Neurological distress in Togolese newborn: Prevalence, causes and clinical features

Background: The transition from fetal to neonatal life during birth is difficult for all babies. We aim to analyze the demography, clinical presentation, causes, and outcome of neurologically distressed newborns. Materials and Methods: We reviewed a total of 615 newborns files admitted with life threatening condition. Amongst them, 453 had presented neurological distress syndrome. Only cases with severe neurological impairment (Apgar Score System [ASS] ≤6) with no other associated injury were included in the study group. The study covered a period from January to December 2011 and located in pediatric intensive care unit. The information regarding clinical presentation, condition of birth, causes of distress, and outcome were analyzed. Neonate examination had been conducted by neonatologist and pediatric neurologist. Results: The sample included 272/453 (60.04%) males and 181/453 (39.96%) females. Newborns were aged from 1 to 14 days. The incidence of neurological distress amongst all admissions was 453/615 (73.65%). Clinical signs were weakness of primary reflexes (86.70%), non reactivity (78.19%), flaccid muscle tone (59.49%) and impaired consciousness (32.29%). On Apgar score, 73 (20.68%) had a score from 0 to 3; 234 (66.29%) had a score 4-6 in the first minute of life. A total of 307 (86.97%) newborns had been resuscitated at birth during the first five minutes. Death rate was 35.69%. Asphyxia (51.27%) and neonatal infection (43.34%) were the most common causes of death. Conclusion: These results show that much effort remains to be done in obstetric care, resuscitation management and improvement in neonatal infection care.