Risk Factors of Birth Asphyxia among Newborns at Debre Markos Comprehensive Specialized Referral Hospital, Northwest Ethiopia: Unmatched Case-Control Study

The association of umbilical hyperlactatemia with short- and tong-term outcomes in extremely low birth weight neonates: a matched cohort study

The objective of this study is to quantify the impact of umbilical arterial isolated hyperlactataemia and lactic acidosis on mortality, morbidity, and neurodevelopmental outcomes at 24 months corrected age in extremely low birth weight (ELBW) infants. The study population consisted of ELBW patients born between January 1, 2015, and December 31, 2023, at the Klinikum Kassel, receiving umbilical arterial blood analysis immediately after birth. Isolated hyperlactataemia was defined as a lactate concentration > 7.00 mmol/L, lactic acidosis as a pH < 7.10 and a lactate > 7.00 mmol/L, controls as pH ≥ 7.10 and lactate ≤ 7 mmol/L. Outcomes were analysed utilising a 1:2 case-control matched approach. Using the hospital data management system, 241 patients were eligible, 150 controls, 47 with isolated hyperlactataemia and 26 with lactic acidosis. Increased 28-day mortality was observed in both isolated hyperlactataemia patients (continuity corrected aOR 29.60 [1.63, 537.76], p = 0.022), and lactic acidosis patients (aOR 27.00 [3.18, 228.96], p = 0.003). Isolated hyperlactataemia was also associated with an increased risk for NEC stage ≥ 2 (aOR 10.00 [1.17, 85.59]), BPD ≥ moderate (aOR 2.68 [1.08, 6.65]), ROP grade ≥ 2 (aOR 13.77 [4.12, 46.02]), IVH grade ≥ 2 (aOR 2.91 [1.04, 8.13]), and septicaemia (aHR 16.76 [7.97, 35.22]). Lactic acidosis patients showed a more pronounced risk for adverse short-term outcomes (ROP grade ≥ 2 (aOR 29.33 [3.23, 266.23]), IVH grade ≥ 2 (aOR 6.31 [1.29, 30.74]), and septicaemia (aOR 1.97 [0.86, 4.54])). Neurodevelopmental outcomes did not differ between groups.

CONCLUSION

Isolated hyperlactataemia and lactic acidosis significantly increased the risk of adverse short-term outcomes; however, neither had a significant effect on long-term developmental outcomes.

WHAT IS KNOWN

• ELBW neonates face high risks of adverse outcomes, particularly with cord hyperlactatemia or lactic acidosis at birth. The long-term neurodevelopmental impact of these markers is unclear.

WHAT IS NEW

• Lactic acidosis predicts worse short-term outcomes than hyperlactatemia. However, survivors to 24 months corrected age show comparable developmental outcomes.

Determinants of birth asphyxia in urban south Ethiopia

Birth asphyxia is a well-known cause of neonatal mortality, and the survivors suffer from long-lasting sequels such as seizures, intellectual disabilities, and motor disorders that are great challenges for newborns. Elucidating the determinants of birth asphyxia helps implement evidence-based practice in the local context. Thus, this study aimed at elucidating the determinants of birth asphyxia in urban south Ethiopia. A community-based unmatched nested case-control study was conducted on a cohort of 2548 pregnant women who were followed up until delivery in urban areas of Hadiya Zone, south Ethiopia. All newborns who experienced birth asphyxia (n = 118) were taken as cases. Newborns who were randomly selected from the risk-set (n = 472) were taken as controls (those without birth asphyxia). A binary logistic regression was done using R software. Induction of labor [AOR = 2.98, 95% CI: 1.20, 7.42], prolonged labor [AOR = 2.12, 95% CI: 1.02, 4.37], delivery through cesarean section [AOR = 3.81, 95% CI: 1.67, 8.72], instrumental delivery [AOR = 3.91, 95% CI: 1.72, 8.89], and low birth weight [AOR = 6.52, 95% CI: 3.40, 12.51] were determinants of birth asphyxia. Asphyxia during birth was mainly related to obstetric care and maternal nutrition, highlighting the need to pay attention during the course of labor and maternal nutrition during pregnancy. This study might have selection bias and loss of power so careful interpretation of the results is needed.

Magnitude of neonatal asphyxia and its predictors among newborns at public hospitals of Wolaita Zone in Southern Ethiopia, 2023

BACKGROUND

Neonatal asphyxia is one of preventable causes of neonatal mortality throughout the world. It could be improved by early detection and control of the underlying causes. However, there was lack of evidence on it in the study setting. Thus, the aim of this study was to assess the magnitude and predictors of neonatal asphyxia among newborns at public hospitals of Wolaita Zone in Southern Ethiopia.

METHOD

A facility-based cross-sectional study was done among 330 mothers with neonates in selected public hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through an interviewer-administered questionnaire and checklist. The collected data were entered into EpiData version 4.6 and exported to SPSS version 26 for analysis. Logistic regression was fitted to examine the association between explanatory variables and outcome variable. In multivariable logistic regression, AOR with 95% CI was reported, and p < 0.05 was used to declare statistically significant variables.

RESULTS

The magnitude of neonatal asphyxia was 26.4% with 95% CI: (21.8, 30.9). In multivariable logistic regression analysis primiparity (AOR = 2.63 95%CI 1.47, 4.72), low-birth-weight (AOR = 3.45 95%CI 1.33, 8.91), preterm birth (AOR = 3.58 95%CI 1.29, 9.92), and premature rupture of membranes (AOR = 5.19 95%CI 2.03, 13.26) were factors significantly associated with neonatal asphyxia.

CONCLUSIONS

In this study, the magnitude of neonatal asphyxia was high. From the factors, premature rapture of the membrane, parity, birth weight of the newborn, and gestational age at birth were significantly associated with neonatal asphyxia. Attention should be given to early detection and prevention of neonatal asphyxia from complicated labor and delivery.

Intimate partner violence during pregnancy and its association with birth asphyxia in hospitals of Tigray region, Ethiopia

BACKGROUND

Birth asphyxia is the main cause of neonatal mortality and morbidity worldwide. Some studies indicate intimate partner violence during pregnancy is a risk factor for birth asphyxia. In Ethiopia, intimate partner violence during pregnancy is reported to be high. Despite this high prevalence, there is a lack of data about the association of birth asphyxia and intimate partner violence. The aim of this study was to assess the prevalence of intimate partner violence during pregnancy and its associated factors with birth asphyxia in health facilities in the Tigray region of northern Ethiopia.

METHODS

This was an institutional-based cross-sectional study conducted at select health facilities in the Tigray region of Ethiopia. Random sampling technique was employed to select health facilities and systematic sampling was used to select 648 study participants. Data was entered by using Epi info version 3.5.1 and was analyzed using SPSS version 20. Bivariate and multivariate analysis was done to assess the association between exposure to intimate partner violence during pregnancy and birth asphyxia after adjusting for possible confounders.

RESULTS

The prevalence of intimate partner violence during pregnancy was 47(7.3%). Eighty two (12.7%) babies were delivered with birth asphyxia. Intimate partner violence during pregnancy had a significant association with birth asphyxia, AOR (95% CI) = 4.4(2-9.8). In addition to this, other factors that were associated with birth asphyxia include place of residence [ AOR (95% CI) = 2.7(1.55-4.8)], age > 19 [AOR (95% CI) = 2.9(1.29-6.5)], age 20-35 [AOR (95% CI) = 3.1(1.06-9.3)], gestational age < 37 weeks [AOR(95% CI) = 7.2(3.5-14.8)] and low birth weight [AOR(95% CI) = 3.9(2.1-7.3)].

CONCLUSIONS

The prevalence of birth asphyxia in this study is high and is further increased by intimate partner violence during pregnancy. Health care providers and policy makers should take measures aimed at preventing intimate partner violence during pregnancy to reduce harm to the mother and adverse birth outcomes.

Risk Factors for Birth Asphyxia in Hospital-Delivered Newborns in Dodoma, Tanzania: A Case-Control Study

Introduction

Asphyxia at birth remains the leading cause of neonatal morbidity and mortality worldwide, accounting for ∼23% of all neonatal deaths. Although the causes vary from country to country, early identification and treatment of risk factors can improve the situation.

Objectives

To determine the risk factors of birth asphyxia in hospital-delivered neonates in Dodoma, Tanzania.

Methods

A matched case-control study was conducted from May to July 2017 at Dodoma Region Referral Hospital. Data were collected using a semistructured questionnaire and a standard antenatal care index card. Cases were neonates diagnosed with asphyxia at birth (N  =  100), while controls were neonates not diagnosed with asphyxia at birth (N  =  300). A binary logistic regression model was used to assess the independent variables associated with birth asphyxia and reported as crude and adjusted odds ratios along with their 95% confidence intervals.

Results

A total of 400 newborns and their birth mothers were involved in the study. The average age of the case mothers was 26.9 years (SD  =  7.85) and that of the control mothers was 27.24 years (SD  =  6.08). Place of residence, anemia, maternal age, prenatal visits attended, use of herbs during labor, previously complicated pregnancy, duration of labor, meconium-stained amniotic fluid, and mode of delivery were predictors of birth asphyxia.

Conclusion

The study showed that most predictors of birth asphyxia can be prevented. The results suggest appropriate health education before conception, effective follow-up through prenatal care, early identification and treatment of high-risk pregnant women, and proper monitoring of labor and delivery.