Factors associated with mortality among asphyxiated newborns in a low-resource setting

Objective: Neonatal asphyxia accounts for a quarter of neonatal deaths. We aimed to assess factors associated with mortality among asphyxiated neonates in a low-resource setting. Methods: A retrospective observational study evaluating all neonates who were admitted for asphyxia to the Neonatal Intensive Care Unit (NICU) at Tosamaganga Hospital (Tanzania) in 2017–2018. Inclusion criteria were: Apgar score <7 at 5 min and/or failure to initiate spontaneous breathing and/or presence of sentinel events and/or clinical signs suggesting encephalopathy not explained by other obvious factors or early convulsions. Newborns with congenital malformations, birth weight <2000 g or those who died in the delivery room were excluded. Results: NICU admission for perinatal asphyxia was 17.5%. In 169 neonates, mortality rate was 23% and was associated with being outborn, low 5-minute Apgar score, depressed clinical status at NICU admission, occurrence of infection or seizures within 24 h from admission, and receiving aminophylline during the hospital stay. Conclusions: Perinatal asphyxia was responsible for a relevant proportion of NICU admissions and neonatal deaths in a low-resource setting. Appropriate clinical examination remains the main asset in settings with limited availability of diagnostic tools. Improvements in antenatal and perinatal care are needed to reduce mortality in asphyxiated newborns. Future studies should assess long-term outcome in survivors.