Article Text

  1. D. R. Halloran*,
  2. B. McClure*,
  3. E. Chombaà,
  4. L. L. Wright§,
  5. W. A. Carlo|
  1. *Saint Louis University, Saint Louis, MO; Research Triangle Institute, Durham, NC
  2. àUniversity of Zambia, Lusaka, Zambia
  3. §National Institute of Child Health and Human Development, Bethesda, MD
  4. |University of Alabama at Birmingham, Birmingham, AL


Background While birth asphyxia is the leading cause of neonatal mortality in sub-Saharan Africa, accounting for 23% of neonatal deaths, little is known of the morbidity of birth asphyxia in developing countries. Survivors of birth asphyxia are at risk for adverse neurodevelopmental outcomes. The purpose of this study was to determine the diagnoses and early neurodevelopmental outcomes of infants evaluated in a neonatal intensive care unit (NICU) follow-up clinic in a developing country in sub-Saharan Africa.

Design/Methods All inborn and outborn admissions to the University of Zambia NICU who survived to discharge were referred to the NICU follow-up clinic for further evaluation and monitoring. A cross-sectional, prospective chart review was completed on all infants followed in this clinic for a 4-week period between March and April 2005. All infants evaluated in this clinic were under 12 months of age at the time of the visit. Descriptive statistics were completed using maternal and infant characteristics, data from the initial hospitalization, physical examination findings during the follow-up visit, and plan of care. Only the most recent examination results were included in the analyses for any infants with multiple visits during the study period.

Results Forty-three of the 183 infants (23%) seen in the NICU follow-up clinic had a clinical diagnosis of birth asphyxia. Twenty-two of the 43 infants (51%) with birth asphyxia were male. Thirty-two of the 43 infants (74%) were also diagnosed with sepsis while 3 infants (7%) were also diagnosed as preterm. On physical examination, 13 of the 43 infants with birth asphyxia (30%) were noted to have an abnormal neurological examination during the clinic visit.

Conclusions Birth asphyxia survivors account for almost a quarter of infants seen in a NICU follow-up clinic in a developing country. Thirty percent of infants with birth asphyxia had abnormal neurological examinations using early neurodevelopmental outcomes within the first year of life. Because early neurodevelopmental outcomes were utilized in this study, this likely underestimate the percent of birth asphyxia survivors who will eventually develop motor, cognitive, and learning disabilities.

Funding by the NICHD Global Network for Women's and Children's Health Research and Bill and Melinda Gates Foundation.

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