Objective: To determine the prevalence, determinants, and outcome of birth asphyxia conceded in the nursery department of Khyber Teaching Hospital Peshawar.
Methodology: It was both a cross-sectional descriptive and a cross-sectional analytical study design conducted in the neonatal unit of Khyber Teaching Hospital, Peshawar, from January 2020 to July 2020. We took all hypoxic-ischaemic encephalopathy (HIE) infants. A total of 730 babies conceded for management of HIE/birth asphyxia were included in the study. Information was gathered and analyzed to evaluate the clinical results of such babies.
Results: A total of 730 (19.7 %) babies were conceded for the management of HIE/birth asphyxia, of which 677 were full term and 53 were untimely. HIE1 was 17%, HIE2 were 58.32% and HIE3 conceded 21.36%. In terms of mortality, mild asphyxia 3%, moderate asphyxia 16%, and extreme asphyxia 83%.
Conclusion: It was inferred that morbidity and mortality can be diminished through an early acknowledgment of birth asphyxia, in reference to tertiary-level hospitals.

Birth asphyxia, Hypoxic ischemic encephalopathy, Mortality, Nursery, Cross-sectional analytical study.

HIE is a sort of newborn brain damage, related to compromised blood flow and oxygen supply to the newborn brain. HIE has three stages: I mild HIE shows mild hypotonia, II moderate with significant hypotonia, and III shows no response to physical stimuli. Alternative terms used for HIE are neonatal encephalopathy, prenatal asphyxia, and birth asphyxia.[1]

Occurrence of HIE, is accounted for to be 1-8/1000 live births in developed countries.[2] In developing nations, the rate is exceptionally high, for example, up to 26 per 1000 live births.[3] Annually, HIE mortality accounts for 20-25% of total neonatal mortality worldwide. Among the survivors, 25% are left with perpetual neuron-formative abnormalities.[3,4] The Result identified with neurologic incapacities relies on the severity of HIE. Death and perpetual neurologic deficiency are high in youngsters with serious acidosis, with up to 90% mortality and up to 72% mortality with a base shortage of more than 25mmol/L/L. Babies with gentle HIE showed lower intelligence quotient (IQ) compared to control infants.[5]

An investigation shows births with low appearance/pulse/grimace/activity/respiration (APGAR) score at 5 minutes, utilization of epinephrine, and cord blood low PH are pre-birth factors related to central nervous system (CNS) entanglement and mortality at the age of eighteen months.[6] The other investigation shows that gestational time of over 41 weeks is the prenatal and crisis c-area, pre-developed rupture of membranes, abnormal echo film, thick meconium, tight nuchal line, and bomb vacuum delivery are the perinatal danger factors for HIE.[7,8]

The result of HIE relies upon APGAR scoring at five minutes, time to first breath, heart rate for 90 seconds, duration of recovery, estimating main blood gases, and corrosive base status.[7] The early result is showing mortality or presence of HIE grade I, II, or III, as indicated by Sarnat staging.[8] As revealed in an examination done in Nepal, in which event was 2.9/1000 live births, of whom 20% had serious (Apgar score of 1 to 3) and 80% moderate birth asphyxia (Apgar score of 4 to 6). The greater part of the HIE cases gave poor neonatal reflexes, limpness, seizures, and strange papillary responses. The most well-known acid-base imbalance in an infant with HIE-III is metabolic acidosis.[9,10]

It was both a cross-sectional descriptive and a cross-sectional analytical study design. Data was collected from the clinical records of the babies born from January 2020 to July 2020 at Khyber Teaching Hospital Peshawar, and who were admitted either in the children’s ward or nursery. This study is approved by the local ethical hospital committee of Khyber Teaching Hospital Peshawar, Pakistan. Parameters like age, gestational age, sex, reason for confirmation, and result were recorded in our pre-designed proforma. Asphyxiation score was utilized both the Sarnat and Apgar scores. Apgar represents activity, grimace, pulse rate, appearance, and respiratory rate. This scoring is typically done at 1, 5, 10, 15, and 20 minutes immediately after birth and showing the level of asphyxia of the neonate. We did the scoring in five minutes in our examination for speedy appraisal and better outcomes. Statistical tests like chi ² were used where comparison was needed between variables.

Records of the total 3698 infants show that 2768 (74.9%) were full term and 930 were preterm (25.1%). Of the total newborn babies, 730 were diagnosed as HIE (19.7%); 677 of Hthe IE were full term and 53 were preterm. Different classes of HIE were as follows: HIE1 125, HIE2 449, and HIE3 156. Of the total 730 babies, 44.74 % were males while 55.26 % were females. The total of 730 HIE, 85.16 % of births were through normal vaginal deliveries while the remaining 14.84 % were born through C- section.

Table 1: HIE according to gestational age in total babies admitted

Chi ² test= 154.6; at a 95 % confidence interval (CI), our calculated value is 154.6, which is higher than the table value of 3.84 at degree of freedom 1. So, the result is highly significant, and the chance of occurrence of the result is less than 0.05 (p-value).

Table 2: Mortality statistics for hospital and home deliveries

Chi ² test = 220.5; at 95% CI our calculated value is 220.5 which is higher than the table value of 3.84 at degree of freedom 1. So, the result is highly significant and the chance of occurrence of the result is less than 0.05 (p value).

Table 3: Mortality statistics for HIE

Chi ² test = 4.7; at 95 % CI, our calculated value is 4.7, which is higher than the table value of 3.84 at degree of freedom 1. So, the result is highly significant, and the chance of occurrence of the result is less than 0.05 (p-value).

Table 4: HIE in hospital and home deliveries

Chi ² test = 129.7; at 95 % CI, our calculated value is 129.7, which is higher than the table value of 3.84 at degree of freedom 1. So, the result is highly significant, and the chance of occurrence of the result is less than 0.05 (p-value).

In our study, the transient result of asphyxiated children was compared to other studies in terms of place, infant age, gestational age, etc. The prevalence of birth asphyxia in our study was 19.7%, while it shifted from 9%.[9] to 19.7%.[10] In past studies, it was a result of the numerous operational definitions for birth asphyxia accepted by various scientists. Apgar score is still the most valuable construct for evaluating the viability and health of the newborn.[11]

Prevalence of birth asphyxia in our study was 19.7%, which is high compared with 0.24% in Canada, 2.69% in Nepal, 2.5% in Ethiopia, and 0.85% in the Netherlands; however, it is lower than the prevalence in Nigeria, which was 29.4%.[13] Furthermore, the male-to-female proportion was noted to be 1.07:1, which is indistinguishable from the investigation of India.[14] This fluctuation may be a direct result of the degree of value care given during the antenatal, natal, or post-pregnancy period among countries.[18] Moreover, the examination likewise shows that the maternal and neonatal components are related to asphyxia. Among the distinguished risk factors, suffocated neonatorum is the key factor for HIE, which is consistent with findings of other studies done in Pakistan, Colombia, Cameroon, and Ethiopia.[15]

Concerning of mode of delivery, 65(14.8%) youngsters were conveyed through Cesarean section (C-section) which is compatible with the world health organization (WHO) suggested rate, 10 to 15%, yet lower than the examinations in Cameroon, India, Nepal, China and Turkey which was 38.1%, 42%, 22.1%, 25%, and 45.6%, respectively. C-section was additionally unequivocally connected with birth Asphyxia in contrast with normal vaginal delivery and different examinations upheld it with various investigation plans.[17] The danger of asphyxia may lower as the fetal chest goes through the birth canal (vagina) is packed, extracting abundance liquid from the lungs, which would be a danger for asphyxia.[18] On the contrary, a huge size of an infant has been discovered as a related factor for birth asphyxia-related neonatal mortality.[20] Meconium-stained amniotic fluid was additionally discovered to be essentially connected with the frequency of perinatal asphyxia, consistent with other studies.[19,20] The Presence of meconium in the amniotic fluid may diffuse into the lung, which can cause perinatal asphyxia.[21]

The normal Pakistani ladies are weak, malnourished, of short stature, adding to cephalopelvic disproportion, leading to adverse outcomes of birth asphyxia. In our investigation, birth asphyxia was the third significant reason for affirmation 251(19.10%), while it was 40.66% at Chandka clinical school, Larkana, 31% at the children’s hospital, Lahore, and 18.85% at the National Institutes of Health (NIH), Karachi.[18] Our outcomes are somewhat better when compared with the above studies. This could be because of people’s preference for tertiary care hospitals.[23]

The event of asphyxia may be further lessened and its difficulties by improving antenatal, natal, and neonatal care locally.[24] More consideration ought to be paid to the preparation of local health volunteers (LHVs) and traditional birth attendants in neonatal care, fundamental infant care, and emergency obstetric and newborn care (EmONC) for better obstetric and neonatal care in the community.[24,25]

Recommendations:

• Hospital deliveries may be incentivized to make it attractive for the public.
• Home deliveries may be legally mandated to be attended by a trained birth attendant.
• All the health care workers dealing with newborns must be trained on a United Nations International children’s emergency fund (UNICEF) designed training module “helping baby breathe”.

The end was that morbidity and mortality can be decreased through an early acknowledgment of birth asphyxia and in time reference to tertiary level hospitals.

Not reported

There is no financial support for this study.

Corresponding Author:
Hamid Iqbal Bangash
Department of Pediatrics
Health Department Peshawar, Pakistan
Email: hamidbangash2000@gmail.com

Co-Authors:
Naveed and Yusra
Department of Nursery
Khyber Teaching Hospital Peshawar, Pakistan

Hayat Muhammad Khan
Department of Community Medicine
Khyber Teaching Hospital Peshawar, Pakistan

Sadia Nasir
Department of Obstetrics & Gynaecology
MTI Khyber Teaching Hospital Peshawar, Pakistan

All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation, and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.

This study is approved by the local ethical hospital committee of Khyber teaching hospital Peshawar, Pakistan.

Not reported

None

https://doi.org/10.63096/medtigo30622430

Iqbal HB, Hayat MK, Sadia N, Naveed, Yusra. Prevalence and Determinants of Birth Asphyxia in Khyber Teaching Hospital Peshawar, Pakistan. medtigo J Med. 2024;2(4):e30622430. doi:10.63096/medtigo30622430 Crossref