Birth Asphyxia Research Priorities

Birth Asphyxia Research Needs

During the workshop, the assembled experts collaborated to determine the highest priority research needs for preventing and treating birth asphyxia. These were determined to be:

The need for a standardized definition of birth asphyxia or its component conditions.

Definitions of birth asphyxia vary widely. For meaningful data to be collected globally and compared between countries clinical research is needed to either determine a common definition for birth asphyxia, or define the types of disorders. These definitions must be feasible for use in communities within developing countries.

The need to determine the effectiveness, including cost effectiveness, in community and home settings of the following interventions:

Training community health workers appears to be effective in reducing birth asphyxia-related deaths, but additional controlled clinical trials are needed to verify this. Neurophysiologic studies reveal that damage from birth asphyxia progresses for hours after the initial insult, suggesting that therapy during that extended period may improve outcomes. Traditional forms of treatment for birth asphyxia, such as oral suctioning and oxygen therapy, have not been proven to be effective. Indeed some neurophysiologic studies indicate that oxygen therapy can be harmful.

The need to ascertain antenatal and intrapartum factors which relate to the development of birth asphyxia

Communities with low levels of antenatal and intrapartum care have higher rates of birth asphyxia. Clinical research is required to determine the precise underlying causative and associated risk factors for birth asphyxia occurring in the antenatal and intrapartum periods.

The need to understand the impact of birth asphyxia on the long-term health of survivors

The number and type of disabilities and impairments resulting from birth asphyxia should be determined using a simplified means of evaluating child development that can be applied at community level. This information should be related back to the type of episode at birth to determine the true incidence of disability from birth asphyxia and the value of various interventions.

It must be kept in mind that intervening in an attempt to reduce deaths from birth asphyxia could lead to an increase in the number of handicapped children, as some with more severe grades of asphyxia may survive. Therefore, programs aimed at reducing neonatal mortality must be linked to follow-up studies determining the subsequent health of survivors of asphyxia and to interventions targeting improvements in outcomes for those survivors.

In order to best address the above needs, there is also a need for ongoing communication and collaboration within and between research and educational networks, and individuals throughout the world who are engaged in research related to birth asphyxia, as well as with national governments and those responsible for implementing programmes.

PGPR will continue to facilitate this communication and collaboration. More links need to be established so that it becomes easier for researchers to share information and work together. International colloquia must continue to be organized. Training that has proven to be effective in randomized controlled trials must be promoted and community-based solutions must be encouraged.

Through research, education, ongoing communication, collaboration and advocacy the global community of paediatric researchers has incredible power to change health outcomes for some of the world’s most vulnerable children. Global funding partners are needed to carry this work forward and national research agendas must respond to the crisis by prioritizing the research necessary to save children at greatest risk of being killed or injured by birth asphyxia.

The above statement has been endorsed by the following participants of the May 18, 2005 PGPR  Workshop "Global Perspectives on Birth Asphyxia"