A clinico-epidemiological profile of neonates with birth asphyxia in SNCU and NICU of a tertiary care hospital with special reference to renal parameters and serum calcium levels in birth asphyxia
Keywords:Birth asphyxia, Epidemiological profile, Neonates, Renal parameters, Serum calcium
Background: Birth asphyxia accounts for around 23% of annual neonatal deaths in the developing world. Perinatal asphyxia or birth asphyxia as is more commonly used is one of the most common presentations of a neonate in Special Newborn Care Units (SNCUs) and Neonatal Intensive care Units (NICUs) all around the world. The main objective of the study was to study electrolyte status and renal parameters in asphyxiated newborns of different severity in early neonatal period and to determine the occurrence of renal failure in asphyxiated neonates and to correlate severity with Apgar score and hypoxic ischaemic encephalopathy grading of neonates.
Methods: The present study was a Prospective Cross-Sectional Hospital based single centre study conducted in the Department of Paediatrics, Midnapore Medical College, Paschim Medinipur, West Bengal, India. Term, appropriate for gestational age babies born/admitted in SNCU and NICU with birth asphyxia between January, 2020 to June, 2021 were included in the study.
Results: Our study showed that, in control group 1 (60%) were male and 6 (40%) were female. In case group 18 (51.4%) were male and 17 (48.6%) were female. Among 35 cases renal failure is seen in 68.57 % and none of the controls had renal failure. Oliguria >0.5 ml/kg/hr was found in 14 (93.3%) patients in the control group, in case group it was found in 32 (91.4%) patients. The incidence of renal failure is highest with moderate asphyxia accounting for 41.67%.
Conclusions: Perinatal asphyxia is one of the commonest cinical conditions encountered in the sick neonate. It affects almost all organ systems of the body. As the pre renal type of kidney injury is more common, these babies usually recover fully with fluid resuscitation in majority of cases.
Karlowicz MG, Adelman RD. Nonoliguric and oliguric acute renal failure in asphyxiated term neonates. Pediatr Nephrol. 1995;9(6):718-22.
Misra PK, Kumar A, Natu SM, Kapoor RK, Srivatsava KL, Das K. Renal failure in Symptomatic perinatal asphyxia. Indian Pediatrics 1991;28(10):1147-51.
Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: A clinical and electroencephalographic study. Arch Neurol. 1976;33(10):695-706.
Levene MI. The asphyxiated newborn infant. In: Levene MI, Lilford RJ. Fetal and neonatal neurology and neuro-surgery. Edinburgh: Churchil Livingstone; 1995:405-426.
Perlman JM, Tack ED, Martin T, Shackelford G, Amon E. Acute systemic organ injury in term infants after asphyxia. Am J Dis Child. 1989;143(5):617-20.
Roberts DS, Haycock GB, Dalton RN, Turner C, Tomlinson, Stommler L, et al. Prediction of acute renal failure in after birth asphyxia. Arch Dis Child. 1990;65(10 Spec No):1021-8.
Jayashree G, Dutta AK, Sarna MS, Saili A. Acute renal failure in asphyxiated newborns. Indian Pediatrics. 1991;28(1):19-23.
Rennie JM. Robertons Text book of Neonatology. 4th ed. Elsevier Churchill living stone; 2005:1128-1138.
Stapleton FB, Jones DP, Green RS. Acute renal failure in neonates: incidence, etiology and outcome. Pediatric Nephrol. 1987;1:314-20.
Costello A, Francis V, Byrne A, Puddephatt C. State of the World's Newborns: A Report from Saving Newborn Lives. Save the Children, Department of Public Affairs and Communications, 54 Wilton Road, Westport, CT 06880; 2001.
National Neonatology Forum, India. Report of the National Neonatal Perinatal Database, 2000. Available at: https://newbornwhocc.org/pdf/HRRC-Report_2002-03. Accessed on 10 May 2023.
Behrman RE, Lees MH, Peterson EN. Distribution of the circulation in the normal and asphyxiated primate. Am J Obstetric Gynaecol. 1970;180(6):956-61.
Mohan PV, Pai PM. Renal insult in asphyxia neonatarum. Indian Pediat. 2000;37(10):1102-6.
Aggarwal A, Kumar P, Chowdhay G, Mazumdar S, Narang A. Evaluation of renal functions in asphyxiated newborns. Jl. of Trop Pediatrics. 2005;51(5):295-9.
Gillam-Krakauer M, Gowen CW. Birth Asphyxia. In: Stat Pearls. Treasure Island, FL: StatPearls Publishing; 2022.
Mac Donald HM, Mulligan JC, Allen AC, Taylor PM. Neonatal asphyxia. Relationship of obstetric and neonatal complication to neonatal mortality in 38,405 consecutive deliveries. J Pediatr 1980;96(5):898-902.
Gupta BD, Sharma P, Bagla J, Parakh M, Soni JP. Renal failure in asphyxiated neonates. Indian Pediatrics. 2005;42(9):928-34.
Basu P, Das H, Choudhuri N. Electrolyte status in birth asphyxia. The Indian Journal of Pediatrics. 2010;77(3):259-62.