Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital

Pediatrics. 2012 May;129(5):e1238-43. doi: 10.1542/peds.2011-3134. Epub 2012 Apr 16.


Objective: Early neonatal mortality within the first 24 hours contributes substantially to overall neonatal mortality rates. The definition of birth asphyxia (BA) is imprecise, and reliable cause-specific mortality data are limited; thus the estimated proportion of BA-related deaths globally remains questionable. The objective was to determine the presumed causes of neonatal death within the first 24 hours in a rural hospital in Northern Tanzania.

Methods: This is a prospective descriptive observational study conducted in the delivery room and adjacent neonatal area. Research assistants were trained to observe and record events related to labor, neonatal resuscitation, and 24-hour postnatal course. BA was defined as failure to initiate spontaneous respirations and/or 5-minute Apgar score <7, prematurity as gestational age <36 weeks, and low birth weight (LBW) as birth weight <3rd centile for gestational age. Data were analyzed with χ(2) and Student's t tests.

Results: Over 1 year, 4720 infants were born and evaluated. Of these, 256 were admitted to the neonatal area. Forty-nine infants died secondary to BA (61%), prematurity (18%), LBW (8%), infection (2%), congenital abnormalities (8%), and unclear reason (2%). The 5-minute Apgar score was ≥7 in 50% of the infants who died secondary to BA.

Conclusions: Most cases of early neonatal mortality were related to BA, and prematurity and LBW are additional important considerations. Reducing perinatal mortality requires a multifaceted approach with attention to issues related to BA, potential complications of prematurity, and LBW. The 5-minute Apgar score is a poor surrogate of BA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apgar Score
  • Asphyxia Neonatorum / mortality*
  • Cause of Death*
  • Congenital Abnormalities / mortality
  • Developing Countries*
  • Female
  • Hospital Mortality*
  • Hospitals, Rural / statistics & numerical data*
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature, Diseases / mortality
  • Male
  • Prospective Studies
  • Resuscitation
  • Risk Factors
  • Stillbirth / epidemiology
  • Tanzania