Conclusions et recommandations
De cette étude, il ressort que l'incidence de l'ANN est
de 80,5 pour 1000 naissances vivantes à l'HGOPY avec un taux de
mortalité de 6,7%. La mère célibataire, le mauvais suivi
des grossesses, la survenue des pathologies pendant la grossesse et
l'apparition des signes et symptômes anormaux pendant l'accouchement
restent les facteurs de risques les plus prédisposants.
L'information et l'éducation de la jeune fille en
âge de procréer, l'amélioration du plateau technique, la
formation continue des sages femmes et du personnel accoucheur pour un meilleur
suivi de la grossesse et une meilleure prise en charge des nouveau-nés
en salle d'accouchement resteront l'assurance de l'amélioration de cette
situation.
SUMMARY
Introduction and objectives
WHO estimates the number of children born every year with
asphyxia at 4 million, amongst which 1 million die and an approximate equal
number survive with severe neurologic sequellae. This level varies from 36 to
240 per thousand in developing countries and from 6 to 46 per thousand in
developed countries. The objective of this study was to identify the risk
factors of birth asphyxia and the hospital outcome of these children at the
Yaounde Gynaeco-Obstretric and Pediatric Hospital (YGOPH) from May 2010 to
September 2010.
Material and methods
An analytic and descriptive prospective case control study on
term neonates delivered at the YGOPH, with an Apgar score less than 7 at the
5th minute as the cases and those with an Apgar score greater than
or equal to 7 at the 5th minute as controls. For all the neonates
included in the study, the following data was collected: age on admission,
weight, sex, term of the pregnancy, socio-demographic and obstetric
characteristics of the mother, the delivery outcome, Sarnat's score, time of
death if it occurred and duration of hospitalization. Data collected was
analyzed using SPSS version 12.0 and Stata version 8 softwares. The probability
threshold P = 0.05 was retained to characterize any statistically significant
results.
Results
We sampled a total of 1117 deliveries that occurred during the
study period, and 90 newborns had asphyxia giving an incidence of 80.5%o.
Amongst the maternal socio-demographic factors studied, only
the marital status statistically influenced significantly the occurrence of
birth asphyxia.
The statistically significant ante-partum risk factors for
birth asphyxia were: the place of antenatal visit, malaria during pregnancy,
and preeclampsia/eclampsia. The significant intra-partum risk factors found
were: prolonged labor, stationary labor, and term prolonged rupture of
membranes. As concerns outcome of all our patients, 6.7% died, 12.2% discharged
with neurological sequelae and/or an abnormal electroencephalography and
transfontanellar ultrasound. We noted that 5.6% of these deaths occurred during
the early neonatal period. Amongst the 90 cases of birth asphyxia, 44
developped a hypoxo-ischemic encephalopathy.
Malaria in pregnancy, preeclampsia/eclampsia, prolonged labor,
were the main factors that statistically influenced significantly the
occurrence of hypoxo-ischemic encephalopathy.
The mean duration of hospital stay of the asphyxiated neonates
was 6 days with range 2 to 20 days.
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