title: Incidence of and risk factors for neonatal respiratory depression and encephalopathy in rural Sarlahi, Nepal.
abstract: OBJECTIVE
  To characterize the incidence of, risk factors for, and neonatal morbidity and mortality associated with respiratory depression at birth and neonatal encephalopathy (NE) among term infants in a developing country.
  
  
  METHODS
  Data were collected prospectively in 2002-2006 during a community-based trial that enrolled 23 662 newborns in rural Nepal and evaluated the impact of umbilical-cord and skin cleansing on neonatal morbidity and mortality rates. Respiratory depression at birth and NE were defined on the basis of symptoms from maternal reports and study-worker observations during home visits.
  
  
  RESULTS
  Respiratory depression at birth was reported for 19.7% of live births, and 79% of cases involved term infants without congenital anomalies. Among newborns with probable intrapartum-related respiratory depression (N = 3465), 112 (3%) died before their first home visit (presumed severe NE), and 178 (5%) eventually developed symptoms of NE. Overall, 629 term infants developed NE (28.1 cases per 1000 live births); 2% of cases were associated with congenital anomalies, 25% with infections, and 28% with a potential intrapartum event. The incidence of intrapartum-related NE was 13.0 cases per 1000 live births; the neonatal case fatality rate was 46%. Infants with NE more frequently experienced birth complications and were male, of multiple gestation, or born to nulliparous mothers.
  
  
  CONCLUSIONS
  In Sarlahi, the incidence of neonatal respiratory depression and NE, associated neonatal case fatality, and morbidity prevalence are high. Action is required to increase coverage of skilled obstetric/neonatal care in this setting and to evaluate long-term impairments.
authors.affiliation: Department of International Health, International Center for Advancing Neonatal Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Anne C C
authors.initials: AC
authors.lastname: Lee
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.forename: Ramesh K
authors.initials: RK
authors.lastname: Adhikari
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
mesh_terms: D001238:Asphyxia Neonatorum / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*