Intrapartum asphyxia and hypoxic ischaemic encephalopathy in a public hospital: incidence and predictors of poor outcome

Abstract

To determine the incidence of intrapartum asphyxia and hypoxic ischemic encephalopathy (HIE) and predictors of poor outcome in term and near term infants in a hospital from a developing country. METHODS: Neonates with birth weight ≥2000g who required bag mask ventilation and were admitted with a primary diagnosis of intrapartum asphyxia from January-to-December 2011 were included. Medical records were retrieved, maternal and infant data were collected and analysed. Comparison between infants with severe HIE and/or died and those who survived normal or with mild to moderate HIE was performed. RESULTS: There were 21086 live births with birth weight of ≥2000 grams over this period, the incidence of intrapartum asphyxia varied from 8.7 to 15.2/ 1000 live births and that of HIE from 8.5 to 13.3/ 1000 live births based on definition of intrapartum asphyxia used. Sixty percent of patients with HIE had moderate to severe HIE. Overall mortality rate was 7.8-12.3% (dependent on definition used) and 14.2% when including the deaths from labour ward. Mortality rate in infants with moderate and severe HIE was 7.1%, and 62.5% respectively. Odds of severe HIE and/or death were high if Apgar score was <5 at 10 minutes (OR 19.1; 95% CI 5.7;66.9), no spontaneous respiration at 20 minutes (OR 27.2; 95% CI 6.9;117.4), need for chest compressions (OR 8.37; 95% CI 3.71;19.1), need for adrenalin (OR 81.2; 95% CI 13.2;647.7) and pH<7 (OR 5.33; 95% CI 1.31;25.16). Predictors of poor outcome ( namely severe HIE and/or death) were Apgar score at 10 minutes (p=0.004), adrenaline (p=0.034) and low serum bicarbonate (p=0.028). CONCLUSION: Incidence of intrapartum asphyxia in term and near-term infants is higher than that reported in developed countries. Low Apgar score at 10 minutes and the need for adrenalin remain important factors in predicting poor outcome in infants with intrapartum asphyxia.