Declining Diagnosis of Birth Asphyxia in California: 1991-2000

Birth asphyxia is recognized as an important cause of neonatal morbidity and mortality. Whether advances in perinatal care have altered the incidence of birth asphyxia is unknown. We determined the incidence of birth asphyxia diagnoses made over a 10-year period in California. In a population-based...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2004-12, Vol.114 (6), p.1584-1590
Main Authors: Wu, Yvonne W, Backstrand, Kendall H, Zhao, Shoujun, Fullerton, Heather J, Johnston, S. Claiborne
Format: Article
Language:English
Subjects:
Asphyxia
Asphyxia Neonatorum - epidemiology
Asphyxia Neonatorum - ethnology
Asphyxia Neonatorum - mortality
Biological and medical sciences
Birth Weight
Births
California - epidemiology
Databases, Factual
Diagnosis
Encephalopathy
Female
General aspects
Health aspects
Humans
Incidence
Infant mortality
Infant, Newborn
Infants
International Classification of Diseases
Male
Medical diagnosis
Medical sciences
Morbidity
Patient Discharge
Pediatrics
Retrospective Studies
Risk Factors
Sex Factors
Socioeconomic Factors
Suffocation
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Summary:Birth asphyxia is recognized as an important cause of neonatal morbidity and mortality. Whether advances in perinatal care have altered the incidence of birth asphyxia is unknown. We determined the incidence of birth asphyxia diagnoses made over a 10-year period in California. In a population-based retrospective cohort study of 5,364,663 live births, we determined the incidence and case fatality of birth asphyxia between 1991 and 2000. Using a statewide administrative hospital discharge database, we identified all newborn admissions that generated a diagnosis of birth asphyxia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 768.5, 768.6, or 768.9) or a diagnosis that overlaps with birth asphyxia, such as congenital encephalopathy or fetal distress. We determined incidence and in-hospital case fatality rates adjusted for birth weight and demographic characteristics and stratified by associated perinatal complications. The 24 330 newborns who received a diagnosis of birth asphyxia yielded a population incidence of 4.5 per 1000 live births. Black ethnicity (relative risk [RR]: 1.3; 95% confidence interval [CI]: 1.2-1.3), male gender (RR: 1.2; 95% CI: 1.1-1.2), and low socioeconomic status (RR: 1.2; 95% CI: 1.1-1.2) all were associated with increased risk. The diagnosis of birth asphyxia decreased by 91% from 14.8 to 1.3 per 1000 live births during the study years. This decrease could not be explained by an increased diagnosis of overlapping conditions. Overall case fatality was 4%, and the majority of deaths in infants >2000 g occurred in the presence of congenital anomalies, cord abnormalities, or maternal hemorrhage. In newborns
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2004-0708