Wudu Muluken Amare, Wondifraw Endalik Birrie, Getaneh Fekadeselassie Belege, Hailu Molla Kassa, Belete Melaku Ashagrie, Yosef Selamyhun Tadesse, Bekalu Yemane Eshetu, Birhanu Tarikua Afework
Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, P. O. Box 1145, Dessie, 1145, Ethiopia.
Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia.
BMC Pediatr. 2025 Feb 26;25(1):140. doi: 10.1186/s12887-025-05481-3.
Birth asphyxia is the second leading cause of neonatal mortality worldwide, including in Ethiopia, and remains a significant public health concern. Despite the availability of national data on neonatal mortality in Ethiopia, there remains a gap in understanding the specific incidence and predictors of mortality among asphyxiated neonates. To address this information gap, this meta-analysis was conducted to assess the incidence and predictors of mortality among asphyxiated neonates in Ethiopia.
This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Relevant studies were identified through various databases, including PubMed, CINAHL, Scopus, EMBASE, and Google Scholar. Data analysis of pooled estimates for mortality incidence and its predictors was performed via STATA 17 software with the DerSimonian and Laird model. Heterogeneity was assessed via Cochrane's Q-test and the I² statistic. Additionally, publication bias was evaluated through funnel plots, Egger's test, and Doi plots.
Out of 68 identified studies, only 10 met the eligibility criteria, including a total of 4,866 participants. The pooled incidence rate of birth asphyxia mortality was 4 per 100 person-days (95% CI: 3-5), which was 35,754 person-days of observation. Furthermore, predictors of birth asphyxia mortality included: pregnancy complications (HR 1.52, 95% CI: 1.41-1.64), labor complications (HR 1.29, 95% CI: 1.15-1.44), severe hypoxic-ischemic encephalopathy (HR 1.67, 95% CI: 1.51-1.85), neonatal seizures (HR 1.23, 95% CI: 1.11-1.38), and comorbidities in neonates (HR 1.31, 95% CI: 1.24-1.39).
In the current study, the pooled incidence of birth asphyxia mortality was high, falling short of the Sustainable Development Goals target and highlighting the need for immediate intervention. Additionally, pregnancy and labor complications, severe hypoxic-ischemic encephalopathy, neonatal seizures, and neonatal comorbidities were identified as predictors of birth asphyxia mortality. These findings underscore the urgent need to enhance early detection and intervention for pregnancy- and labor-related complications, as well as severe neonatal complications related to asphyxia, in to reduce mortality.
出生窒息是全球新生儿死亡的第二大主要原因，在埃塞俄比亚亦是如此，仍然是一个重大的公共卫生问题。尽管埃塞俄比亚有关于新生儿死亡率的国家数据，但在了解窒息新生儿的具体死亡率及死亡预测因素方面仍存在差距。为填补这一信息空白，开展了这项荟萃分析，以评估埃塞俄比亚窒息新生儿的死亡率及死亡预测因素。
本系统评价和荟萃分析按照PRISMA指南进行。通过包括PubMed、CINAHL、Scopus、EMBASE和谷歌学术在内的各种数据库识别相关研究。使用DerSimonian和Laird模型，通过STATA 17软件对死亡率及其预测因素的合并估计值进行数据分析。通过Cochrane Q检验和I²统计量评估异质性。此外，通过漏斗图、Egger检验和Doi图评估发表偏倚。
在68项已识别的研究中，只有10项符合纳入标准，共纳入4866名参与者。出生窒息死亡率的合并发生率为每100人日4例（95%置信区间：3 - 5），观察天数为35754人日。此外，出生窒息死亡的预测因素包括：妊娠并发症（风险比1.52，95%置信区间：1.41 - 1.64）、分娩并发症（风险比1.29，95%置信区间：1.15 - 1.44）、重度缺氧缺血性脑病（风险比1.67，95%置信区间：1.51 - 1.85）、新生儿惊厥（风险比1.23，95%置信区间：1.11 - 1.38）以及新生儿合并症（风险比1.31，95%置信区间：1.24 - 1.39）。
在本研究中，出生窒息死亡率的合并发生率很高，未达到可持续发展目标的指标，凸显了立即进行干预的必要性。此外，妊娠和分娩并发症、重度缺氧缺血性脑病、新生儿惊厥以及新生儿合并症被确定为出生窒息死亡的预测因素。这些发现强调迫切需要加强对妊娠和分娩相关并发症以及与窒息相关的严重新生儿并发症的早期检测和干预，以降低死亡率。
