Muhammad Faheem Afzal, Aneela Anjum, Muhammad Ashraf Sultan.
Risk factor analysis in asphyxiated newborns and their outcome in relation to stage of hypoxic ischemic encephalopathy.
Pak Paed J Jan ;31(2):63-8.

Background: Hypoxic ischemic encephalopathy (HIE) is one of the common causes of neonatal mortality and long term sequale. The incidence is reported at 2-9/1000 live births. Objectives: To find out the frequency of risk factors in asphyxiated newborns and outcome of these newborns in relation to the stage of hypoxic ischemic encephalopathy in hospital setting. Study Design: Prospective descriptive study Place and Duration of study: This study was conducted in the Neonatology Unit of the Department of Paediatrics Unit-II, King Edward Medical University/Mayo hospital, Lahore, over a period of six months from April 01, 2006, to September 30, 2006. Patients and Methods: All the asphyxiated babies admitted during study period were included in study. Babies having congenital anomalies were excluded. The mothers were interviewed by using a pre-tested structured questionnaire. Results: Out of 449 total admissions in study period, 227(51%) babies were asphyxiated. Eighty five(37%) newborns had stage I HIE, 39% had stage II and 24% had stage III HIE . One hundred and sixty four(73%) were full term. Majority of the newborns were male (60%). One hundred and thirteen (49%) newborns were between 1.5 and 2.5kg. One hundred and thirty four (59%) babies delivered normally while seventy four (33%) were delivered by caesarian section. Hundred and sixty seven(74%) newborns were referred from government hospitals. Most of the deliveries (80%) were conducted by doctors. Majority of the mothers (48%) were below 25 years of age, 34% mothers were primigravida and 33% mothers received general anesthesia during labor. One hundred and sixty five (73%) babies had cephalic presentation. None of the deliveries were attended by a paediatrician in any of the cases. Maternal hypertension was found in 53(23%) mothers, gestational diabetes in 9(4%), hypoxia in 6(3%), anemia in 31(14%), toxemia in 19(8%), pelvic abnormality in 30(13%) and antepartum hemorrhage in 14(6%). No mother was found to be smoker. Eight (4%) babies had cord around the neck during delivery. One hundred and ten (48%) newborns were brought to the neonatal unit within one hour of delivery. Majority 21% of HIE I remained admitted in neonatology unit for less than 24 hours while 27(12%) of babies of HIE III died within 24 hour of admission. Among the factors studied, gestational age, weight, mode of delivery, birth attendant, sedation during labor and late arrival in neonatal unit were found to be significant with p value of < 0.05. Conclusion: HIE is caused by the risk factors that may be antepartum, intrapartum or postpartum. Monitoring for the known risk factors of asphyxia, proper training of primary birth attendants and improvement in neonatal resuscitation services can minimize the incidence of HIE.

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