Prevention & Treatment
Birth Asphyxia: A Review of the Clinical Problem
Prevention and Treatment of Birth Asphyxia
Ola Saugstad, of Rikshospitalet University Hospital in Oslo, Norway described the enormous global problem of birth asphyxia (Figure 3.1) responsible for more than one million deaths annually. He emphasized that although infant mortality has decreased in recent years there has been little change in neonatal mortality and specifically in the incidence of birth asphyxia. He also pointed out that in addition to neonatal deaths there is also a high incidence of late stillbirths and of permanent disability related to the problems associated with birth asphyxia (Figure 3.2). He estimated that one million children annually have “asphyxia related neurological disability”. These are all problems that primarily exist in low income countries.
Dr. Saugstad spoke of the need for a common definition of birth asphyxia which would be applicable to births in developing countries. It is very difficult to obtain meaningful data without a working definition. He referred to the definitions prepared by the American College of Obstetricians and Gynecologists (American College of Obstetricians and Gynecologists Committee on Obstetric Practice. (1) and one prepared by the WHO working group on birth asphyxia (2004).
Dr. Saugstad compared the incidence of and risk factors for neonatal encephalopathy (“NE”) in developed and developing countries (Figure 3.3, 3.4). The important finding was that intrapartum factors appeared to be responsible for NE in 60% of cases in developing countries but in only 30% in developed countries where the major cause appeared to be antepartum factors (Figure 3.5). Also, the antepartum factors in developing countries were different than in the developed countries, with a major cause being lack of neonatal care.
Dr. Saugstad reviewed the clinical indices that predicted mortality in the first week of life. This is discussed in detail in Dr. Saugstad’s article in Acta Paediatrica (2).
Dr. Saugstad then reviewed infant mortality world wide and pointed out that, in general, there is a direct relationship between GDP per capita and infant mortality, (Figure 3.6). However some countries with a low GDP have very low infant mortality reflecting that infant mortality is greatly dependent on health systems available and priorities directed to the care of children.
Treatment of birth asphyxia was discussed. Studies on birth attendant training have been performed. These are detailed in several other studies. There is considerable evidence that training in techniques which are applicable in the community, village or home will reduce mortality due to birth asphyxia.
Finally, Dr. Saugstad reviewed his remarkable studies comparing resuscitation using oxygen versus air. A meta-analysis of five studies indicated that neonatal mortality was reduced using air (Figure 3.7). He concluded that, using air resuscitation, short term recovery is improved, neonatal mortality is reduced 40% and “tens of thousands of newborn lives may be saved annually” (Figure 3.8).
1. ACOG Committee Opinion #303: Inappropriate use of the terms fetal distress and birth asphyxia. Obstet Gynecol. 2004 Oct;104(4):903.)
2. Saugstad OD Ramji S, Rootwelt T, Vento M. Response to resuscitation of the newborn:early prognostic variables. Acta Paediatr 2005;94:890-5.