Severity Of Birth Asphyxia Research Articles

Relationship Between Mode of Delivery and Rate of Birth Asphyxia in a Tertiary Care Hospital, Rawalpindi; A Case-Control Study

Abstract: Objective: To assess the relationship between mode of delivery and rate of birth asphyxia in a Tertiary care Hospital, Rawalpindi. Methodology: This prospective case control study was conducted in Holyfamily Hospital,Rawalpindi from August 2021 to December 2021.One hundred and seventy two newborns were enrolled after assessing the inclusion criteria and divided equally into cases(neonates with birth asphyxia) and controls(neonates without birth asphyxia).A structured performa was designed to take detailed history of mode of delivery and severity of birth asphyxia by using APGAR score. Data analysis was done using SPSS 24.00. Results: One hundred and seventy two neonates were included in the study. 110 were males (63.9%) and 62 were females (36%). Term infants were more affected with birth asphyxia rather than preterm infants(53.6%). Meconium stained liquor(61.9%) and non-booked cases(55.1%) were seen more in case group.Spontaneous vaginal delivery was the common mode among all in our study population(91%). Emergency caesarean sections have higher frequency of birth asphyxia as compared to elective caesarean sections (39.3%) but no statistically significant difference found in frequency of birth asphyxia between case and control groups with regards to mode of delivery (p value=0.620) but significant in terms of neonatal mortality(p value=0.000). Conclusion: Birth asphyxia is a common contributor to neonatal mortality and improving perinatal care can help in reducing neonatal morbidity and mortality in developing countries.

Comparative Study to Correlate Hematological Parameters with the Severity of Birth Asphyxia

Introduction: Birth asphyxia can alter biophysical characteristics of erythrocytes, leukocytes and platelets. Nucleated red blood cell (NRBC) in the umbilical venous blood of neonates has been reported as a possible marker of perinatal asphyxia. NRBCs, platelet count, total leukocyte count, hemoglobin, and hematocrit were taken as hematological parameters. The purpose of this study was to evaluate the various hematological changes following birth asphyxia and their correlation with the severity of birth asphyxia and its outcome. Materials and Methods: It was hospital-based comparative observation study conducted in neonatal units of a tertiary hospital in the northern part of India from May 2019 to May 2020. All term appropriate for gestational age newborns with birth asphyxia were taken as cases and healthy newborns as controls. The sample size of 80 participants in each group was calculated. 2 ml cord blood sample was taken for parameters used in the study. P < 0.05 was taken as statistically significant. Results: There was no statistically significant difference in relation to sex distribution, birth weight, parity of mothers, and mode of delivery between cases and controls. NRBC and total leukocyte count were statistically positively correlated with the severity of hypoxic-ischemic encephalopathy (HIE), whereas hemoglobin, hematocrit, and platelet counts were not statistically significant. Area under the Receiver operating characteristic (ROC) curve of NRBC was 0.812, and the NRBC count cutoff of >20 has a sensitivity of 83% and specificity of 72%. Forty-six percent of total cases with NRBC 20 or more died. Conclusions: NRBC has a significant positive correlation with the severity of HIE and a negative with the Apgar score. NRBCs value more than or equal to 20 can be used as a prognostic marker for assessing the severity and outcome of birth asphyxia.

Serum magnesium levels of term neonates with birth asphyxia and relationship to severity of asphyxia.

Birth asphyxia is one of the three main causes of neonatal mortality in Nigeria. Hypomagnesaemia has been reported amongst severely asphyxiated babies. Despite this, the prevalence of hypomagnesaemia amongst newborns with birth asphyxia has not been well researched in Nigeria. This study set out to determine the prevalence of hypomagnesaemia in term neonates with birth asphyxia and the relationship (if any) between magnesium levels and the severity of birth asphyxia or encephalopathy. In this cross-sectional analytical study, the serum magnesium levels of consecutive cases of birth asphyxia were compared to that of gestational age-matched healthy term neonates. Babies with Apgar scores <7 in the 5th minute of life were recruited into the study. Blood samples were taken from each baby at birth and 48 h. Serum magnesium was measured using spectrophotometry. Hypomagnesaemia was found in 36 (35.3%) babies with birth asphyxia and 14 (13.7%) healthy controls; this difference was statistically significant (χ2 = 18.098, P = 0.001), with an odds ratio of 3.4 (95% confidence interval = 1.7, 6.9). The median (interquartile range) levels of serum magnesium in babies with mild, moderate and severe asphyxia were 0.7 mmol/L (0.5-1.1), 0.7 mmol/L (0.4-0.9) and 0.7 mmol/L (0.5-1.0), respectively (P = 0.316), while those of babies with mild (stage 1), moderate (stage 2) and severe (stage 3) encephalopathy were 1.2 mmol/L (1.0-1.3), 0.7 mmol/L (0.5-0.8) and 0.8 mmol/L (0.6-1.0), respectively (P = 0.789). This study has shown that hypomagnesaemia was more common in babies with birth asphyxia and there was no relationship between magnesium levels and the severity of asphyxia or encephalopathy.

Association of Cord Blood Glucose, Sodium, Potassium, and Calcium Levels With Neonatal Birth Asphyxia: A Hospital-Based Study.

ContextNeonatal birth/perinatal asphyxia is a serious condition with the potential to cause damage to various tissues of the body especially the brain. Hypoxia can cause metabolic disturbances, which in turn can lead to imbalances in the levels of glucose, electrolytes, and calcium, which can further worsen the condition. Early detection of these biochemical derangements and immediate correction can prevent the complications and lifelong disabilities of birth asphyxia due to injury to vital organs particularly the brain. The aim is to assess any correlation between the cord blood glucose, electrolytes, and calcium levels and the severity of birth asphyxia.Methods and materialIn this study, 50 birth asphyxia neonates with birth weight >2.5 kg, and a 5-minute Apgar score ≤ 6 at birth with clinical evidence of asphyxia were compared with healthy neonates with birth weight > 2.5 kg, and a 5-minute Apgar score > 7. In all the cases and controls, cord blood glucose was estimated by glucose oxidase and peroxidase (GOD-POD) method, total calcium by Arsenazo method, and sodium and potassium were estimated by ion-selective Electrode (ISE) method using fully automated biochemistry analyzers.ResultsThe mean cord blood concentrations of glucose, sodium, potassium, and calcium were significantly lower among birth asphyxia neonates in comparison with that of controls (p < 0.05). The correlation coefficient (r) for the study variables among cases indicates that there is a low to moderate positive correlation between the 5-minute Apgar score which is a measure of severity of birth asphyxia and cord blood concentrations of glucose, sodium, and calcium.ConclusionIn our study, birth asphyxiated neonates were found to have statistically significant low levels of cord blood glucose and electrolytes like sodium and calcium except for potassium. There was a low to moderate positive correlation between cord blood glucose and electrolyte concentrations with the severity of birth asphyxia. Analysis of cord blood for these simple biochemical tests can help pediatricians in the active management of birth asphyxia cases.

EVALUATION OF THE SERUM CALCIUM AND GLUCOSE LEVEL IN MODERATE AND SEVERE BIRTH ASPHYXIA: A CASE CONTROL STUDY IN SCB MEDICAL COLLEGE CUTTACK, ODISHA

Aprospective case control study was conducted in Department of Pediatrics, Newborn ward of S.C.B. Medical College &amp; Hospital and SVPPGIP, Cuttack, Odisha from September 2017 to September 2019 by taking 202 newborns having history and clinical features of moderate &amp; severe hypoxic ischemic encephalopathy and they were evaluated for their serum calcium and blood glucose levels. In the present study mean serum calcium level was found to be low in babies with moderate birth asphyxia and severe birth asphyxia as compared to control. Again it was also found to be low in severe birth asphyxia as compared to moderate birth asphyxia. The percentage of hypo calcemic babies was found to be more in babies with moderate birth asphyxia and severe birth asphyxia as compared to control. Again it was also found to be more in severe birth asphyxia as compared to moderate birth asphyxia. In this study percentage of hypoglycemic babies was found to be more in babies with moderate birth asphyxia and severe birth asphyxia as compared to control. Again it was also found to be more in severe birth asphyxia as compared to moderate birth asphyxia. All the comparison was signicant statistically(P&lt;0.05). This study showed that risk of hypocalcemia and hypoglycemia increased with severity of birth asphyxia. The present study showed that survival was more with normal serum calcium level as compared to low serum calcium level (95.5% vs 74.7%) whereas fatal outcome was more with low serum calcium level as compared to normal serum calcium level (22.2% vs 2.3%). Low serum calcium level was associated with more fatal outcome. The difference was statistically signicant as P&lt; 0.05.The present study showed that survival was more with normal blood glucose level as compared to low blood glucose level (92.5% vs 44.6%) whereas death was more with low blood glucose level (48.2% vs 6.2%). Low blood glucose level was associated with more fatal outcome. The difference was statistically signicant (P&lt; 0.05).Although the study result has resemblance to previous studies, as there is no such type of study has been done previously in this institution, where patient burden is much more higher than resources and where emphasis on prevention, this study will establish an cost effective management protocol of birth asphyxia babies in my institution.

Co-relation Between Perinatal Asphyxia with Hypoxic Ischemic Encephalopathy (PNA with HIE) and Blood Sugar Level

Introduction: Perinatal asphyxia is one of the most common primary causes of mortality and morbidity among neonates. Perinatal asphyxia will result in neonatal hypoxia and tissue/organ injury. Objective: The aim of this study was to observe the Co-relation between Perinatal asphyxia with Hypoxic Ischemic Encephalopathy (PNA with HIE) and Blood sugar level. Methodology: This is a descriptive cross-sectional case study where a total of 182 neonates were admitted to the hospital with the problem of Perinatal asphyxia with Hypoxic Ischemic Encephalopathy and with some other associated problem. Result: Among the cases, 114 (62.6%) were Boys and 68 (37.45%) Girls. The mean age was 29.72 ± 78.42, Weight 2.77 ± .60, RBS 6.57 ± 7.38. Among the asphyxiated neonates blood sugar levels in arterial cord blood were significantly lower and had a negative (r=−0.195, P<0.01) correlation with the severity of birth asphyxia and different stages of HIE. Conclusion: Perinatal asphyxia can result in neonatal hypoxia and tissue/organ injury. A variety of maternal, obstetric, and neonatal conditions predispose the fetus and newborn to asphyxia, which can occur before, during, or after birth From our result, we can conclude that the relationship between Perinatal asphyxia and blood sugar level is significantly lower and negative.

Clinico-Biochemical Correlation in Birth Asphyxia and Its Effects on Outcome.

BackgroundBirth asphyxia is a major cause of early neonatal death and leads to severe consequences such as epilepsy, cerebral palsy, and developmental delay. This study aims to determine the correlation between dyselectrolytemia and the degree of hypoxic-ischemic encephalopathy (HIE) and to find out major risk factors contributing to the severity of HIE and neonatal death.MethodsIn this prospective cohort study (n=150), term babies weighing ≥ 2.5 kg at birth, with the diagnosis of birth asphyxia, admitted in a medical college in Odisha state from September 2014 to August 2016 were included. Clinical findings, biochemical parameters, treatment, and outcome of HIE babies were recorded.ResultThe majority of the asphyxiated babies were having moderate HIE (HIE II) (57.33%), whereas mild and severe stages were seen in 15.33%, and 27.34% of babies, respectively. Factors like prolonged labor (87.8%) and meconium-stained liquor (63.4%) were mostly attributed to the severe degree of birth asphyxia (p < 0.001). Apnea, lethargy, and hypothermia were the most remarkable feature of HIE III. The degree of hyponatremia, hypocalcemia, and hyperkalemia (124.4±4.4 mmol/l, 0.83±0.08 mmol/l, and 6.17± 0.89 mmol/l, respectively) were more severely affected in HIE III as compared to HIE l (137.5±3.8 mmol/l, 1.06±0.17 mmol/l, and 5.0±0.79 mmol/l, respectively). Serum urea and creatinine increased proportionately with an increase in the severity of HIE grade. The mildly asphyxiated neonates recovered completely, whereas all the cases who died (n=29,19.3%) belonged to the moderate or severe degree of birth asphyxia.ConclusionThe asphyxiated neonates had hyponatremia, hypocalcemia, hyperkalemia, raised serum urea, and creatinine and correlated with the severity of birth asphyxia. Prolonged labor and meconium-stained liquor were the most attributable factor for the severe degree of birth asphyxia. Effective neonatal resuscitation and quick correction of electrolyte imbalances will help in the reduction of neonatal mortality and long-term neurological sequelae.

To study renal parameters and serum calcium levels in birth asphyxia

Background: Birth asphyxia is a common neonatal problem and contributes significantly to neonatal mortality and long term morbidity. Any organ can be affected but the brain, heart, kidneys are more sensitive to hypoxic injury. Aim and Objective: To study renal parameters and serum calcium levels in birth asphyxia, to determine the incidence of renal failure in asphyxiated newborns, and to correlate the renal parameters with different severity of birth asphyxia and with different stages of hypoxic-ischemic encephalopathy. Method and material: A comparative study of 69 term newborns, appropriate for gestational age born/admitted to tertiary care Centre RDGMC Ujjain with birth asphyxia and 69 normal newborns without birth asphyxia was done. Perinatal history, physical examinations, New Ballard score, Apgar score was done. Data collected and entered in the master chart for results and analysis. Result: The study included 69 cases and 69 controls with the majority of boys. Mild, moderate, and severe birth asphyxia was7%, 29%, and 64% of all cases respectively. The incidence of acute renal failure was 57% among cases of birth asphyxia. The incidence of acute renal failure was 53% and 50% in hypoxic-ischemic encephalopathy stages III and II respectively. Incidence of renal failure with mild, moderate, and severe asphyxia was 40%, 50%, and 39% respectively Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. Monitoring of urea, creatinine and urine output helps in the early diagnosis and management of acute renal failure

A study of renal parameters and serum electrolytes level in newborns with birth asphyxia

Perinatal hypoxia is one of the most common primary cause of neonatal mortality and morbidity in India. WHO has defined perinatal asphyxia as a “failure to initiate and sustain breathing at birth.” Asphyxiated newborns are more prone to hypoxic injury so in these cases any organ can be affected but the brain, myocardium, kidneys and bowels appear to be more sensitive.1 This study was conducted in asphyxiated newborns to interprets serum electrolytes levels and renal parameters levels in cases of birth asphyxia. |Materials and Methods: This study was done in 100 Newborn out of which 50 were cases & 50 were control from May, 2015 to May, 2016 were taken up for the study. The detailed perinatal history was obtained. Urine sample was collected by neonatal urobegs in cases and in control it was by spot sample. Blood sample were collected by routine venous sampling. Serum electrolytes levels and renal parameters were evaluated in cases and control. Results: In our study male babies had higher incidence of birth asphyxia as compared to female babies. In our study blood urea nitrogen (BUN) and creatinine level was higher among cases. Therefore there is a linear correlation with severity of asphyxia. Urine sodium and urine creatinine also increased among cases and therefore they had a higher incidence with severity of asphyxia. In our study we found serum sodium level was lower among cases than the controls. There was linear correlation between severity of asphyxia. The serum potassium was higher among cases than control and serum calcium had lower with severity of birth asphyxia. Conclusions: The study of Birth asphyxiated newborn shows that monitoring renal parameters and serum electrolytes helps in the early diagnosis and management of renal failure. Therefore they had a linear correlation with severity of birth asphyxia. Keywords: Perinatal hypoxia, HIE, APGAR score, Serum electrolytes levels, Renal parameters.

Prevalence of electrolyte disturbances in perinatal asphyxia: a prospective study

BackgroundBirth asphyxia is defined as the presence of hypoxia, hypercapnia, and acidosis leading the newborn to systemic disturbances probably electrolyte disturbance also. Knowledge of these electrolyte disturbances is very valuable as it can be an important parameter affecting perinatal morbidity, mortality and ongoing management.MethodsSerum sodium, potassium and ionized calcium of asphyxiated term newborn were sent within one hour of birth as per the inclusion criteria. Statistical comparison of mean values of different electrolytes between different groups of perinatal asphyxia was performed by ANOVA test for parametric data and significant data were further analyzed using post hoc test. Bivariate analysis was done to determine the correlations between Apgar score at 5 min and serum electrolytes. Pearson test was used to calculate the correlation coefficient. Box plot was used to show the median and quartile between serum electrolytes and Apgar score at 5 min.ResultThe mean values of sodium for mild, moderate and severe asphyxia were 135.52, 130.7 and 127.15 meq/l respectively. The values of potassium for mild, moderate and severe asphyxia were 4.96, 5.93 and 6.78 meq/l respectively. Similarly, the mean values of ionized calcium for mild, moderate and severe asphyxia were 1.07, 1.12 and 0.99 mmol/l respectively. The values of sodium and potassium among different severity of asphyxia were significantly different (p-value< 0.001). Significant positive correlation was found between serum sodium and Apgar score at 5 min. Significant negative correlation was present between serum potassium and Apgar score at 5 min.ConclusionThe degree of hyponatremia and hyperkalemia was directly proportional to the severity of birth asphyxia. So these electrolyte disturbances should always be kept in mind while managing cases of perinatal asphyxia and should be managed accordingly.

Study of Myocardial Dysfunction in Perinatal Asphyxia Field

Aims and Objectives: To study an incidence of myocardial dysfunction in neonates admitted with perinatal asphyxia, to find out its correlation with severity of birth asphyxia and its outcome.&#x0D; Methods: This prospective study was conducted among 40 term neonates admitted in NICU of Civil Hospital Ahmedabad who had suffered with perinatal asphyxia (defined by WHO ), resuscitated as per NRP guidelines-2015 including both intramural and extramural admissions and who developed to hypoxic ischemic encephalopathy as defined by Levene staging. Neonates with congenital heart diseases, major central nervous system malformations and neonatal sepsis were excluded. Myocardial involvement was assessed by clinical evaluation, ECG, Creatinine Kinase Total (25-200IU/L), CK-MB (0-25IU/L) and Troponin I (0-0.03ug/L) measurements.&#x0D; Results: Among 40 cases, 10(25%) neonates had moderate birth asphyxia while 30(75%) had severe birth asphyxia. Respiratory distress was observed in 34(77.5%), poor spontaneous respiration 4(10%),shock in 14(35%),CCF 19(47.5%) while ECG was abnormal in 30(76.7%). Serum levels of CPK Total, CPK- MB and Troponin I were raised in 34(85%), 32(80%) and 28 (70%) neonates, respectively. &#x0D; Conclusion: There was a direct correlation between ECG changes and enzymatic levels which showed increasing abnormalities with increasing with severity of HIE.&#x0D;

Study of neuro developmental outcome of hypoxic ischemic encephalopathy of less than one-year infant in a tertiary care institute

Introduction: Perinatal asphyxia can lead to hypoxic ischemic encephalopathy (HIE). The mortality due to hypoxic ischemic encephalopathy is as high as 28.8 % and morbidity is 30 % of surviving new-born due to hypoxic ischemic encephalopathy. Aim &amp; Objective: To study the neuro developmental outcome of surviving neonate with hypoxic ischemic encephalopathy till one year of age and to give early stimulation to such baby to decrease the morbidity. Material &amp; Method: It isa hospital based prospective study done in tertiary care hospital in SCB Medical College Hospital &amp; SVP PG Institute, Cuttack from July 2015 to June 2017. Result: The incidence of asphyxia neonatorum among the babies in normal delivery was very high compared to the babies of lower section caesarean section (LSCS) delivery. Severity of birth asphyxia was high in face presentation, followed by breech than normal vertex presentation. Respiratory distress was found to be associated with neonatal asphyxia in this study. Mortality is highest in severe encephalopathy and least in mild variety. In follow, up study neurodevelopmental abnormality is found to be 100% in HIE-III. 34.4% in HIE-II and normal development in stage –I HIE. Conclusion: Institutional delivery with trained personal with neonatal resuscitation at first golden minute will prevent birth asphyxia. Timely screening of asphyxiated babies and early sensory stimulation decreases the morbidity in asphyxiated newborn.

Correlation of nucleated red blood cells with severity of birth asphyxia and its immediate outcome in term newborns

Background: The severity of birth asphyxia can be predicted by APGAR score and umbilical cord blood pH. The Nucleated Red Blood Cells (NRBCs) in the cord blood at birth emerged as a newer predictor of birth asphyxia. This study was conducted to find the correlation of cord blood Nucleated Red Blood Cell (NRBC) count with the severity of birth asphyxia and its immediate outcome in term newborns. Methods: An observational hospital based prospective case control study was conducted at inborn NICU, Bal Chikitsalya, RNT Medical College, Udaipur (Raj.) INDIA from March 2015 to September 2015. Total 100 term newborns including 50 as cases (with birth asphyxia) and 50 as controls (normal babies) were enrolled for the study. The cord blood was collected immediately after birth for the measurement of NRBC/100 WBC count and pH value. All the enrolled cases were admitted in NICU and observed for the immediate neurological outcome. The correlation of cord blood NRBC count with APGAR scores, cord blood pH and outcome was analysed statistically. Results: The mean NRBC (NRBC/100 WBC) count was 17.82±19.55 (range from 0-102) in case group and 1.42±3.26 (range from 0 to 18) in control group (p < 0.001). A statistically significant negative correlation of NRBC count was found with severity of birth asphyxia. Conclusions: A simple, cheap, rapid and non-invasive test of NRBC count from umbilical cord blood correlates well with APGAR score and cord blood pH to predict the severity of birth asphyxia and immediate outcome.

Persistence of atrioventricular valve regurgitation and electrocardiographic abnormalities following transient myocardial ischemia of the newborn.

To determine the sequelae of transient myocardial ischemia (TMI) in term infants, we reviewed clinical and investigative data in 59 infants (37 male, 22 female) with structurally normal hearts admitted over the 2-year period of 1983-1985. Twenty-three were diagnosed prior to admission as cases of birth asphyxia (5-min Apgar score less than 6), and 36 had signs of persistent fetal circulation with electrocardiographic (ECG) changes of ischemia greater than 24 h after birth. Murmurs of atrioventricular valve regurgitation (AVVR), detected in 28 patients, were confirmed in 23 of the 24 patients investigated. The murmurs resolved over a 2-day to 6-month period (median 6 days). In three patients, AVVR, left ventricular dyskinesia, and ECG anomalies persisted for 2 months (until death), 4 months, and 48 months. Initial ECGs were abnormal in 57 patients, and (of those reviewed) 60% returned to normal over a 6-day to 7-month period (median 2 months). Residual ECG anomalies included second-degree AV block and persistent ST-T wave changes. Ten patients died from noncardiac causes. Neither the presence nor resolution of AVVR correlated significantly with the severity of birth asphyxia using the Apgar score, nor with the severity of the ischemic changes on the ECG. Although the cardiovascular sequelae of myocardial ischemia are usually transient, the data should prompt the need for careful review after the initial admission.

Clinical Events Relating to Intraventricular Haemorrhage in the Newborn

Continuous measurements of arterial pressures, heart rates, respiratory movements, and respiratory rates were made from birth in 44 infants at risk from intraventricular haemorrhage (IVH). 17 babies died with IVH, in 10 of whom the event was timed objectively. Events in these babies were compared with survivors of similar birthweights, gestational ages, severity of birth asphyxia, and severity of hyaline membrane disease (HMD). IVH followed severe HMD and was associated with cessation of the babies' own respiratory efforts while on a ventilator and also with characteristic cardiorespiratory events. The minimum arterial pressure before IVH was lower than in comparable babies who survived. It is suggested that fluctuations of systemic blood pressure from initial low levels may be important in the pathogenesis of IVH. It is possible that changes in cerebral blood flow are of even greater significance.

Clinical events relating to intraventricular haemorrhage in the newborn.

Continuous measurements of arterial pressures, heart rates, respiratory movements, and respiratory rates were made from birth in 44 infants at risk from intraventricular haemorrhage (IVH). 17 babies died with IVH, in 10 of whom the event was timed objectively. Events in these babies were compared with survivors of similar birthweights, gestational ages, severity of birth asphyxia, and severity of hyaline membrane disease (HMD). IVH followed severe HMD and was associated with cessation of the babies' own respiratory efforts while on a ventilator and also with characteristic cardiorespiratory events. The minimum arterial pressure before IVH was lower than in comparable babies who survived. It is suggested that fluctuations of systemic blood pressure from initial low levels may be important in the pathogenesis of IVH. It is possible that changes in cerebral blood flow are of even greater significance.