7/24/2019 Over 9 Million Children Die Each Year During the Perinatal and Neonatal Periods

1/2

Over 9 million children die each year during the perinatal and neonatal periods, and nearly all of

these deaths occur in developing countries.1Perinatal asphyxia is a serious clinical problem

globally. Every year approximately 4 million babies are born asphyxiated; this results in 1million deaths and an eual number of serious neurological conseuences ranging from cerebral

palsy and mental retardation to epilepsy.!Perinatal asphyxia is a ma"or factor contributing to

perinatal and neonatal mortality, #hich is an indicator of the social, educational and economicstandards of a community.

Perinatal asphyxia is defined as any perinatal insult resulting in suffocation #ith anoxia and

increased carbon dioxide.!$evere fetal hypoxia or ischaemia can manifest in the ne#born as

encephalopathy, and may result in neonatal death or permanent motor and mental disability.!

%a&ing into account that neonatal deaths account for almost 4'( of deaths of children under ), it

is apparent that *illennium +evelopmental oal 4 -aiming at a t#othirds reduction in under)

mortality by the year !'1) from a baseline in 199'/ can only be met by substantially reducing

neonatal deaths. Perinatal asphyxia is the fifth largest cause of under) deaths -0.)(/ after

pneumonia, diarrhoea, neonatal infections and complications of preterm birth.!

%he death of an infant as a result of perinatal asphyxia is devastating and freuently avoidable. n

developed countries #ith #ellfunctioning health services these deaths are rare and #ays to

prevent them are #idely understood and applied. 2o#ever, a perinatal audit using the PerinatalProblem dentification Programme -PPP/ -###.ppip.co.3a/ has identified perinatal asphyxia as

a common and important cause of death in $outh frica.5t 6hris 2ani 7ara#agnath 2ospital

in auteng, !'( of all neonatal deaths are due to asphyxia.4 group of !) term asphyxiatedinfants admitted to the 8ohannesburg 2ospital eonatal :nit #as studied bet#een $eptember

190' and *arch 190!. %his study sho#ed a mortality rate of !'(, 1( of children #ere

disabled at the !year assessment, and !'( #ere lost to follo#up.)n a follo#up retrospective

study of 1'9 term infants #ith moderate to severe perinatal asphyxia, prognosis #as often poor,particularly in patients #ith sei3ures, cardiopulmonary signs of asphyxia and multiorgan

dysfunction.

%he fundamental goal of establishing perinatal audits in areas #ith high perinatal mortality ratesis to reduce the number of perinatal deaths through improvement in the uality of care. $everal

studies have sho#n a strong association bet#een the establishment of an effective audit process

and improvement of the uality of maternal health services and perinatal mortality rates.56urrently there are limited data on perinatal mortality rates, and although available figures are

very high, they are li&ely to underestimate the problem.

%he ma"or difficulty in collecting accurate epidemiological data is lac& of a common definitionof the diagnostic criteria of perinatal asphyxia.!%he umbilical artery p2 that defines asphyxia ofa sufficient degree to cause brain in"ury is un&no#n. lthough the most #idely accepted

definition is a p2 of

7/24/2019 Over 9 Million Children Die Each Year During the Perinatal and Neonatal Periods

2/2

lac&ing in developing countries, perinatal asphyxia can be crudely assessed by use of the pgar

score.0

pgar scores at 1' minutes provide useful prognostic data before other evaluations are availablefor infants. ?o# pgar scores at 1, ) and 1' minutes have been found to be mar&ers of an

increased ris& of death or chronic motor disability.9*ore scientific methods have been used, butthis is not possible in settings #here resources are scarce.1'

%he ma"or conseuence of perinatal asphyxia is hypoxic ischaemic encephalopathy -2E/.+iagnosis of 2E reuires abnormal findings on neurological examination the day after birth.

%he clinical spectrum of 2E is described as mild, moderate or severe according to the $arnat

stages of 2E. nfants can progress from mild to moderate and@or severe encephalopathy over the=! hours follo#ing the hypoxicischaemic insult.11%he terms Aperinatal asphyxiaB and A2EB are

often inappropriately used to define the same pathology. %he problem of benchmar&ing

definitions of 2E in the $outh frican context has been specifically discussed in a recent

publication. 2orn et al. sho#ed that there is #ide variation in the incidence and grade of 2E,

depending on #hich criteria are used.1!

:ntil recently, solving the problem of perinatal asphyxia lay mainly in the obstetric realm.

Prompt, effective neonatal resuscitation can improve outcome. %his has been addressed by the

development and implementation of the $outh frican neonatal resuscitation programme,15endorsed by the $outh frican Paediatric ssociation -$P/.

6erebral cooling has been sho#n to significantly improve the outcome for neonates #ith

moderate 2E.14n order to effectively implement and monitor such intervention for perinatalasphyxia, it is necessary to have current data on neonates #ith perinatal asphyxia and those #ith

2E. :nli&e #ith moderate to severe 2E, the association of perinatal asphyxia #ith brain

damage is not defined, and perinatal asphyxia is not itself an indication for cerebral cooling. %heaim of the present study #as to revie# neonates #ith perinatal asphyxia and determine ho#many had 2E, the grade of 2E, factors associated #ith survival at discharge and morbidity on

follo#up, and specifically the burden of disease of moderate to severe 2E, as this is the group

that reuires cooling.

http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-8http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-8http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-9http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-10http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-10http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-11http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-12http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-13http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-14http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-8http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-9http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-10http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-11http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-12http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-13http://www.sajch.org.za/index.php/SAJCH/article/view/574/446#ref-14