Analyzing the Predictors of Mortality Among Asphyxiated Neonates

Abstract

Birth asphyxia refers to the inability to initiate and sustain breathing at birth, leading to inadequate oxygen supply to vital organs. It is one of the most common causes of perinatal brain injury, contributing to high rates of morbidity and mortality. Neonatal asphyxia is a major cause of early neonatal death, accounting for an estimated 900,000 deaths annually. It results from impaired respiratory gas exchange in the fetus or newborn, causing hypoxia, hypercapnia, and, in some cases, ischemia. This condition can affect multiple organs, leading to biochemical and functional changes, such as lactic acidosis, which may result in death or severe neurological impairment. Neonatal asphyxia is frequently associated with multiple organ failure, primarily impacting the brain, heart, and kidneys. It can lead to complications affecting motor, sensory, cognitive, and psychological development. Several factors contribute to birth asphyxia, including maternal anemia, diabetes, and placental abruption. Other significant predictors of mortality among asphyxiated neonates include neonatal sepsis, preterm birth, lack of Kangaroo Mother Care (KMC), low birth weight, seizures, need for resuscitation at birth, stage III asphyxia, hypoxic-ischemic encephalopathy (stages II and III), seizures and thrombocytopenia. This systematic review aims to identify the pooled predictors of mortality among asphyxiated neonates. Various online databases, including PubMed, MEDLINE, Google Scholar, and WHO websites, were searched for relevant studies. The review included cross-sectional, case-control, and cohort studies conducted in Pakistan and Ethiopia. Data entry and statistical analysis were performed using Excel and SPSS (version 27). The pooled mortality rate of birth asphyxia was found to be 64.0%. Among asphyxiated neonates, 27.1% who were delivered via spontaneous vaginal delivery (SVD) did not survive. Mortality rates were 39.4% for neonates born after prolonged labor, 42.6% for those delivered following premature rupture of membranes, and 50% for those weighing less than 2500g at birth. Additionally, 60.2% of asphyxiated neonates with seizures and 35.7% requiring resuscitation at birth did not survive. The highest mortality rate (81.1%) was observed in neonates with stage III asphyxia. It is concluded that asphyxiated neonates exhibit a high mortality rate. Key predictors of mortality include neonatal sepsis, vaginal delivery, lack of Kangaroo Mother Care (KMC), low birth weight, seizures, need for resuscitation at birth, stage III asphyxia, advanced maternal age, delivery complications, and prolonged rupture of membranes.