Abstract
Introduction: Perinatal asphyxia is one of the leading causes of mortality and morbidity in neonates in developing countries. 1 The exact burden of asphyxia in not known in developing countries like India because of lack of robust data collection and monitoring. Most of the cases with moderate-to-severe asphyxia are referred to tertiary care centers for further management. Hence, this study was planned to know the burden of perinatal asphyxia from the place of referral.
Objectives: The main objective of this study was to map the cases of perinatal asphyxia referred to a tertiary care hospital from the place of referral and to know the burden of asphyxia after this from the places of referral to plan educational interventions accordingly.
Methods: It was a retrospective study conducted in a tertiary care center over a period of 3 years. A total of 388 neonates referred with perinatal asphyxia were analyzed from January 2015 to December 2017. Baseline characteristics, demographic and geographical data, pattern of referral, mode of transport, clinical outcome, morbidity and mortality patterns were analyzed. For the purpose of ease of analysis, possible dissemination of data, and fulfilling the need for intervention, the whole of Bangalore district was divided into different zones as per Bruhat Bangalore Mahanagara Palike (BBMP). The data were further mapped on the state map and the BBMP map. The analysis was done by standard statistical methods.
Results: A total of 388 neonates were analyzed. Majority of cases were referred from Karnataka followed by Andhra Pradesh and Tamil Nadu. From our state most of them were from Bangalore Urban (43%) followed by Tumkur (14%), Bangalore Rural (11%), Chikkaballapur (10%), and Ramnagara (5.4%). In Bangalore, most of the asphyxia cases were from Bangalore South followed by Bangalore East and West. Males outnumbered females by nearly 30%. Nearly 80% of cases needed tactile stimulation and bag and mask ventilation.
Resuscitation was carried out by doctors (70%) in majority of cases followed by nurses. In spite of having good ambulance service in our state, self-arranged ambulance was used in nearly 60% of cases for transport. The proportion of self-arranged ambulance remained higher even when analysis was made on the basis of districts and zones. Nearly 80% were successfully discharged with mortality rate being 5%.
Conclusion: Geographical mapping showed that majority of the cases of perinatal asphyxia were from Bangalore South and East, and neighboring districts such as Tumkur, Bangalore Rural, and Chikkaballapur.
Targeted training of health care workers, especially nurses in neonatal resuscitation in the areas of high mortality/morbidity, might reduce the incidence of perinatal asphyxia from these areas much quicker than focusing on urban areas only.
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