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:
- prenatal training
- training community health workers in neonatal care and resuscitation
- airway suctioning
- methods of neonatal resuscitation
- neuroprotective interventions including head/body cooling and drug therapy
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"
- Mohamed Reda Basiouny, Mansoura University, Egypt
- Swati Bhave, Indreprastha Apollo Hospital, New Delhi, India
- Zulfiqar Bhutta, The Aga Khan University, Karachi, Pakistan
- Waldemar Carlo, University of Alabama, Birmingham, U.S.A.
- Philippe Chessex, Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Elwyn Chomba, University of Zambia, Lusaka, Zambia
- Gary Darmstadt, Johns Hopkins University, Baltimore, U.S.A.
- Lizhong Du, Zhejiang University School of Medicine, Hangzhou, China
- Matthew Ellis, Southmead Hospital, Bristol, U.K.
- Cyril Engmann, The University of North Carolina, Chapel Hill, U.S.A.
- William Feldman, The University of Toronto, Canada
- Philip Fischer, Mayo Clinic, Rochester, U.S.A.
- Joseph Haddad, Saint George University Hospital, Beirut, Lebanon
- Judith Hall, Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- J. Richard Hamilton, McGill University, Montreal, Canada
- Jeffrey Horbar, Vermont Oxford Network, Burlington, U.S.A.
- Assaye Kassie, Addis Ababa University, Ethiopia
- William Keenan, St. Louis University, U.S.A.
- Mohamed T. Khashaba, Mansoura University, Egypt
- Niranjan Kissoon, Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Danuta Krotoski, National Institute of Child Health and Human Development/National Institutes of Health, Bethesda, U.S.A.
- Joy Lawn, Saving Newborn Lives/Save the Children U.S.A.and Instituteof ChildHealth, London, U.K.
- David Lee, University of Western Ontario, London, Canada
- Shoo Lee, Universityof British Columbia, Vancouver, Canada
- Nyok Ling Lim, Hospital Selayang, Selangor, Malaysia
- Ornella Lincetto, World Health Organization, Geneva, Switzerland
- Juan Lozano, Pontificia Universidad Javeriana, Santa Fe de Bogotá, Colombia
- Dharma Manandhar, Mother Infant Research Activities, Kathmandu, Nepal
- N B Mathur, Maulana Azad medical College, New Delhi, India
- Elizabeth McClure, RTI International, Chapel Hill, U.S.A.
- Chhour Y. Meng, National Pediatric Hospital, Phnom Penh, Cambodia
- Mario Merialdi, World Health Organization, Geneva, Switzerland
- Nancy Moss, Center for Research for Mothers and Children, National Institutes of Health, Bethesda, U.S.A.
- Teresa Murguía de Sierra, Hospital Infantil de México, México City, México
- Margaret Nakakeeto, Mulago Hospital, Kampala, Uganda
- Susan Niermeyer, Universityo f Colorado, Denver, U.S.A.
- Pinaki Panigrahi, University of Maryland, Baltimore, U.S.A.
- Vinod Paul, All India Institute of Medical Sciences, New Delhi, India
- Cherif Rahimy, National University of Republic of Benin (West Africa), Cotonou, The Republic of Benin (West Africa)
- Siddarth Ramji, Maulana Azad Medical College, New Delhi, India
- Saroj Saigal, McMaster University, Hamilton, Canada
- Ola Saugstad, National Hospital, Oslo, Norway
- Eileen Schoen, American Academyof Pediatrics, Elk Grove Village, U.S.A.
- Gunnar Sedin, Children’s Hospital, Uppsala, Sweden
- Tina Slusher, University of Louisville, U.S.A.
- Jean J. Steichen, Cincinnati Children’s Hospital, Cincinnati, U.S.A.
- Sarayut Supapannachart, Mahidol University, Bangkok, Thailand
- Adrian Toma, Maternity Hospital of Prof. Dr. Parnait Sarbu, Bucharest, Romania
- Fabio Uxa, Burlo Garofolo Pediatric Institute, Trieste, Italy
- Yvonne Vaucher, Universityof California, San Diego, U.S.A.
- Sithembiso Velaphi, University of the Witwatersrand, Johannesburg, South Africa
- Dharmapuri Vidyasagar, University of Illinois, Chicago, U.S.A.
- Stephen Wall, Saving Newborn Lives/Save the Children, Washington, U.S.A.
- David Woods, University of Cape Town, South Africa
- Alvin Zipursky, The Programme for Global Paediatric Research, The Hospital for Sick Children, Toronto, Canada