral facilities, newborns resuscitated using a bag and mask, and those delayed to breastfeed. It is important to pay close attention to these factors while managing a laboring mother and newborns as this may alter the course and modify the risk of HIE. It is imperative, therefore to optimize the response to emergencies as this may succeed in minimizing the incidence of HIE. Keywords: birth asphyxia, hypoxic ischemic encephalopathy, newborn and factors.