Abstract
Objectives: to determine the risk factors and short term outcome (till discharge) of neonates with perinatal asphyxia at RMMCH, Chidambaram.
Material and Methods: A prospective (case-control) study was conducted between January 2015 and July 2016 in the Neonatal Intensive Care Unit, Department of Paediatrics, Rajah Muthiah Medical College & Hospital. Venous blood collected from 50 term asphyxiated neonates comprising cases & 50 healthy neonates comprising controls constituted the material for study. Details of mother and baby were collected and compared between cases and controls.
Results: There is no statistical significant difference in the age, parity status, gestational age of mother, birth weight and mode of delivery between cases and control newborns. Antepartum risk factors were maternal age of 20 to 25 years, Pre eclampsia (16%), Anemia (8%), primigravidity (58%). Intra partum risk factors were breech presentation (4%), prolonged second stage of labour (44%), meconium staind amniotic fluid (26%) and cord around the neck (6%). Among the babies, 48% had stage 2 HIE& there is statistically positive correlation between stages of HIE & short term outcome with NRBC count.
Conclusion: Early identification of high risk mothers and timely referral to tertiary care center can reduce the mortality. Furthermore, there is need to carefully evaluate and monitor the babies with perinatal asphyxia immediately after birth. NRBC count can serve as simple and cost effective test in evaluating perinatal asphyxia thus reducing mortality and morbidity.
Keywords: Perinatal asphyxia, risk factors, short term outcome, hypoxic ischemic encephalopathy (HIE), neucleated red blood cells (NRBC).
References
1. National Neonatal and Perinatal Database Report. 2002- 2003:1-58.
2. World Health Organization. Neonnatal and Perinatal Mortality; Country, Regional and Global estimates, 2004; WHO,Geneva. 2006; 1-25.
3. Haider BA, Bhutta ZA: Birth asphyxia in developing countries: current status and public health implications. Curr Probl Pediatr Adolesc Health Care. 2006, 36 (5): 178-188. 10.1016/j.cppeds.2005.11.002.
4. Kaye D: Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric referrals in Mulago Hospital, Kampala, Uganda. East Afr Med J. 2003, 80 (3): 140-143.
5. Majeed R, Memon Y, Majeed F, Shaikh NP, Rajar UD: Risk factors of birth asphyxia. J Ayub Med Coll Abbottabad. 2007, 19 (3): 67-71.
6. Forestier F, DaVos F, Catherine N, et al. Developmental Hematopoiesis In Normal Human Fetal Blood. Blood 1991;77:2360–3.
7. Ghosh B, Mittal S, Kumar S, Dadhwal V. Prediction Of Perinatal Asphyxia With Nucleated Red Blood Cells In Cord Blood Of Newborns. Int J Gynaecol Obstet. 2003;81(3):267-271.
8. Lippman HS. Morphologic And Quantitative Study Of Blood Corpuscles In The Newborn Period. American Journal of Diseases in Children 1924;27:473–515.
9. Black RE, Kelley L. Reducing Perinatal and Neonatal Mortality. Child Health Res-earch Project. Special Report1999. p1-48.
10. Shrestha M, Shrestha L, Shrestha PS. Profile of asphyxiated babies at Tribhuvan University Teaching Hospital. J Nepal Pediatr Soc 2009;29:3-5.
11. Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: Incidence, clinical course and outcome in a Swedish population. Acta Paediatr 1995;84:927-32.
12. Bhuiyan SJ. Incidence, risk factors and immediate outcome of asphyxia neonatorum in hospitalized neonates. Department of Paediatrics IPGMR [Dessertation]. Dhaka: BCPS; 1996.
13. Crawford JS. Maternal age as an isolated factor in the incidence of perinatal asphyxia. Am J Obstet Gynecol 1966;95:569-71.
14. Pitsawong C, Panichkul P: Risk factors associated with birth asphyxia in Phramongkutklao Hospital. Thai J Obstet Gynaecol. 2012, 19 (4): 165-171.
15. Chandra S, Ramji S, Thirupuram S: Perinatal asphyxia: multivariate analysis of risk factors in hospital births. Indian Pediatr. 1997, 34 (3): 206-212.
16. Lee AC, Mullany LC, Tielsch JM, Katz J, Khatry SK, LeClerq SC, Adhikari RK, Shrestha SR, Darmstadt GL: Risk factors for neonatal mortality due to birth asphyxia in southern Nepal: a prospective, community-based cohort study. Pediatrics. 2008, 121 (5): e1381-e1390. 10.1542/ peds. 2007-1966.
17. Hermansen MC.(2001). Nucleated red blood cells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed, 84(3), F211-F215.
18. Sikarwar S, Gupta S. (2011). The correlation of clinical perinatalsphyxia with counts of NRBC/100 WBC in cord blood. Webmed central Obset Gynaecol, 2 (1), WMC001511.
19. Phelan JP, Korst LM, Ahn MO, Martin GI. (1998). Neonatal nucleated red blood cell and lymphocyte counts in fetal brain injury. Obset Gynecol, 91(4), 485-9.
20. Philip AG, Tito AM. (1989). Increased nuclelated red blood cell counts in small for gestational age infants with very low birth weight. Am J Dis Child, 143(2), 164-9.
21. Boskabadi H, Maamouri G, Sadeghian MH, Ghayour-Mobarhan M, Heidarzade M, Shakeri MT, et al. (2010). Early diagnosis of perinatal asphyxia by nucleated red blood cell count, a case-control study. Arch Iran Med, 13(4), 275-81.
22. Saracoglu F, Sahin I, Eser E, Gol K, Turkkani B. (2000). Nucleated red blood cells as a marker in acute and chronic fetal asphyxia. Int J Gynaecol Obstet, 71(2), 113-8.
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.84
