Prognostic Factors for Neonatal Mortality with Perinatal Asphyxia in a Neonatal Intensive Care Unit

Abstract

Perinatal asphyxia is a complicated health problem in newborns and leads to increased neonatal mortality. In Thailand, perinatal asphyxia has been the most common cause of severe morbidity and mortality for the past 10 years. If the prognostic factors of death were known in severe perinatal asphyxia cases requiring neonatal intensive care unit (NICU) admission, the treatment could be planned more efficiently. The objective of this retrospective case-control research was to identify the prognostic factors of neonatal mortality with perinatal asphyxia in NICU. The study was conducted on 120 newborns (60 dead cases and 60 survived controls) undergoing treatment for perinatal asphyxia in the NICU of Chonburi Hospital from January 2018 to December 2021. The risk factors for perinatal asphyxia mortality were identified using multiple logistic regression. A prognostic model was created by using the coefficient of the regression weighted scores of significant risk factors to predict the chance of mortality. The results showed that the prognostic factors affecting mortality were: female (OR 3.60, 95%CI 1.21-10.65, p<0.05), requirement for advanced neonatal resuscitation (OR 3.72, 95%CI 1.14-12.17, p<0.05), and severe acidosis (OR 4.58, 95%CI 1.53-13.70, p<0.05). The predictive model was developed by applying scores of 1, 2 and 2, respectively, for these significant risk factors. With the cutoff point of 3 from the model, the probability of death within 28 days was approximately 60% with a hazard ratio of 6.82, 95%CI 3.82-12.20, and p<0.05.