Perspective on India

A Global View on Birth Asphyxia: Perspective on India

Vinod Paul of the All India Institute of Medical Sciences in New Delhi presented a perspective on birth asphyxia in India. He pointed out that there are 26 million births annually in India and that this represents 20% of all global live births (Figure 8.1). There are also over one million neonatal deaths per year in India. This is 25% of the total global burden of neonatal deaths. The overall neonatal mortality rate in Indiai s 44/1000 live births, however this figure varies greatly from province to province, with some above 50 and others below 20 (Figure 8.2, 8.3).

Click on images to enlarge:

As in some other developing regions, birth asphyxia is the cause of 20% of neonatal deaths in India. Dr. Paul referred to the studies of Bang et al (1) who found that the incidence of severe birth asphyxia (no cry or breath absent, slow or gasping at five minutes) was 4.6% of all births. By extrapolation, Dr. Paul calculated that in Indiathere are 0.5-1.0 million cases of birth asphyxia per year.

The case fatality rate in a 2005 study by Bang et al (1) was 3.7% for mild asphyxia and 38.5% for severe asphyxia. Other studies showed a higher case fatality rate for those with severe birth asphyxia.

Dr. Paul indicated that the incidence of stillbirth was comparable to that of neonatal mortality and that 33% or more of stillbirths in Indiarelate to intrapartum asphyxia (2) (Figure 8.4).

Click on image to enlarge:

Dr. Paul described Dr. Bang’s studies (1) of community-based interventions that involved training health workers in neonatal resuscitation. These interventions resulted in a significant reduction of asphyxia-related deaths (Figures 8.5, 8.6).

Click on images to enlarge:

Dr. Paul also described the Indian “National Neonatal Perinatal Database” which attempts to gather accurate perinatal data from 18 centres (Figure 8.7). In 2002 there were 69,271 live births, 2,759 stillbirths, and 1,800 neonatal deaths in those centres (Figure 8.8). The number of babies with asphyxia (Apgar 0-3) was 2044 at 1 minute and 533 at 5 minutes. The resuscitation methods employed included free flow oxygen in most cases, as well as additional forms of resuscitation. Of the 1800 neonatal deaths, it was concluded that 517 (28.7%) were due to perinatal hypoxia. Hypoxic ischemic encephalopathy was found in 1092 (1.6%) of live births. It was clear that the incidence of Apgar scores of <4 varied greatly among the 18 centres.

Click on images to enlarge:

Finally, Dr. Paul described the National Neonatal Resuscitation Program which resulted in training 11,000 physicians and other health care workers. The results of that program have been published by Drs. Deorari, Paul et al in 2001 (3) and show a reduction in neonatal mortality due to asphyxia.


1. Bang AT, Bang RA, Baitule SB, Reddy HM, Deshmukh MD. Management of birth asphyxia in home deliveries in rural Gadchiroli: The effect of two types of birth attendants and of resuscitating with mouth-to-mask, tube-mask and bag-mask. J Perinatol 2005; 25: S82-S91.

2. Dadhich JP, Paul VK. State of India’s Newborns. New Delhi: 2005.

3. Deorari AK, Paul VK, Singh M, Vidyasagar D, Medical Colleges Network. Impact of education and training on neonatal resuscitation practices in 14 teaching institutions in India. Ann Trop Pediatr 2001; 21: 29-33.