Short-term outcome of infants born with low apgar scores at The University Teaching Hospital,Lusaka,Zambia : A medical audit

Abstract

Birth asphyxia contributes significantly to infant morbidity and mortality. Vital centers in the brain are depressed and if the infant survives the initial insult, neurological handicap may arise. Other than the brain, various other organs in the body can be affected by the hypoxia-ischaemia. This study was carried out at the University Teaching Hospital (UTH) Lusaka, Zambia over a 4 month period. An attempt was made to document immediate complications associated with low Apgar scores as defined by the International Classification of Diseases. Other than complications, predictors of adverse outcome were also looked at. A total of 1,101 infants were admitted to the neonatal intensive care unit during the period of the study and 161 satisfied the entry criteria of the study and were therefore recruited. Sixty percent of the infants were male and forty percent were female. Eighty of the infants died, eighty were discharged without sequelae i.e generalized hypertonia and one was still on the ward on the 28* day of life. One hundred and forty three infants had hypoxic-ischaemic encephalopathy (HIE). Hypoxic-ischaemic encephalopathy was significantly associated with death. Fifty seven infents had seizure activity recorded but this was not significantly associated with mortality. Seizure activity was either subtle (lip smacking, limb cycling, and high pitched cry) or generalized tonic fits.Eighty-seven infants developed respiratory distress (tachypnoea and subcostal recession) and 49 required ventilatory support. Ventilation was significantly associated with death; this may be a reflection of the severity of the hypoxic insult rather than ventilation per se. Five infants developed cardiac failure and all of these infants died. Though 40 of the neonates were suspected to have sepsis only 4 had positive blood cultures. However it should be noted that the blood cultures were done after the infants had received antibiotic therapy. Mortality was significantly associated with Apgar scores less than 4, ventilation, cardiac failure, and hypoxic-ischaemic encephalopathy 3. ' Study limitations included lack of an independent observer to assess Apgar scores, missing data rendering analysis of certain variables impossible, and reliance on a number of healthworkers' records as the true and correct analysis of the situation. Further studies are required to assess the long-term impact of the hypoxic insult on these infants who are well at discharge.