Avoidable factors and causes of neonatal deaths from perinatal asphyxia-hypoxia in South Africa: national perinatal survey

Abstract

Background: Fetal or neonatal hypoxia owing to asphyxia can result in death or severe irreversible brain damage. To prevent this, factors contributing to the development of fetal or neonatal hypoxia must be identified.

Aims: To determine the primary obstetric and neonatal causes or diagnoses and avoidable factors associated with death from asphyxia-hypoxia.

Methods: Data from a computerised database from 142 hospitals using the Perinatal Problem Identification Program in South Africa from October 1999 to September 2003 were analysed. All records of deaths from asphyxia-hypoxia were retrieved and analysed. Primary obstetric and neonatal causes or diagnoses and factors associated with these deaths were identified. Each case identified as having died from asphyxia-hypoxia was analysed for possible and probable avoidable factors.

Results: Among 4502 neonatal deaths weighing >999 g, 1459 (32.4%) were identified as being related to asphyxia-hypoxia. Intrapartum asphyxia was the most common diagnosis (72% of deaths). Hypoxic-ischaemic encephalopathy was identified as the main neonatal diagnosis in these deaths. The most common category of probable avoidable factors was health worker-related. Inadequate fetal monitoring was the most common health worker-related probable avoidable factor. Substandard care related to resuscitation was recorded infrequently, most likely because of inability to assess neonatal resuscitation.

Conclusions: Asphyxia-hypoxia is responsible for about one-third of neonatal deaths. Intrapartum asphyxia is the major primary obstetric cause of deaths from hypoxia. A third of the deaths were judged to be preventable.