Short term outcomes of term neonates admitted with perinatal asphyxia in Kenyatta National Hospital newborn unit

Abstract

Background:Perinatal asphyxia contributes significantly to perinatal morbidity and mortality especially in resource poor countries. In Kenyatta National Hospital (KNH) perinatal asphyxia on an average accounts for 20% of the weekly admissions to the Newborn Unit (NBU). The short term outcomes and factors associated with adverse outcome have not been established.

Study objectives To determine the short term outcomes and the factors associated with adverse outcomes in term babies with perinatal asphyxia in KNH NBU.

Methods A hospital based short longitudinal survey study, was carried out at the Newborn Unit, Kenyatta National Hospital during the period of 6 months from June 2010 to November 2010. All term neonates with the diagnosis of perinatal asphyxia based on failure to initiate and sustain breathing at birth PLUS clinical evidence of hypoxic ischemic encephalopathy were eligible for inclusion. Neonates were evaluated clinically every 24 hours for the first 7 days of the neonate's life for the primary outcomes of clinical improvement, persistence of abnormal neurological signs or death by day 7 of life.

Results 119 neonates were enrolled into the study. By day 7 of life, 31.1 % of infants with perinatal asphyxia had died and another 31.1% continued treatment. The rest of the infants (37.8%) had been discharged from the hospital with 6.7% being infants discharged with neurologic sequelae and 31.1 % discharged with no neurologic sequelae. Babies had increased risk of adverse outcome if their mothers' were unemployed, P< 0.001, education level below secondary, P<O.OOI or had less than two Antenatal Clinic visits (ANC), P< 0.001. Delivery outside KNH, prolonged labour, lack of resuscitation with Bag Valve Mask (BVM) and presence of seizures were also associated with adverse outcome (P<O.OOl)

CONCLUSION At KNH NBV, perinatal asphyxia has a poor outcome with a mortality of 31.1 % by day 7 of life and a further 31.1 % continuing treatment beyond day 7 for complications of asphyxia .The rest of the infants (37.8%) were discharged from the hospital with 6.7% being discharged with neurologic sequelae and 31.1 % discharged with no sequelae. Babies had increased risk of death if they were delivered outside KNH, had an Apgar score ofless than 3 at five minutes, had seizures and if their mothers' were unemployed, had education level below secondary or attended ANC:::; 2 times. Other factors include prolonged labour and lack of resuscitation with BVM

Recommendations In a resource constrained country like Kenya, efforts should be put on preventing birth asphyxia through sensitizing mothers/communities on the need for regular ANC visits and delivery in good health institutions. Follow up study should be done on the long term outcome of babies with moderate and severe asphyxia discharged from the newborn unit.