CORRELATES OF MORTALITY AMONG HOSPITAL-BORN NEONATES WITH BIRTH ASPHYXIA

Background. Birth asphyxia is a major cause of neonatal mortality. An understanding of the determinants of mortality among asphyxiated neona tes will help formulate effective management protocols. Methods. One h undred and fifty consecutive neonates with birth asphyxia (apnoea or g asping respiration at 1-minute of age) were prospectively studied. The association of the outcome variable, namely, mortality before dischar ge, was documented in relation to a number of clinically important ris k factors. Results. The neonatal mortality of 24.7% (37/150) among asp hyxiated neonates was 34.5-times compared to that of the non-asphyxiat ed population (p<0.001). The mortality rates in preterm- and term-asph yxiated neonates were 47.8% and 6%, respectively (p<0.0001). The relat ive risk of mortality increased progressively with increasing birth-we ight. On univariate analysis, prematurity, low birth-weight, respirato ry distress, severity of asphyxia, hypoxic-ischaemic encephalopathy, a pnoea, acidosis and seizures were found to be significant risk factors of death. However, on step-wise regression analysis, prematurity emer ged as the most significant determinant of mortality. The highest posi tive predictive value (58.3%) for mortality was documented for hypoxic -ischaemic encephalopathy. Conclusion. A significant reduction in mort ality among asphyxiated neonates will require aggressive management of prematurity-related neonatal complications and hypoxic-ischaemic ence phalopathy.