Birth asphyxia is under-rated as a cause of preterm neonatal mortality in low- and middle-income countries: A prospective, observational study from PURPOSe

Authors

Robert L. Goldenberg, Columbia University
Sangappa Dhaded, J N Medical College, Belagavi
Sarah Saleem, Aga Khan UniversityFollow
Shivaprasad S. Goudar, J N Medical College, Belagavi
Shiyam Sunder Tikmani, Aga Khan UniversityFollow
Marissa Trotta, RTI International, Durham
Kay Hwang Jackson, RTI International, Durham
Gowder Guruprasad, J.J.M. Medical College, Davangere
Zeesham Uddin, Aga Khan University
Sayyeda Reza, Aga Khan UniversityFollow

Document Type

Article

Department

Community Health Sciences

Abstract

Objective: To assess respiratory distress syndrome (RDS) compared with birth asphyxia as the cause of death in preterm newborns, assigned by the neonatal intensive care unit (NICU) physician at the time of death and assigned by a panel with complete obstetric history, placental evaluation, tissue histology and microbiology.
Design: Prospective, observational study.
Settings: Study NICUs in India and Pakistan.
Population: Preterm infants delivered in study facility.
Methods: A total of 410 preterm infants who died in the NICU with cause of death ascertained by the NICU physicians and independently by expert panels. We compared the percentage of cases assigned RDS versus birth asphyxia as cause of death by the physician and the panel.
Main outcome measures: RDS and birth asphyxia.
Results: Of 410 preterm neonatal deaths, the discharging NICU physicians found RDS as a cause of death among 83.2% of the cases, compared with the panel finding RDS in only 51.0%. In the same neonatal deaths, the NICU physicians found birth asphyxia as a cause of death in 14.9% of the deaths, whereas the panels found birth asphyxia in 57.6% of the deaths. The difference was greater in Pakistan were the physicians attributed 89.7% of the deaths to RDS and less than 1% to birth asphyxia whereas the panel attributed 35.6% of the deaths to RDS and 62.7% to birth asphyxia.
Conclusions: NICU physicians who reported cause of death in deceased preterm infants less often attributed the death to birth asphyxia, and instead more often chose RDS, whereas expert panels with more extensive data attributed a greater proportion of deaths to birth asphyxia than did the physicians.

Comments

Volume, issue, and pagination are not provided by the author/publisher

Publication (Name of Journal)

BJOG : an international journal of obstetrics and gynaecology

Recommended Citation

Goldenberg, R. L., Dhaded, S., Saleem, S., Goudar, S. S., Tikmani, S. S., Trotta, M., Jackson, K. H., Guruprasad, G., Uddin, Z., Reza, S. (2022). Birth asphyxia is under-rated as a cause of preterm neonatal mortality in low- and middle-income countries: A prospective, observational study from PURPOSe. BJOG : an international journal of obstetrics and gynaecology.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/1012