Neonatal resuscitation impact of neonatal resuscitation programmes on birth asphyxia, the actual situation

ABSTRACT

Each Year Billions of dollars have been spent on the various programmes for Maternal and child health services in collaboration with international organizations and hundreds of doctors and thousands of skilled [SBAs] birth attendants and lady heal workers have been trained. To evaluate the impact of neonatal resuscitation programs on the prevalence of birth asphyxia in a hospital which drains a large population of Punjab. Cross sectional. Department of Paediatric Medicine, Nishtar Medical College and Hospital, Multan from January 2008-December 2008. All newborns with a H/o failure to initiate or sustain respiration at birth or H/o associated convulsions who were admitted [referred or hospital based] with the diagnosis of Birth Asphyxia and a weight > 1.5 kg were included, still born and those with lethal congenital malformations were excluded. A questionnaire was designed after extensive review of literature and data recorded. The data of past 10 years for Birth Asphyxia was also collected from the hospital record and compared with the present results. In year 1998 a total of 722 Newborns were admitted our neonatal unit out of which 210 [29.0%] were diagnosed as Asphyxia Neonatorum. This number has progressively increased over the past 10 years with a total of 846 out of total 2079 newborns [40.78%] admitted in 2008 with a diagnosis of asphyxia. Out of the total 8461 patients, there were 69% Male and 31% Female with a MF ratio of 2.21.46% were delivered by SVD [17.39% in Nishtar Hospital 15.21% by dais, 32.6% by Private doctors and 34.78% by LHV] and 54% were delivered by caesarian section, out of which 46.29% were delivered in Private hospitals and 54% in Nishtar Hospital. Overall 65% deliveries were in the private sector or at home and 35% in the government hospitals 60% babies had come from Multan and 40% from other town or cities. A H/o one or more antenatal visits was present in 68% of others. Out of total cases of B.A. 26% were in B.A Grade-159% in Birth Asphyxia Grade-II 15% in B.A Grade-lll. Out of this total 45% expired. As we are moving towards the 4[th] MDG and Pakistan strives to improve its health indicators and we claim to decrease the infant mortality, neonatal and perinatal mortality rate. The incidence of birth asphyxia rises with increased burden of, morbidity. Even though the principles of NRPs are recommended for international application, this program widely used in the developed world has not been properly disseminated in communities in the developing countries, especially Pakistan