Birth asphyxia at a district hospital in Kigali, Rwanda

Background: Prematurity, birth asphyxia (BA), and sepsis are the leading causes of neonatal mortality. The BA prevalence rate is 23% worldwide and affects up to 39% in Rwanda. Birth asphyxia is an insult with significant consequences to the neonate’s brain and other vital organs due to decreased oxygen before, during or immediately after birth. Objective: To assess the BA prevalence, associated factors, and outcomes at a district hospital in Kigali. Methods: A retrospective, cross-sectional study of 340 neonates admitted to the NICU in 2016. Results: Birth asphyxia was identified in 135 out of 340 newborns (39.7%). Associated factors included gravida, meconium-stained amniotic fluid, normal duration of labor, normal duration of ROM, vaginal delivery, Apgar score of ≤5 at 5 minutes, respiratory ventilation and cardiac massage and normal birth weight (2500-3999gr). Two-thirds were born via vaginal birth (66.5%), and nearly half (47.3%) had BA. One-third was born via cesarean (33.5%), and a quarter (24.6%) had BA. Other BA outcomes included prolonged hospitalization beyond the neonatal period at 75% compared to non asphyxiated babies (25%). The mean days of NICU stay was 7.6 (SD: 6.1) for BA while it was 5.3 (SD: 4.16) for non-asphyxiated babies; early seizures (52.6%) and high specific mortality (87%). Discussion: Findings revealed a 6% BA prevalence increase, and a BA-specific mortality rate 13 times higher than previously recorded. Trained healthcare professionals need to reverse this significant trend in both vaginal and cesarean births that likely has a profound effect on the neonate, family, and community. Keywords: Birth asphyxia, neonatal morbidity, mortality, prevalence, risk factors, outcomes, sub-Saharan Africa