Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg,

Over 9 million children die each year during the perinatal and neonatal periods, and nearly all of these deaths occur in developing countries. Perinatal asphyxia is a serious clinical problem globally. Every year approximately 4 million babies are born asphyxiated; this results in 1 million deaths and an equal number of serious neurological consequences ranging from cerebral palsy and mental retardation to epilepsy. Perinatal asphyxia is a major factor contributing to perinatal and neonatal mortality, which is an indicator of the social, educational and economic standards of a community. Perinatal asphyxia is defined as any perinatal insult resulting in suffocation with anoxia and increased carbon dioxide. Severe fetal hypoxia or ischaemia can manifest in the newborn as encephalopathy, and may result in neonatal death or permanent motor and mental disability. Taking into account that neonatal deaths account for almost 40% of deaths of children under 5, it is apparent that Millennium Developmental Goal 4 (aiming at a two-thirds reduction in under5 mortality by the year 2015 from a baseline in 1990) can only be met by substantially reducing neonatal deaths. Perinatal asphyxia is the fifth largest cause of under-5 deaths (8.5%) after pneumonia, diarrhoea, neonatal infections and complications of preterm birth. The death of an infant as a result of perinatal asphyxia is devastating and frequently avoidable. In developed countries with well-functioning health services these deaths are rare and ways to prevent them are widely understood and applied. However, a perinatal audit using the Perinatal Problem Identification Programme (PIPP) (www.ppip.co.za) has identified perinatal asphyxia as a common and important cause of death in South Africa. At Chris Hani Barawagnath Hospital in Gauteng, 20% of all neonatal deaths are due to asphyxia. A group of 25 term asphyxiated infants admitted to the Johannesburg Hospital Neonatal Unit was studied between September 1980 and March 1982. This study showed a mortality rate of 20%, 16% of children were disabled at the 2-year assessment, and 20% were lost to follow-up. In a follow-up retrospective study of 109 term infants with moderate to severe perinatal asphyxia, prognosis was often poor, particularly in patients with seizures, cardiopulmonary signs of asphyxia and multi-organ dysfunction. The fundamental goal of establishing perinatal audits in areas with high perinatal mortality rates is to reduce the number of perinatal deaths through improvement in the quality of care. Several studies have shown a strong association between the establishment of an effective audit process and improvement of the quality of maternal health services and perinatal mortality rates. Currently there are limited data on perinatal mortality rates, and although available figures are very high, they are likely to underestimate the problem. The major difficulty in collecting accurate epidemiological data is lack of a common definition of the diagnostic criteria of perinatal asphyxia. The umbilical artery pH that defines asphyxia of a sufficient degree to cause brain injury is unknown. Although the Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa