title: Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990.
abstract: BACKGROUND
  Intrapartum hypoxic events ("birth asphyxia") may result in stillbirth, neonatal or postneonatal mortality, and impairment. Systematic morbidity estimates for the burden of impairment outcomes are currently limited. Neonatal encephalopathy (NE) following an intrapartum hypoxic event is a strong predictor of long-term impairment.
  
  
  METHODS
  Linear regression modeling was conducted on data identified through systematic reviews to estimate NE incidence and time trends for 184 countries. Meta-analyses were undertaken to estimate the risk of NE by sex of the newborn, neonatal case fatality rate, and impairment risk. A compartmental model estimated postneonatal survivors of NE, depending on access to care, and then the proportion of survivors with impairment. Separate modeling for the Global Burden of Disease 2010 (GBD2010) study estimated disability adjusted life years (DALYs), years of life with disability (YLDs), and years of life lost (YLLs) attributed to intrapartum-related events.
  
  
  RESULTS
  In 2010, 1.15 million babies (uncertainty range: 0.89-1.60 million; 8.5 cases per 1,000 live births) were estimated to have developed NE associated with intrapartum events, with 96% born in low- and middle-income countries, as compared with 1.60 million in 1990 (11.7 cases per 1,000 live births). An estimated 287,000 (181,000-440,000) neonates with NE died in 2010; 233,000 (163,000-342,000) survived with moderate or severe neurodevelopmental impairment; and 181,000 (82,000-319,000) had mild impairment. In GBD2010, intrapartum-related conditions comprised 50.2 million DALYs (2.4% of total) and 6.1 million YLDs.
  
  
  CONCLUSIONS
  Intrapartum-related conditions are a large global burden, mostly due to high mortality in low-income countries. Universal coverage of obstetric care and neonatal resuscitation would prevent most of these deaths and disabilities. Rates of impairment are highest in middle-income countries where neonatal intensive care was more recently introduced, but quality may be poor. In settings without neonatal intensive care, the impairment rate is low due to high mortality, which is relevant for the scale-up of basic neonatal resuscitation.
authors.affiliation: Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Anne C C
authors.initials: AC
authors.lastname: Lee
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Naoko
authors.initials: N
authors.lastname: Kozuki
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Blencowe
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.affiliation: The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors.forename: Adil
authors.initials: A
authors.lastname: Bahalim
authors.affiliation: Family Health Division, Bill and Melinda Gates Foundation, Seattle, Washington.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine and Center for Global Health, Colorado School of Public Health, Aurora, Colorado.
authors.forename: Susan
authors.initials: S
authors.lastname: Niermeyer
authors.affiliation: Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ellis
authors.affiliation: Institute for Women's Health, University College London, London, UK.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Robertson
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.affiliation: 1] MARCH (Maternal Reproductive & Child Health) Centre, London School of Hygiene and Tropical Medicine, London, UK [2] Saving Newborn Lives/Save the Children, Washington, DC.
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
mesh_terms: D001238:Asphyxia Neonatorum / Q000150:complications / Q000453:epidemiology* / Q000266:history; D002493:Central Nervous System Diseases / Q000151:congenital* / Q000453:epidemiology* / Q000209:etiology / Q000266:history; D005260:Female; D014943:Global Health / Q000266:history / Q000706:statistics & numerical data*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D009017:Morbidity; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate