Prospective study of neonatal birth trauma: Indian perspective

Abstract

Background: Birth injuries are mechanical traumas which occur during the process of labor and delivery. The reported incidence varies widely, and various predisposing maternal, neonatal, and labor-related risk factors are documented. However, prospective analysis of epidemiological factors from India is limited. Objective: To delineate the incidence, risk factor, and outcome of birth injuries in our tertiary level teaching and referral hospital. Design: Prospective observational study. Setting: Neonatology Divisions of Department of Pediatric Medicine of our institute. Participants: All inborn babies from singleton pregnancies over an 8 months period. Methods: All newborns were screened for birth trauma after birth. Maternal medical records and labor details were scrutinized. Babies with birth trauma were followed-up for 6 months to assess outcome. Following descriptive analysis, data on risk factors were analyzed in a case-control design. Outcome: Spectrum of birth trauma and its correlation with risk factors. Results: Seventy-three events were recorded from 4741 live births giving an incidence of 15.4/1000 (95% confidence interval 11.9-18.9). Majority were soft tissue injury (0.59%) followed by scalp and skull injury (0.51%). Higher maternal age, shorter height, higher birth weight, instrumental delivery, malpresentations, prolonged labor, obstructed labor, and delivery during risk hours were identified as significant risk factors though the level of risk varied-prolonged labor and instrumental delivery were the strongest. Only two neonatal deaths were attributable to birth trauma. Conclusion: The risk factors for neonatal birth trauma are to be identified and to be addressed for better neonatal outcome.