Moderate and severe birth asphyxia in term neonates: early and late outcomes

Background: Aim was to compare the morbidities, laboratory parameters, immediate outcomes, and growth and development in term neonates with moderate and severe birth asphyxia. Methods: This prospective cohort study was carried out over a duration of 18 months. The neonates fulfilling the inclusion criteria (n=84) were enrolled, and were followed up till 6 months. Their growth was assessed and neuromotor assessment was done using Amiel-Tison angles at the time of discharge, 3 and 6 months of age and neurodevelopmental screening was done using Trivandrum Developmental Screening Chart (TDSC) at 3rd and 6th month and Developmental Assessment Scale for Indian Infants (DASII) as confirmatory test at 6 months. Results: Incidence of perinatal asphyxia was 17.6 per 1000 live births in our study. Of the cohort of 84 term intramural neonates 69.1% of the babies had moderate birth asphyxia and 30.9% had severe birth asphyxia. 34% infants with moderate birth asphyxia had respiratory failure whereas all babies (100%) with severe birth asphyxia suffered respiratory failure. Mean levels of LDH and lactate collected within 6 hours, were significantly higher in severely asphyxiated neonates (p<0.05 and p<0.001 respectively). At 3 months, 25 (96.2%) babies with severe asphyxia failed TDSC, 23 (88.5%) had post discharge seizures and 24 (92.3%) had tone abnormalities. Developmental delay assessed by DASII at 6-month follow-up was statistically significantly higher in severely asphyxiated babies (p<0.001). Conclusions: Incidence of comorbidities is higher in severely asphyxiated babies in comparison to moderately asphyxiated neonates. Laboratory markers like lactate and LDH at birth can be used as predictors of severity of birth asphyxia. Growth, development can be affected and picked up as early as 3 months in these babies on close follow up.