Does early referral to tertiary care decrease the mortality related to birth asphyxia?

Abstract

To find the association of time of referral of asphyxiated newborns with the outcome. Observational study. Neonatal Unit of Children's Hospital, Lahore, from August to December 2000. One hundred fifty newborns with birth asphyxia were studied, who fulfilled four out of six Levene criteria. Exclusion criteria included age more than 48 hours at the time of admission, respiratory depression due to other causes, birth weight less than 1500 grams, gestational age less than 34 weeks, major congenital malformations, dysmorphism, severe hyperbilirubinemia, meningitis and bleeding disorders. Newborns were divided into two groups. Group A (n=78,52%) comprised of those newborns who reached our hospital within 12 hours after birth and group B (n=7, 48%) were those newborns who reached between 12-48 hours. Outcome was described either good outcome (newborns discharged from hospital in good clinical condition having normal vital signs, taking oral feed and not requiring medicine) or poor outcome (newborns expired during stay in neonatal unit). Chi-square test was applied and p-value was calculated. One hundred and seventeen (117) newborns (78%) were males and 33 (22%) were females. Thirty-five (35) mothers (23%) had proper antenatal visits to trained medical professionals. Majority of mothers (n=59, 39%) had their visits to untrained midwives, 56 mothers (37%) to semi-trained persons like a midwife, LHV or nurse. Majority (n =93, 61%) of study population were home delivered. Thirty-six newborns (24%) were delivered at private clinics and maternity homes while only 21 newborns (14%) came from tertiary care centers. Mortality was 24% in group A as compared to 76% in group B (p-value < 0.001). Those asphyxiated newborns who reached to a tertiary care hospital earlier had significantly better outcome as compared to those who arrived late. Early recognition of birth asphyxia and referral, therefore, reduces morbidity and mortality.