7-day Outcome of Term Neonates Admitted at Pumwani Maternity Hospital Newborn Unit With Perinatal Asphyxia

Abstract

Background: Birth asphyxia still is a significant cause of newborn mortality and morbidity globally. There is paucity of data on short term outcomes of perinatal asphyxia in Africa and in particular Kenya. Study objective: To find out 7-Day outcome and the factors contributing to adverse outcome in term newborns admitted at Pumwani Maternity Hospital newborn unit with perinatal asphyxia. Methods: We conducted a short descriptive longitudinal study in Pumwani Maternity Hospital newborn unit between October 2020 to February 2021. Term newborns with perinatal asphyxia on the basis of failure to initiate and sustain breathing at birth with features of hypoxic ischemic encephalopathy admitted within 24 hours of birth were enrolled. Clinical evaluation was conducted daily within the first week of the newborn’s life for the primary outcome i.e.persistence of abnormal neurologic signs, clinical improvement, or death. RESULTS Of 172 neonates enrolled into the study,15.1% died and 28.5% continued treatment and the rest (56.4%) discharged from hospital including 14.4 % being those discharged with neurological impairment. Prolong duration of resuscitation [OR 2.2 (95% CI 1.7-3.3), p<0. 001], presence of seizures [OR 98.6(95% CI 23.6-411), p<0. 001] and low Apgar score at 5 minutes [OR 0.05(95% CI 0.01-0.23), p<0.001] were associated with adverse outcome. Breech vaginal delivery [OR 21.3 (95% CI 3.1-147.8) p=0.002], prolong duration of labor [OR 1.3 (95% CI 1.1-1.4),p<0.001] and prolong rupture of membranes [OR 1.3 (95% CI 1.2-1.5),p<0.001]were also associated with adverse outcome. Similarly, infants were more likely to die if they were delivered in facilities other than Pumwani Maternity hospital [OR 28.8 (95% CI 3.4-252.5), p=0. 002]. CONCLUSION Perinatal asphyxia has remained significant contributor to newborn mortality and morbidity at Pumwani Maternity hospital. Improved quality of intra-partum care services aimed at monitoring mothers with prolong rupture of membranes and preventing prolong labor and fetal complications are needed.