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Birth Asphyxia in a Paediatric Patient in Sub-Saharan Africa.

Birth Asphyxia in a Paediatric Patient in Sub-Saharan Africa.

Patient details
Patient details.
M, a 3-day-old male neonate born at a rural health center in Malawi.
Patient case fields
Presenting Complaint

 M was brought to the neonatal ward due to concerns about lethargy, poor feeding, and breathing difficulties since birth. His mother reports that he has not been breastfeeding well and seems weaker than other new-borns she has seen.

History

M was delivered at full term via emergency caesarean section after prolonged labor. His mother had limited access to antenatal care. At birth, M did not cry immediately and required resuscitation, including bag-mask ventilation, for several minutes. He was transferred to the neonatal unit after stabilization. Apgar scores were recorded as 3 at 1 minute, 5 at 5 minutes, and 6 at 10 minutes.

Examination

Vitals: Heart rate 120 bpm, respiratory rate 65 breaths per minute, oxygen saturation 89% on room air.

Neurological Exam: Decreased muscle tone, weak cry, and poor reflexes (Moro and sucking reflexes absent). Episodes of intermittent twitching movements in the arms, suggestive of seizures.

Respiratory Exam: Shallow breathing with mild chest retractions.

 

Other Systems: Mild jaundice, no dysmorphic features, normal abdominal exam.

Investigations

A blood glucose test revealed mild hypoglycaemia (2.2 mmol/L).

An arterial blood gas showed metabolic acidosis.

Cranial ultrasound revealed signs of hypoxic-ischemic encephalopathy (HIE).

Diagnosis

M was diagnosed with birth asphyxia leading to hypoxic-ischemic encephalopathy (HIE), likely secondary to prolonged labour and delayed access to appropriate obstetric care.

Management Plan
  1. Immediate Care: M was placed on supplemental oxygen and started on anticonvulsants (phenobarbital) for seizure control. Intravenous fluids were administered to correct hypoglycaemia and support hydration.
  2. Neuroprotective Measures: The medical team considered therapeutic hypothermia for neuroprotection, though access to such specialized care is limited in rural Malawi.
  3. Supportive Care: M was provided with nutritional support via nasogastric feeding due to poor sucking and continued monitoring in the neonatal intensive care unit (NICU).
  4. Family Education and Follow-up: The family was educated on the importance of follow-up care to monitor for potential long-term neurological complications, including developmental delays and cerebral palsy.
Prognosis

M’s long-term outcome is uncertain, as his recovery will depend on the extent of brain injury and access to rehabilitation services. Early intervention may improve his chances of achieving developmental milestones, though access to specialized care remains a challenge in rural areas of sub-Saharan Africa.

Discussion
No data was found
Questions
1. What is the most likely diagnosis for M, given his history of poor feeding, lethargy, and delayed crying at birth?

(a). Neonatal sepsis

(b). Neonatal hypoglycaemia

(c). Birth asphyxia with hypoxic-ischemic encephalopathy (HIE)

(d). Congenital heart disease

2. Which of the following is a common neurological finding in newborns with hypoxic-ischemic encephalopathy (HIE)?

(a). Hypertonia

(b). Weak cry and poor reflexes

(c). Hyperreflexia

(d). Normal Moro reflex

3. What is the most appropriate initial treatment for M’s seizures in the context of birth asphyxia?

a). Antibiotics

b). Phenobarbital

c). Steroids

d). Vitamin K

4. What long-term complication is M at risk of developing due to birth asphyxia?

a). Asthma

b). Cerebral palsy

c). Diabetes

d). Neonatal jaundice

Reveal answers

Answers

  1. c) Birth asphyxia with hypoxic-ischemic encephalopathy (HIE)
  2. b) Weak cry and poor reflexes
  3. b) Phenobarbital
  4. b) Cerebral palsy