Failure to establish spontaneous breathing at birth: A 5-year longitudinal study of newborns admitted for birth asphyxia in Enugu, Southeast Nigeria

Background: Birth asphyxia is a leading cause of death in neonates and long-term neurodevelopmental disability in children. Identification of risk factors and implementing adequate obstetric care could help prevent its occurrence, thus averting the psychosocial and economic burden of the disease on family and society. Materials and Methods: This 5-year longitudinal study enrolled newborns admitted for birth asphyxia in the Neonatal Intensive Care Unit (NICU) of the Enugu State University Teaching Hospital and followed them up until discharge or death. Multi-level regression analysis was used to determine the factors that predicted the outcome in the admitted newborn. Results: Two thousand four hundred and fifty newborns were admitted into the NICU during the study period, and 180 were managed for birth asphyxia which resulted to an in-hospital incidence rate of 73.5 per 1000 admitted newborns (95% confidence interval 63.1-84.2). The mean age at presentation was 1.51 ± 1.59 days and mean birth weight at admission was 3.05 ± 0.67 kg. There was no significant difference in the mean age at presentation (T = 0.412, P = 0.681) and weight at admission (T = 1.295, P = 0.197) between neonates who survived and those who did not. Significant predictive association was seen between management outcome and maternal and neonate socio-demographic parameters such as gestational age at birth (P = 0.020), maternal occupation (P = 0.041), place of birth (P = 0.020), and asphyxiation score at presentation (P = 0.024). Prolonged labor (45.6%), obstructed labor (10.4%), and prematurity (8.0%) were the most common causes of asphyxiation encountered in surveyed neonates. No cause was obvious in 12% of cases. Conclusion: The incidence of birth asphyxia is unacceptably high in our setting. Practical and hands-on measures to control modifiable risk factors and prevention of causes identified in this study need to be sustained to reduce neonatal mortality and morbidity associated with birth asphyxia in resource-limited settings like ours.