NEM-YUN BOO AND MUNN-SANN LYE

Factors Associated with Clinically Significant Perinatal Asphyxia in the Malaysian Neonates: a Case-control Study by Nem-Yun Boo, MRCP, FRCP (Edin & Glasg),* and Munn-Sann Lye,** MBBS, MPH, DR PH *Neonatology Unit, Department of Pediatrics, Faculty of Medicine, National University of Malaysia, Jalan Raja Muda, 50300 Kuala Lumpur, Malaysia **Department of Biostastistics and Epidemiology, Insitute of Medical Research, Kuala Lumpur, Malaysia

Introduction Perinatal asphyxia is defined as an impairment in the exchange of respiratory gases, oxygen and carbon dioxide during the perinatal period. 1 Studies on monkey fetuses showed that this condition not only caused damage to the brain, heart, liver, kidneys, and guts, but also death when severe. 1 " 3 In humans, this condition is a common cause of morbidity and mortality, especially in the term neonates. 4 ' 5 In the Maternity Hospital, Kuala Lumpur, which had an annual delivery between 24000 to 26000 babies, perinatal asphyxia accounted for 16 per cent of the neonatal deaths. Furthermore, 81 per cent of the deaths due to perinatal asphyxia in this hospital occurred in the term neonates. 6 In view of this high mortality compared with those in the developed countries, 7 " 10 the objective of this study was to determine the common risk factors associated with perinatal asphyxia in the Malaysian neonates. Methods This study was carried out over a 2-month period between 1 July to 31 August 1989 in the Maternity Acknowledgement We would like to thank Mr Tony Barnes, Reader and Associate Professor, Tropical Health Programme, University of Queensland, Australia, for his helpful advice and for running the GLIM programme for us. 284

© Oxford University Press 1992

Hospital, Kuala Lumpur. The study consisted of two parts. Descriptive study During the study period, the labour room registers in this hospital were screened twice daily by one of us (NYB) to identify the neonates who had suffered perinatal asphyxia. In this hospital, the Apgar score, and information on antenatal and intrapartum complications (including signs of fetal distress) of each baby delivered were entered in the labour room registers. Only singleton neonates who fulfilled the following criteria for clinically significant perinatal asphyxia were included as an index case in the study. These criteria were: 1. During intrapartum period, one or more of the following signs of fetal distress were present: (a) fetal bradycardia ( = or < 100 beats/minute) (b) fetal tachycardia ( = or > 160 beats/minute) (c) thick meconium staining of liquor (d) abnormal cardiotocography tracings; 2. Immediately after delivery, one or more of the following were present: (a) Apgar score < 8 at 1 minute of life, (b) patient required > 1 minute of positive pressure ventilation before sustained respiration occurred. After a case was identified, the mother of the neonate was interviewed. The antenatal, intrapartum, and early neonatal records were reviewed. The patient was Journal of Tropical Pediatrics

Vol.38

December 1992

Downloaded from http://tropej.oxfordjournals.org/ at University of Arizona on September 7, 2015

Summary A 2-month prospective study was carried out in a Kuala Lumpur maternity hospital to determine the antenatal and intrapartum factors associated with perinatal asphyxia in the Malaysian neonates. The incidence of perinatal asphyxia was 18.7 per 1000 livebirths. Of the 75 asphyxiated neonates born during this period, 70 (933 per cent) were of term or post-term gestation. The incidence of perinatal asphyxia was more common in the neonates with one of the following characteristics: low birth weight (