Grading of Perinatal Asphyxia by Clinical Parametrs and Its Correlation with Outcome

Najnin umme Zakia1, MAK Azad Chowdhury2, Rashadul Kabir Rassel3, Salim M4, Shahina Akter Mita5,Anita Sarkar3

Background: Perinatal asphyxia is an important cause of neonatal mortality,
morbidity and disability in many countries including Bangladesh.
Objective: To categorize the asphyxiated babies by a new scoring system to reduce
morbidity & mortality, to anticipate future neurological handicap and thereby to
determine the efficacy of this scoring system to predict their future outcome.
Methods: A prospective study was conducted in neonatal care unit of Dhaka Shishu
Hospital from July 2005 to June 2006. A thorough history and physical examination
were carried out and a simple scoring system was designed based on 12 historical &
clinical criteria. Each criteria was given scores of 0 ,1, 2.(Table-I ).Total scores were 0
– 24. Scores <12 was mild perinatal asphyxia (PA), 12-18 was moderate (PA)
and >18 was severe (PA). They were followed up carefully to find out a short
hospital outcome. After discharge from hospital babies were followed up at 3 months
of age to find out any growth & developmental delay or any neurological deficit.
Results: In this study total 97 patients were enrolled. Of 97 patients, 20 died & 77
patients came for follow at 3 months. According to scoring system, 34 were mild PA
with scores <12, 53 were moderate with scores 12-18 and 10 were severe PA with scores
>18. Male babies were more frequently affected than female ones. Primigravidas were
more likely to have asphyxiated babies than multigravidas. Mothers without antenatal
checkup had significantly higher risk to develop perinatal asphyxia. Maximum deliveries,
though took place in clinic or hospital and were conducted by doctors & nurses, APGAR
scores were not recorded in most of the cases. Resuscitation was not adequate in most
of the cases (72%). Statistical analysis revealed insignificant results (p >0.05). Among
the mild PA cases 32 (94.4%) recovered fully & 2 (5.9%) died. In moderate PA, 40
(75.5%) survived & 13( 24.5%) died. Among the survived moderate PA cases 27(67.5%)
were normal & 13 (32.5%) developed neurological deficit at 3 months. Of 10 severe PA
cases, 5 (50%) survived & 5 (50%) died. Only 1 (20%) case was normal & 4 (80%)
developed complication at 3 months follow up. Analysis of outcome revealed statistically
significant difference (p<0.05) between mild Vs moderate & mild Vs severe PA but
insignificant difference (> 0.05) moderate Vs severe cases.
Conclusion: This proposed scoring system may be helpful in diagnosis and
management of asphyxiated babies and will allow for reasonably accurate
prognostication regarding the probability of future handicap.
Keyword: Perinatal asphyxia, Hypoxic- ischaemic encephalopathy, Neurological deficit.

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