title: Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital.
abstract: 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.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. lehe@sus.no
authors.forename: Hege Langli
authors.initials: HL
authors.lastname: Ersdal
authors.forename: Estomih
authors.initials: E
authors.lastname: Mduma
authors.forename: Erling
authors.initials: E
authors.lastname: Svensen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perlman
mesh_terms: D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000401:mortality*; D002423:Cause of Death; D000013:Congenital Abnormalities / Q000401:mortality; D003906:Developing Countries; D005260:Female; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D013636:Tanzania