SYNERGISTIC EFFECTS OF BIRTH ASPHYXIA AND NEONATAL SEPSIS ON MORTALITY IN PRETERM INFANTS
Main Article Content
Keywords
Preterm infants, birth asphyxia, neonatal sepsis, synergistic mortality, neonatal intensive care.
Abstract
ABSTRACT
Background: Preterm infants are at high risk of mortality due to complications such as birth asphyxia and neonatal sepsis. While both conditions independently increase mortality, their combined effect remains underexplored. This study investigates whether their co-occurrence leads to a synergistic increase in mortality risk among preterm neonates.
Methods: A hospital-based retrospective cohort study was conducted at the Neonatal Intensive Care Unit of Sindh Rangers Hospital, Karachi, from June 2023 to May 2024. A total of 400 preterm infants (<37 weeks gestation) were stratified into four groups: birth asphyxia only, neonatal sepsis only, both conditions, and controls (neither condition). Birth asphyxia was defined by APGAR ≤5 at 5 minutes and/or hypoxic-ischemic encephalopathy, while sepsis was diagnosed via culture or clinical criteria. Multivariate logistic regression and interaction analyses (RERI, AP, SI) were used to assess synergistic mortality risk, adjusting for gestational age, birth weight, and other confounders.
Results: Infants with both birth asphyxia and sepsis had the highest mortality (48.7%) compared to those with asphyxia alone (23.9%), sepsis alone (25.5%), or controls (7.4%). Adjusted analyses confirmed a synergistic effect (adjusted OR = 9.84, 95% CI: 4.21–23.01). Interaction measures demonstrated significant excess risk (RERI = 4.21, 95% CI: 1.89–6.53; AP = 0.42, 95% CI: 0.28–0.56; SI = 2.15, 95% CI: 1.47–3.14). Extremely preterm (<30 weeks) and very low birth weight (<1500g) infants exhibited the most pronounced synergistic mortality.
Conclusion: The co-occurrence of birth asphyxia and neonatal sepsis has a synergistic effect on mortality in preterm infants, exceeding their individual risks. These findings underscore the need for integrated clinical strategies to manage high-risk neonates with both conditions, particularly in resource-limited settings.
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Dr Farhat Ali
MBBS. FCPS (PEADS). Paediatric Consultant, Sindh Rangers Hospital Karachi, 03332316188
Dr Naseem Khalid
FCPS Paediatrics Resident at Children Hospital Quetta,
Abdul Hameed Radhan
MBBS, FCPS, CHPE, Associate Professor Department of Paediatrics Liaquat University of Medical and Health Sciences Jamshoro,
Noorullah Ahmed Shaikh
MBBS (Final Year), Liaquat University of Medical and Health Sciences/Jamshoro (LUMHS
Zamir Ahmed Qambrani
MBBS FCPS, CHPE, Assistant Professor Department of Paediatrics Liaquat University of Medical and Health Sciences Jamshoro, Sindh,
Dr Bilal Masood
Assistant Professor, Department of Community Medicine, Bolan Medical College, Quetta
Muhammad Hashir Khan
MBBS (Final Year), Liaquat University of Medical and Health Sciences/Jamshoro LUMHS),
Mir Mehrab Jan Khetran
MBBS (Final Year) Liaquat University of Medical and Health Sciences/Jamshoro (LUMHS)
Chandan Singh
MBBS ( Final Year) Liaquat University of Medical and Health Sciences/Jamshoron( LUMHS)
Laiba Asif
MBBS (Final Year) Liaquat University of Medical and Health Sciences/Jamshoro (LUMHS)