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Background More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven’t been addressed in the prior studies. Methods Hospital based cross sectional study was conducted on a sample of 582 mother newborn dyads at maternity ward. Every other mother newborn dyad was included from December 2019 to March 2020. Pre-tested structured questionnaire and checklist were used for data collection. The collected data were processed and entered into Epidata version 4.2 and exported to Stata version 14. Binary logistic regressions were fitted and statistical significance was declared at p less than 0.05 with 95% CI. Results The prevalence of birth asphyxia was 28.35% [95% CI: 26.51, 35.24%]. From the final model, fetal mal-presentation (AOR = 6.96: 3.16, 15.30), premature rupture of fetal membranes (AOR = 6.30, 95% CI: 2.45, 16.22), meconium stained amniotic fluid (AOR = 7.15: 3.07, 16.66), vacuum delivery (AOR =6.21: 2.62, 14.73), night time delivery (AOR = 6.01: 2.82, 12.79) and labor attendance by medical interns alone (AOR = 3.32:1.13, 9.78) were positively associated with birth asphyxia at 95% CI. Conclusions The prevalence of birth asphyxia has remained a problem of public health importance in the study setting. Therefore, the existing efforts of emergency obstetric and newborn care should be strengthened to prevent birth asphyxia from the complications of fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid and vacuum delivery. Moreover, night time deliveries and professional mixes of labor and/delivery care providers should be given more due emphasis.

Background Birth asphyxia (BA) is a significant global health challenge, contributing to an estimated 23% of neonatal deaths worldwide and a substantial burden of long-term disabilities. It results from interrupted blood flow and gas exchange to the fetus, leading to neuronal injury and short or long-term outcomes. While most affected newborns recover fully, a notable proportion develop hypoxic-ischemic encephalopathy (HIE), associated with high morbidity and mortality. This study aimed to describe Birth asphyxia outcomes and associated factors among newborns admitted at Mbale Regional Referral Hospital (MRRH.) Methodology We conducted a longitudinal prospective study involving mother-baby pairs with birth asphyxia within the first 24 hour (of life admitted to MRRH. Participants were recruited using a consecutive sampling approach. Data was collected using structured questionnaires and analysed with STATA version 15. Logistic regression was employed to determine factors associated with poor outcomes among newborns with birth asphyxia, with results presented as crude and adjusted odds ratios (AOR). Results A total of 286 mother-baby pairs participated in the study. Hypoxic ischemic encephalopathy (HIE) was observed in 70.3% of cases at admission, which decreased to 45.1% at 12 h and 24.6% at 24 h. Mortality rates were 4.6%, 4.4%, and 1.2% at admission, 12 h and 24 h, respectively. Key independent factors associated with severe HIE included referral from lower-level health facilities (AOR 4.2; CI 1.7–10.0; P  < 0.001), passage of meconium-stained amniotic fluid (AOR 2.2; CI 1.2–4.1; P  = 0.014), and newborn resuscitation (AOR 5.1; CI 1.8–15.0; P  = 0.003). Conclusion The incidence of mortality and HIE among asphyxiated newborns remains high. Referral from lower-level health facilities, the passage of meconium-stained amniotic fluid, and the need for newborn resuscitation were significant predictors of severe HIE and mortality. Strengthening maternal and neonatal care at peripheral health facilities and timely referrals could mitigate these outcomes.

Neonatal encephalopathy (NE) due to birth asphyxia and trauma has become the second leading cause of global neonatal and under-5 deaths. However, comprehensive data on the global NE burden is scarce. This study aimed to determine the global, regional, and national trends in NE burden from 1990 to 2019, utilizing the 2019 Global Burden of Disease (GBD) study data. Annual incident cases, deaths, disability-adjusted life years (DALYs), and age-standardized rates (incidence [ASIR], mortality [ASMR], DALYs) of NE were collected from the 2019 GBD study. The percentage of relative changes and estimated annual percentage changes (EAPCs) were calculated to assess temporal trends. NE global incident cases increased from 1.33 million in 1990 to 1.38 million in 2019, with a 4.87% rise in ASIR. Global NE deaths remained at 0.57 million in 2019, despite a 29.88% reduction from 1990. Significant annual reductions in ASMR and DALYs were observed post-2005. South Asia and sub-Saharan Africa accounted for 80.00% of global NE cases, with South Asia, Eastern and Western sub-Saharan Africa contributing to 81.42% of global deaths and 79.50% of DALYs. NE-related deaths comprised 22.76% and 11.24% of neonatal and under-5 mortality. There were 3.91 million epilepsy, 4.23 million developmental intellectual disability, and 0.57 million blindness cases caused by NE globally in 2019. Despite a significant reduction in NE mortality from 1990 to 2019, the ongoing rise in incidence, particularly in South Asia and sub-Saharan Africa, is alarming. Targeted initiatives to prevent NE are needed, especially tailored to high-burden regions.

ObjectiveTo compare the efficacy and safety of theophylline or aminophylline for prevention of acute kidney injury (AKI) in neonates and children.DesignSystematic review and meta-analysis with application of Grading of Recommendations, Assessment, Development and Evaluation system.Data sourcesPubMed/MEDLINE, Embase, Google Scholar and Cochrane renal group were searched from 1970 to May 2018.Eligibility criteriaRandomised clinical trials and quasi-randomised trials comparing the efficacy and safety of prophylactic theophylline or aminophylline for prevention of AKI in neonates and children were included. The primary outcomes were: incidence of AKI, serum creatinine levels and all-cause mortality.ResultsA total of nine trials were included in the qualitative synthesis. Six trials including 436 term neonates with birth asphyxia who received a single dose of theophylline were finally included in the meta-analysis. The pooled estimate showed 60% reduction in the incidence of AKI in neonates with severe birth asphyxia (RR: 0.40; 95% CI 0.3 to 0.54; heterogeneity: I2=0%) (moderate quality evidence), decrease in serum creatinine over days 2–5 (very low to low quality evidence) without significant difference in all-cause mortality (RR: 0.88; 95% CI 0.52 to 1.50; heterogeneity: I2=0%) (very low-quality evidence). A significant difference in the negative fluid balance, increase in GFR and decrease in urinary β2 microglobulin was seen in favour of theophylline.Conclusion and relevanceA single dose of prophylactic theophylline helps in prevention of AKI/severe renal dysfunction in term neonates with severe birth asphyxia (moderate quality evidence) without increasing the risk of complications and without affecting all-cause mortality (very low-quality evidence).Trial registration numberCRD 42017073600.

Background Birth asphyxia is one of the leading causes of most neonatal deaths. Hence, strengthening and investing in care is crucial, particularly around birth and the first week of life. As a result, several studies, including an umbrella review, were conducted even though significant variations were observed among those investigations. Thus, this is an updated systematic review and meta-analysis aimed to determine predictors of birth asphyxia in Ethiopia. Methods Online databases such as CINAHL, PubMed, Embase, Web of Science, and Cochrane Library were searched. Online searches turned up pertinent grey literature, and repositories of several universities were also searched. Observational studies carried out in Ethiopia were included. The authors conducted an independent search, quality check, and data extraction. The Newcastle Ottawa Scale checklist was used to evaluate the quality of articles. STATA version 17 was used for both data entry and statistical analysis. Since there were variations among studies, a random-effect model was employed for analysis. Egger’s regression test and funnel plot were utilized to assess publication bias, and the I-squared test was performed to verify the studies’ heterogeneity. Results This analysis comprised 38 studies with 13,593 sample sizes. The pooled prevalence of birth asphyxia was 23.07% (95% CI: 19.96, 26.18). An intrapartum (i.e., prolonged labor, blood- or meconium-stained amniotic fluid, tight nuchal cord, cord prolapse, intrapartum fetal distress, malposition/malpresentation, and premature rupture of membrane) and obstetric procedure (i.e., labor induction, emergency cesarean sections, instrumental deliveries, and night time deliveries) factors were significantly associated with birth asphyxia. Moreover; neonatal (i.e., low birth weight, premature birth, and the male sex of the neonate), and maternal (i.e., place of residence, primigravida, mother’s age, chronic hypertension, pregnancy-induced hypertension, anemia throughout pregnancy, antepartum hemorrhage, absence of antenatal care follow-up) were also significantly associated with birth asphyxia. Conclusions This meta-analysis indicates nearly one in four newborns suffered from birth asphyxia in Ethiopia. It implicates tailored interventions for an intrapartum, maternal, neonatal, and an obstetrics procedure-related associated factors are needed to reduce birth asphyxia, thereby enhancing achievement of the sustainable development goal that aimed to reduce neonatal mortality to less than 12 per 1000 live births. Therefore, advocacy for public health initiatives aimed at increasing awareness of birth asphyxia and promoting early detection and intervention strategies, multidisciplinary approaches, and interventional studies are crucial.

Birth asphyxia is a major cause of newborn deaths worldwide, especially in developing countries where access to skilled delivery care is limited. It is a significant health challenge in Ethiopia, contributing to many newborn deaths and long-term health issues. Despite efforts to improve maternal and newborn care, it remains a serious concern. Thus, this study was aimed at identifying the determinants of birth asphyxia among newborns at a tertiary care hospital in Central Ethiopia. An institution-based unmatched case-control study was conducted among 345 participants with a case-to-control ratio of 1:2. Data were collected using a pretested, structured, interviewer-administered questionnaire and a data abstraction checklist. The collected data were entered into Epi Info Version 7.2 and analyzed using SPSS Version 27. Binary logistic regression analysis was performed to identify the determinants of birth asphyxia. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to estimate the strength of associations. Statistical significance was set at a  value < 0.05. In this study, the place of residence (rural) (AOR = 2.34; 95% CI: 1.29-4.26), premature rupture of membrane (AOR = 3.47; 95% CI: 1.52-7.92), prolonged labor (AOR = 10.12; 95% CI: 5.36-19.11), noncephalic fetal presentation (AOR = 2.40; 95% CI: 1.01-5.74), instrumental delivery (AOR = 2.67; 95% CI: 1.15-6.16), and cesarean section delivery (AOR = 3.99; 95% CI: 1.84-8.63) were identified as independent determinants of birth asphyxia. Rural residence, premature rupture of membranes, prolonged labor, noncephalic fetal presentation, instrumental delivery, and cesarean section delivery were determinants of birth asphyxia. Efforts to reduce birth asphyxia should focus on improving maternal healthcare in rural areas, enhancing the management of labor complications, and ensuring skilled delivery care, especially for noncephalic presentations and operative deliveries.

Background Birth asphyxia is the second leading cause of neonatal mortality worldwide, including in Ethiopia, and remains a significant public health concern. Despite the availability of national data on neonatal mortality in Ethiopia, there remains a gap in understanding the specific incidence and predictors of mortality among asphyxiated neonates. To address this information gap, this meta-analysis was conducted to assess the incidence and predictors of mortality among asphyxiated neonates in Ethiopia. Methods This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Relevant studies were identified through various databases, including PubMed, CINAHL, Scopus, EMBASE, and Google Scholar. Data analysis of pooled estimates for mortality incidence and its predictors was performed via STATA 17 software with the DerSimonian and Laird model. Heterogeneity was assessed via Cochrane’s Q-test and the I² statistic. Additionally, publication bias was evaluated through funnel plots, Egger’s test, and Doi plots. Results Out of 68 identified studies, only 10 met the eligibility criteria, including a total of 4,866 participants. The pooled incidence rate of birth asphyxia mortality was 4 per 100 person-days (95% CI: 3–5), which was 35,754 person-days of observation. Furthermore, predictors of birth asphyxia mortality included: pregnancy complications (HR 1.52, 95% CI: 1.41–1.64), labor complications (HR 1.29, 95% CI: 1.15–1.44), severe hypoxic-ischemic encephalopathy (HR 1.67, 95% CI: 1.51–1.85), neonatal seizures (HR 1.23, 95% CI: 1.11–1.38), and comorbidities in neonates (HR 1.31, 95% CI: 1.24–1.39). Conclusion In the current study, the pooled incidence of birth asphyxia mortality was high, falling short of the Sustainable Development Goals target and highlighting the need for immediate intervention. Additionally, pregnancy and labor complications, severe hypoxic-ischemic encephalopathy, neonatal seizures, and neonatal comorbidities were identified as predictors of birth asphyxia mortality. These findings underscore the urgent need to enhance early detection and intervention for pregnancy- and labor-related complications, as well as severe neonatal complications related to asphyxia, in to reduce mortality.

Background Developing a prediction model that incorporates several risk factors and accurately calculates the overall risk of birth asphyxia is necessary. The present study used a machine learning model to predict birth asphyxia. Methods Women who gave birth at a tertiary Hospital in Bandar Abbas, Iran, were retrospectively evaluated from January 2020 to January 2022. Data were extracted from the Iranian Maternal and Neonatal Network, a valid national system, by trained recorders using electronic medical records. Demographic factors, obstetric factors, and prenatal factors were obtained from patient records. Machine learning was used to identify the risk factors of birth asphyxia. Eight machine learning models were used in the study. To evaluate the diagnostic performance of each model, six metrics, including area under the receiver operating characteristic curve, accuracy, precision, sensitivity, specificity, and F1 score were measured in the test set. Results Of 8888 deliveries, we identified 380 women with a recorded birth asphyxia, giving a frequency of 4.3%. Random Forest Classification was found to be the best model to predict birth asphyxia with an accuracy of 0.99. The analysis of the importance of the variables showed that maternal chronic hypertension, maternal anemia, diabetes, drug addiction, gestational age, newborn weight, newborn sex, preeclampsia, placenta abruption, parity, intrauterine growth retardation, meconium amniotic fluid, mal-presentation, and delivery method were considered to be the weighted factors. Conclusion Birth asphyxia can be predicted using a machine learning model. Random Forest Classification was found to be an accurate algorithm to predict birth asphyxia. More research should be done to analyze appropriate variables and prepare big data to determine the best model.

Background Birth asphyxia is a critical condition caused by an insufficient oxygen supply during delivery, and it poses a major threat to the health of newborns. The present meta-analysis aimed to estimate the prevalence of birth asphyxia among neonates and identify its risk factors in China. Methods PubMed, EMBASE, Scopus, Web of Science, the China Academic Journals (CNKI), the Chinese Biomedical Literature (CBM), the China Science and Technology Journal Database (VIP), and the WanFang database were searched for related publications. Two researchers independently selected the literature, extracted the relevant data, and assessed its methodological quality. The meta-analysis applied a random-effects model with Stata 17.0 software to calculate the pooled prevalence of birth asphyxia among neonates delivered in China and to merge the odds ratios (ORs) of risk factors. Subgroup analysis was performed on the included studies. Publication bias was assessed by funnel plots and Egger's test. Results Eighty studies were eligible for inclusion. The overall prevalence of birth asphyxia in newborns was 4.8% (95% CI, 4.5%–5.2%). In the subgroup analyses, the northern area presented the highest prevalence (5.1%; 95% CI, 4.1%–6.3%), followed by the southern area (4.1%; 95% CI, 3.3%–5.1%). The rural setting presented the highest prevalence (6%; 95% CI, 4.6%–7.4%), followed by the urban (4.2%; 95% CI, 4.6%–7.4%) and mixed (5.8%; 95% CI, 5.3%–6.3%) settings. The Apgar score demonstrated the highest prevalence (4.6%; 95% CI, 3.8%–5.4%), followed by the Apgar score with the umbilical artery blood pH (3.7%; 95% CI, 2.2%–5.7%). A significant difference in prevalence was found between studies with sample sizes greater than 5,000 (2.2%; 95% CI, 1.6%–3%) and those with 5,000 or fewer participants (6.2%; 95% CI, 5.5%–7.1%). Furthermore, there was a significant decrease in the incidence of birth asphyxia from 1995–2016 (4.9%; 95% CI, 4.2%–5.9%) to 2017–2023 (3.7%; 95% CI, 2.6%–5%). Placental abruption (OR = 5; 95% CI, 3.08–8.13), placenta previa (OR = 2.57; 95% CI, 1.84–3.58), advanced maternal age (OR = 3.94; 95% CI, 1.46–10.62), primigravida (OR = 5.33; 95% CI, 0.41–68.71), premature birth (OR = 3.36; 95% CI, 2.61–4.32), intrauterine distress (OR = 4.48; 95% CI, 3.47–5.80), stained amniotic fluid (OR = 3.28; 95% CI, 2.25–4.79), macrosomia (OR = 6.30; 95% CI, 0.61–65.22), foetal malformation (OR = 7.44; 95% CI, 1.46–38.02), breech birth (OR = 2.42; 95% CI, 1.24–4.73), caesarean section (OR = 1.72; 95% CI, 0.91–3.24), assisted delivery (OR = 13.62; 95% CI, 5.50–33.73), prolonged second stage of labour (OR = 1.43; 95% CI, 0.68–3.01), and malpresentation (OR = 4.20; 95% CI, 2.21–7.99) were major risk factors. Conclusions The prevalence of birth asphyxia among newborns in China is relatively high. In addition, 14 risk factors are related to neonatal birth asphyxia. Urgent attention needs to be focused on regionalized maternal and child management to address this problem in China.

Birth asphyxia is a potential cause of death that is also associated with acute and chronic morbidities. The traditional and immediate approach for monitoring birth asphyxia (i.e., arterial blood gas analysis) is highly invasive and intermittent. Additionally, alternative noninvasive approaches such as pulse oximeters can be problematic, due to the possibility of false and erroneous measurements. Therefore, further research is needed to explore alternative noninvasive and accurate monitoring methods for asphyxiated neonates. This study aims to investigate the prominent ECG features based on pH estimation that could potentially be used to explore the noninvasive, accurate, and continuous monitoring of asphyxiated neonates. The dataset used contained 274 segments of ECG and pH values recorded simultaneously. After preprocessing the data, principal component analysis and the Pan–Tompkins algorithm were used for each segment to determine the most significant ECG cycle and to compute the ECG features. Descriptive statistics were performed to describe the main properties of the processed dataset. A Kruskal–Wallis nonparametric test was then used to analyze differences between the asphyxiated and non-asphyxiated groups. Finally, a Dunn–Šidák post hoc test was used for individual comparison among the mean ranks of all groups. The findings of this study showed that ECG features (T/QRS, T Amplitude, Tslope, Tslope/T, Tslope/|T|, HR, QT, and QTc) based on pH estimation differed significantly (p < 0.05) in asphyxiated neonates. All these key ECG features were also found to be significantly different between the two groups.