Determinants of admissions for birth Asphyxia among term babies admitted to the Neonatal Intensive Care Unit at the University Teaching Hospital
Abstract
Background: Birth asphyxia is defined as failure to initiate and sustain breathing at birth, and is graded using Apgar Score: Apgar 1-3 severe, 4-6 moderate, 7-10 normal. Various risk factors contribute to birth asphyxia and include high maternal age, parity, postdates, preterm deliveries, prolonged labour and fetal malpresentation, and unemployment, and premature rapture of membranes (PROM). It can be prevented and early referral for complicated cases is recommended. Asphyxia is a major contributor of neonatal admission to (NICU) at UTH and this study aimed to determine the differences in term babies admitted to the UTH with low Apgar score compared to other reasons.
Methodology: A prospective case control study at the UTH, Neonatal intensive care unit (NICU). All term, singleton deliveries born at UTH admitted to NICU were considered and term deliveries admitted to the NICU meeting eligibility criteria were included. Cases: term babies with an Apgar score of less than 7. Controls: term babies admitted to NICU for any other reasons. Sample size calculated at160 (80 cases and 80 controls). Details of medical and demographic details were abstracted from patient’s files, antenatal cards and confirmed from the mother. SPSS version 14 was used for analysis. The dependent variable was low Apgar score (as defined for the cases and controls). Independent variables included maternal, intrapartum and neonatal factors. Comparison between cases and controls assessed using chi-square (odds ratios). Confounders of determinants assessed using multivariate logistic regression. Ethical approval was obtained from the University of Zambia Biomedical Research Ethics Committee. Results. There were 71 cases and 76 controls. Cases were defined by their low Apgar score (<7) and controls included grunting respiration (38, 50%), macrosomia (20, 26.5%), and meconium aspiration (11, 14.5%). Cases were more likely than controls to be referred from the clinic, to be young (<25 years), unemployed, primiparous, have a non-cephalic presentation, be admitted at night, and delivered by a junior doctor (SRMO). However, HIV status, past obstetric history, augmentation, delivery by caesarean and sex of baby had no bearing on being a case or control. Using regression analysis to control for potential confounders, being a case was independently associated with a clinic referral (high OR as all cases were clinic referrals), admitted at night (OR 3.34, 95% CI 1.47-7.58), and delivered by an SRMO (OR 13.41, 95% CI 3.49- 51.49).
Conclusions: Health systems are important determinants (referral mechanisms, trained staff, staffing out of hours). This calls for an evaluation of the referral system as all asphyxiated babies had mothers that were clinical referrals. Early referral and delivery at UTH is essential, as is the need for more supervision of junior staff and more staffing out of hours.