Incidence and characteristics of neonatal birth injuries in Maiduguri North-Eastern Nigeria
Background: Birth injury is defined as impairment of neonate’s body function that occur due to mechanical forces during the process of delivery. Incidence of birth injury varies from place to place, with place of delivery, experience of birth attendants, and mode of delivery.
Objective: To determine the incidence, characteristics of birth injury in the Special Care Baby Unit of the University of Maiduguri Teaching Hospital (UMTH).
Subjects and methods: This is a prospective observational study that was conducted in a Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital. The subjects were recruited between 1st January, 2016 and 31st December, 2016. Neonatal birth injury was diagnosed based on paediatrician or senior registrar examination. Demographic variables: maternal age, maternal weight, and height, reproductive and labour variables: prenatal care, parity, gestational age, presence and duration of PROM, duration of labour, type of delivery, and skill of delivery attendance, while neonatal variables, includes: neonatal age, sex, birth weight, length, Apgar score, and type of birth injury. The treatment administered to the patients were either medical management such exchange blood transfusion in case of severe Jaundice complicating cephalhaematoma and/or simple transfusion for anaemia without complication, phototherapy, antibiotics, among others, or surgical/orthopaedic treatment in the presence of surgical injury. Statistical analysis was done using SPSS version 16 (SPSS Inc., Illinois, Chicago USA). A P-value <0.05 was considered statistically significant.
Results: Sixty one out of 1078 admitted to SCBU during the 12 months period of the study had different types of birth injuries giving an incidence of 5.7/1000 live births, p < 0.0001. Soft tissue injury constituted the majority accounting for 37/61 (60.7%), closely follo wed by subconjunctival haemorrhages 25/61 (41.0%). Severe perinatal asphyxia also constituted significant proportion of the birth injury 24/61 (39.3%). Other central nervous system (CNS) birth injuries includes facial nerve palsy and Erb’s palsy 13.1% each. The commonest of the fractures was femoral bone fracture 9/61 (14.8%), followed by clavicular fracture 5/61 (8.2%). It was revealed that urea 2.5 mmol/L, total serum bilirubin (TSB) 12.4 μmol/L and random blood sugar 2.6mmol/L were deranged in those neonates with three or more birth injuries and all the three parameters were statistically significant p<0.05. The common complications encountered in these patients were jaundice, anaemia and sepsis though were not statistically significant P >0.05. Four patients died, two with internal organ injury were, of which one with splenic rupture and the other one with liver damage in addition to severe perinatal asphyxia died while the remaining two patients with severe perinatal asphyxia also died with mortality rate of 6.6%.
Conclusion: The incidence of birth injury has decreased overtime especially in the affluent economy where obstetric and perinatal diagnosis has remarkably improved, but in the developing economy like ours as demonstrated in this study such an improvement is yet to be achieved. However education of the general populace especially the pregnant women so that they attend antenatal care and deliver at health facility with skilled health personnel will remarkably reduce birth injury.
Keywords: Neonatal, birth injury, incidence, Maiduguri