Developmental trajectories of children with birth asphyxia through 36 months of age in low/low-middle income countries

Abstract

Background: Resuscitation following birth asphyxia reduces mortality, but may be argued to increase risk for neurodevelopmental disability in survivors.

Aims: To test the hypothesis that development of infants who received resuscitation following birth asphyxia is not significantly different through 36months of age from infants who had healthy births.

Study design: Prospective observational cohort design comparing infants exposed to birth asphyxia with resuscitation or healthy birth.

Subjects: A random sample of infants with birth asphyxia who received bag-and-mask resuscitation was selected from birth records in selected communities in 3 countries.

Exclusion criteria: birth weight<1500g, severely abnormal neurological examination at 7days, mother<15years, unable to participate, or not expected to remain in the target area. A random sample of healthy-birth infants (no resuscitation, normal neurological exam) was also selected. Eligible=438, consented=407, and ≥1 valid developmental assessment during the first 36months=376.

Outcome measure(s): Bayley Scales of Infant Development-II Mental (MDI) and Psychomotor (PDI) Development Index.

Results: Trajectories of MDI (p=.069) and PDI (p=.143) over 3 yearly assessments did not differ between children with birth asphyxia and healthy-birth children. Rather there was a trend for birth asphyxia children to improve more than healthy-birth children.

Conclusions: The large majority of infants who are treated with resuscitation and survived birth asphyxia can be expected to evidence normal development at least until age 3. The risk for neurodevelopmental disability should not justify the restriction of effective therapies for birth asphyxia.

Keywords: Birth asphyxia; Developmental outcomes; Low resource countries; Neurodevelopmental disability; Resuscitation.