PERINATAL ASPHYXIA AND ITS CONSEQUENCES: TODAY’S CHALLENGES IN UKRAINE

Abstract

Despite recent advances in perinatal medicine, neonatal hypoxic- ischemic encephalopathy, approximately 4 million babies worldwide are born asphyxiated each year. According to the World Health Organization (WHO), perinatal asphyxia is the third leading cause of neonatal death (23 %) and accounts for 8 % of all deaths in children under 5 years of age. Modern studies have identifi ed a number of risk factors for birth asphyxia, which may vary according to the level of development of the health care system. Despite the diffi culties in predicting and diagnosing neonatal asphyxia in settings with limited resources, there are potential opportunities to reduce neonatal mortality. Successful resuscitation, including early and eff ective positive pressure ventilation and/or tracheal intubation, and maintenance of normal body temperature are strategies that have the potential to reduce mortality.The aim of the study was to determine the number of hypoxic/asphyxial states of the fetus/child in 2023 according to the data of EHCS (Electronic Health Care System), as well as to identify problematic issues of clinical and organizational nature facing the obstetric and neonatal service of Ukraine. To achieve the goal, the following tasks were defi ned: to analyze the frequency of hypoxic states of the fetus during pregnancy, the number of infants with a diagnosis of severe asphyxia, severe hypoxic- ischemic encephalopathy and diagnoses related to brain damage coded in the EMR (electronic medical records), and also to analyze the number of deaths among infants with severe asphyxia.Materials and methods. The information base of the study became all the EMRs created by doctors according to the following packages «Medical assistance during childbirth»; «Medical care for newborns in complex neonatal cases» with the basis «born in a hospital» and «transferred from another institution» (hereinafter, the neonatal package); «Inpatient care for adults and children without surgical operations» with the basis «born in a hospital» (hereinafter, the therapeutic package) and «sectional examination». If two or more EMRs were created for a child, the information from these EMRs was combined into one treated case.The results of the study showed that a total of 9,938 (5.7 %) women were coded with a diagnosis of «labor and delivery complicated by fetal distress,» while 72 women were coded with two diagnoses of the same rubric. This diagnosis is also reported in the EMR for women who gave birth prematurely. The main cause of fetal distress was a violation of the fetal heart rate in 77.9 % of cases, the presence of meconium and other fetal distress in 21.7 % of cases.The next step in our research was to determine the number of children whose medical records indicated a diagnosis of asphyxia or a condition related to asphyxia. A total of 587 diagnoses with code P21.0 (severe asphyxia) were identifi ed in the primary or secondary diagnoses of the EMR, or 1.04 %. It should be noted that 178 term infants had asphyxia without HIE of any stage according to EMR, which raises some doubts. Severe asphyxia or severe HIE – all EMRs with code P21.0 or code P91.63 (hypoxic- ischemic encephalopathy [HIE] in a newborn of stage 3) in the principal or secondary diagnoses occurred in 765 cases (1.35 %), which more realistically refl ects the frequency of severe central nervous system damage in newborns due to asphyxia and hypoxia. In general, the incidence of severe birth asphyxia or HIE III stage among full-term newborns in Ukraine is 0.34 %, with the highest number of cases in Donetsk – 1.9 %, Kharkiv – 0.99 %, Kherson – 0.78 %, regions closest to active hostilities and temporarily occupied territories. Studying the number of full-term infants transferred to other institutions, it became clear that the diagnosis of «severe asphyxia» or «HIE III stage» was determined in 100 patients (17.8 %), while at birth in 563. According to the information from the autopsy package, 58 autopsies were performed on infants with the diagnosis of severe asphyxia, of which 36 (62.06 %) died within 1 day, while in 7 cases there are discrepancies in the main diagnosis, and in 16 cases no EMR was found (comparison: institution of death, age, sex, date of death).Conclusions. About 10,000 women had diagnosed and coded fetal distress, 8,024 babies were born with Apgar score less than 7 points, 600 of them developed severe asphyxia. Every year in Ukraine about 100 full-term babies with severe asphyxia die in the early neonatal period. On the basis of the obtained results, it is necessary to further improve the educational system of obstetric and neonatal care, which should be carried out on a continuous basis, to develop recommendations for correct coding of neonatal conditions, to introduce at the national level indicators directly related to asphyxia, as well as their constant monitoring and public reporting. Emphasis should be placed on increasing the responsibility of each physician for the correct billing of medical services provided to the newborn.