Prevelance of neurodevelopmental sequelae in infants who suffered moderate to severe neonatal asphyxia
Globally four to nine million cases of newborn asphyxia occur each year. Despite major advances in monitoring technology, obstetric care and knowledge of fetal and neonatal pathologies, asphyxia remains a serious condition causing significant mortality and longterm morbidity. More than a million newborns that survive asphyxia at birth develop longlasting problems such as cerebral palsy, speaking, hearing and visual disabilities. The role of the physiotherapist in the follow up, assessment and early intervention of at risk infants is poorly researched and subject to much debate. The aims of the study were two-fold. The primary aim was to determine the proportion of neurodevelopmental sequelae in infants who suffered moderate to severe neonatal asphyxia. The secondary aim was to describe the population regarding maternal, neonatal and referral risk factors associated with asphyxia. This retrospective descriptive study included a study population of all infants diagnosed with grade II or III neonatal asphyxia admitted to the Pelonomi Hospital neonatal unit. All subjects had to have had a physiotherapy neurodevelopmental assessment between the ages of six weeks and twelve months of age. A total of 40 subjects were included in the study. Five subjects were lost to follow up and five did not meet the inclusion criteria. Information contained in the subjects’ medical record and physiotherapy file were used to complete a data form. The Data form contained the neurodevelopmental assessment score (NDS), which served as the objective measure for neurodevelopmental outcome. The NDS for the grade II and grade III subjects showed no statistical difference, whilst there was a tendency towards the grade III’s having a higher score indicating poorer developmental performance. The results indicated that 32% of the subjects presented with neurodevelopmental sequelae following moderate to severe birth asphyxia. In terms of risk factors this study found that hypertensive disease of pregnancy and intrauterine growth restriction were the most prevalent maternal risk factors. Neonatal risks indicated the majority of subjects had low (< 7) Apgar scores at both five and ten minutes of life. Five infants required mechanical ventilation following initial resuscitation. In 41% of the subjects, mothers resided outside of Bloemfontein at the time of the birth, and 37% of the deliveries occurred at a primary health care facility. Of the subjects 62% were delivered vaginally and 38% via caesarian section. In conclusion the study indicates that developmental sequelae are common in this study population. In some cases developmental delays were observed as early as six weeks of age. Neurological impairments however were only observed from nine months of age. It would therefore be suggested that all moderate to severely asphyxiated infants be followed up routinely and assessed by a physiotherapist for developmental problems from six weeks of age and on. A routine assessment by an occupational and speech therapist is also advised.