Very early complications of neonatal asphyxia

Background: Neonatal asphyxia may develop complications and may lead to death. This study aimed to know the incidence of complications of neonatal asphyxia within 24 hours after birth. Methods: This cohort study was performed from June 2015 to May 2016. The inclusion criteria were gestational age >28 weeks or birth weight >1000 grams and need positive pressure ventilation (with or without intubation) for 30 seconds or more. Neonates with major congenital anomalies and early-onset infection were excluded from the study. Subjects were followed up for 24 hours to identify any complications related to neonatal asphyxia. Further follow-up was done until the subject was discharged home or died during hospitalization. Complications of neonatal asphyxia monitored were central nervous system, cardiovascular system, respiratory system, gastrointestinal tract system, urinary tract system, hematology system, metabolic disorder, and electrolyte imbalance. An attending neonatologist or neonatology trainee performed a clinical assessment of complications, and a trained medical doctor did the data collection. We analyzed the incidence of neonatal asphyxia complication, mortality, and gestational age sub-analysis. A student t-test with a 95% significance level was used to analyze dichotomous data and regression analysis for correlation between the level of resuscitation and the number of complications. Results: There were 94 subjects included in the study. There was no significant difference in complications in sex, birth weight, gestational age, 1 and 5-minute Apgar score, and level of resuscitation. Seventeen (18.1%) of subjects had no complications. The incidence of complications was respiratory system 67%, hypoglycemia 37.2%, electrolyte imbalance 8.5%, CNS 6.4%, CVS and hematology system complications were 2.1%, and GIT 1.1%. Subjects with 1 organ complication were 48.9%, 2 complications, 3 complications and 4 complications were 24.5%, 7.4%, and 1.1% respectively. Lower gestational age had more complications (p: 0.025). There was weak correlation between level of resuscitation and number of complication (r2: 0.017, p: 0.22), for term (r2: 0.31; p: 0.27), preterm (r2: 0.31; p: 0.27), and very preterm (r2: 0.00; p: 0.98). Three out of five death cases occurred within first week. Conclusion: The most common neonatal asphyxia complication was respiratory distress which may lead to early neonatal death.