Globally four to nine million cases of newborn asphyxia occur each year. Despite major
advances in monitoring technology, obstetric care and knowledge of fetal and neonatal
pathologies, asphyxia remains a serious condition causing significant mortality and longterm
morbidity. More than a million newborns that survive asphyxia at birth develop longlasting
problems such as cerebral palsy, speaking, hearing and visual disabilities. The
role of the physiotherapist in the follow up, assessment and early intervention of at risk
infants is poorly researched and subject to much debate.
The aims of the study were two-fold. The primary aim was to determine the proportion of
neurodevelopmental sequelae in infants who suffered moderate to severe neonatal
asphyxia. The secondary aim was to describe the population regarding maternal,
neonatal and referral risk factors associated with asphyxia.
This retrospective descriptive study included a study population of all infants diagnosed
with grade II or III neonatal asphyxia admitted to the Pelonomi Hospital neonatal unit. All
subjects had to have had a physiotherapy neurodevelopmental assessment between the
ages of six weeks and twelve months of age. A total of 40 subjects were included in the
study. Five subjects were lost to follow up and five did not meet the inclusion criteria.
Information contained in the subjectsâ medical record and physiotherapy file were used
to complete a data form. The Data form contained the neurodevelopmental assessment
score (NDS), which served as the objective measure for neurodevelopmental outcome.
The NDS for the grade II and grade III subjects showed no statistical difference, whilst
there was a tendency towards the grade IIIâs having a higher score indicating poorer
developmental performance. The results indicated that 32% of the subjects presented
with neurodevelopmental sequelae following moderate to severe birth asphyxia.
In terms of risk factors this study found that hypertensive disease of pregnancy and
intrauterine growth restriction were the most prevalent maternal risk factors. Neonatal risks indicated the majority of subjects had low (< 7) Apgar scores at both five and ten
minutes of life. Five infants required mechanical ventilation following initial resuscitation.
In 41% of the subjects, mothers resided outside of Bloemfontein at the time of the birth,
and 37% of the deliveries occurred at a primary health care facility. Of the subjects 62%
were delivered vaginally and 38% via caesarian section.
In conclusion the study indicates that developmental sequelae are common in this study
population. In some cases developmental delays were observed as early as six weeks of
age. Neurological impairments however were only observed from nine months of age. It
would therefore be suggested that all moderate to severely asphyxiated infants be
followed up routinely and assessed by a physiotherapist for developmental problems
from six weeks of age and on. A routine assessment by an occupational and speech
therapist is also advised.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ufs/oai:etd.uovs.ac.za:etd-12072006-110801 |
| Date | 07 December 2006 |
| Creators | Smith, Robyn |
| Contributors | Dr AE van der Vyver, Me H Kriel |
| Publisher | University of the Free State |
| Source Sets | South African National ETD Portal |
| Language | en-uk |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.uovs.ac.za//theses/available/etd-12072006-110801/restricted/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University Free State or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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