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A prospective study was conducted on consequitively born live births for determining the role of certain foetal factors and mode of delivery on asphyxia neonatorum. The difference in the incidence of neonatal asphxia in 1208 singleton births (8.5%) and in the 66 multiple births (9.7%) was statistically significantly (p less than 0.01). Among the singleton live births a significantly increased incidence of asphyxia was recorded in preterms when compared to term and post term babies collectively (p less than 0.001). Small for date babies were at a greater risk for asphxia neonatorum when compared to babies weighing appropriate for gestational age (p less than 0.001). An inverse relationship was observed between birth weight and asphyxia neonatorum. A significant difference was seen in the occurrence of neonatal asphyxia between babies weighing less than 2000 g. and those weighing more than 2000 g. (p less than 0.001). The incidence was significantly influenced by mode of delivery, being highest in vaginal breech delivery followed in decreasing frequency by forceps and normal vaginal delivery. Among vaginal breech delivered neonates those weighing greater than or equal to 2500 g were at the highest risk. Evidence of foetal distress and meconium stained amniotic fluid had a low predictability of asphyxia being 35.0% and 40.0% respectively though both were statistically significant (p less than 0.001).
To assess the influence of maternal malnutrition on the mode of delivery and asphyxia neonatorum, a cross sectional survey of 615 women in the age group of 20-28 yrs at the time of delivery was done. Women with chronic ailments and complicated pregnancies were excluded. The mothers were then classified into three groups based on Weight Height Product Index (WHPI) namely well nourished (WN), moderately malnourished (MMN) and severely malnourished (SMN). The proportion of asphyxiated babies among the three groups did not differ (P greater than 0.05). Abnormal deliveries like caesarean section were more common among SMN group compared to WN group ((P less than 0.01). No such difference was made out between MMN and WN groups (P greater than 0.05).
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Twenty five asphyxiated neonates had ECG changes consistent with degree of asphyxia. Equivocal changes were found in mild asphyxia and changes suggestive of myocardial infarction were seen with severe asphyxia. In most cases, the changes reverted to normal within two weeks signifying great ability of the neonatal heart to withstand hypoxic insult. Four babies with severe asphyxia having ECG changes suggestive of acute myocardial infarction expired within 48 hours of birth.
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