Spectrum of Multi-Organ System Involvement in Perinatal Asphyxia at a Tertiary Care Hospital in Southern India - A Descriptive Study

Author(s): Soumya Satna1, Ramadevi Devagudi2, Ramu Pedada3, Narayana Lunavath4

Perinatal asphyxia (PA) is an important cause of neonatal morbidity, mortality, and
neurologic handicap in children. Dysfunction of organs other than central nervous
system is often recognised after perinatal asphyxia and manifests as hypoxic
ischaemic insults to heart, lungs, kidneys and bowel. The purpose of this study
was to assess the spectrum of multi-organ system involvement in perinatal
This observational, descriptive study was conducted at SVRRGGH (Sri
Venkateswara Ramnarayan Ruia Government General Hospital) - Tirupati from
October 2010 to September 2011 and has Institutional Ethics Committee approval
(Regd. No: 58647, Dt: 20 / 11 / 2010). After considering the inclusion and
exclusion criteria, 204 neonates diagnosed with perinatal asphyxia who got
admitted in our newborn intensive care unit (NICU) were included in this study.
In the present study, we had 118 (57.89 %) male babies and 86 (42.11 %) female
babies. The mean birth weight was 2640 +/- 460 grams. Infants of birth weight
2500 - 4000 grams (appropriate for gestational age - AGA) accounted for 202
(98.96 %). Major maternal risk factors in this study were MSAF (meconium-stained
amniotic fluid (66/204, 32.4 %), PIH (pregnancy induced hypertension) and
Eclampsia (26/204, 12.7 %) and PROM (premature rupture of membranes)
(26/204, 12.7 %). In the present study, we found higher mortality (19/117, 16.2
%) in babies born to multiparous mothers. Respiratory system involvement was
seen in 80 (39.2 %) infants. Renal involvement was observed in 58 (27.5 %)
infants. Acute renal failure was diagnosed in 22 (10.8 %) cases. CVS
(cardiovascular system) involvement was seen in 56 (27.5 %) cases where as GIT
(gastrointestinal tract) involvement was found in 32 (15.68 %) cases.
Epidemiological research is needed to accurately estimate the contribution of birth
asphyxia to perinatal morbidity and mortality, especially in community settings
where the burden of disease, due to high proportion of unattended deliveries, is
likely to be larger than the hospital setting.