Is Birth Asphyxia Decreasing?

Is Birth Asphyxia Decreasing?

Dzakpasu S, Joseph KS, Huang L, et al. Decreasing Diagnoses of Birth Asphyxia in Canada: Fact or Artifact. Pediatrics. 2009 Apr;123(4):e668-72. [Full text] [PDF]

OBJECTIVE. We assessed temporal trends in birth asphyxia in Canada, to determine whether changes were real or secondary to changes in coding.

METHODS. We used data from the Canadian Institute for Health Information Discharge Abstract Database to study the national incidence of birth asphyxia, by using International Classification of Diseases codes. We also studied birth asphyxia by using data from the Nova Scotia Atlee Perinatal Database. In the Nova Scotia Atlee Perinatal Database, we defined a case of birth asphyxia as a live birth with an Apgar score at 5 minutes of 3, depression at birth requiring resuscitation with a mask for 3 minutes and/or intubation, or neonatal postasphyctic seizures.

RESULTS. Nationally, between 1991 and 2005, the incidence of birth asphyxia decreased significantly, from 43.8 to 2.4 cases per 1000 live births. The rate of decrease was highest between 1991 and 1998, corresponding to a period when strict Canadian and international criteria for the diagnosis of birth asphyxia were published. By comparison, neither national rates of related diagnoses nor Nova Scotia birth asphyxia rates, which ranged from 8.8 to 14.3 cases per 1000 live births, showed evidence of a decrease during the study period.

CONCLUSIONS. Comparisons of national trends in birth asphyxia diagnoses and trends in conditions associated with birth asphyxia, both nationally and in Nova Scotia, suggest that the dramatic decrease in the diagnosis of birth asphyxia is an artifact of changes in the use of International Classification of Diseases coding associated with the publication of stricter diagnostic definitions of birth asphyxia. We conclude that International Classification of Diseases codes are not useful for surveillance of birth asphyxia.

Comments. Rates of birth asphyxia appear to have decreased dramatically in several countries, most likely due to increases in cesarean delivery and labor induction rates and fetal heart monitoring. Another explanation for the reported decrease in birth asphyxia rates is related to changes in labeling and coding, given an evolution of concepts related to the definition of birth asphyxia and increasing awareness of the potential for litigation. This results in utilizing stricter diagnostic criteria for birth asphyxia that may contribute to the large decreases in the rates of birth asphyxia.
In this paper, the authors studied the temporal trends in birth asphyxia among live births by using International Classification of Diseases (ICD) diagnoses for 10 of 13 provinces and territories in Canada and by using a composite clinical definition of birth asphyxia for the province of Nova Scotia. The authors found that the dramatic decrease in the diagnosis of birth asphyxia is an artifact of changes in the use of ICD coding associated with the publication of stricter diagnostic definitions of birth asphyxia. They concluded that ICD codes were not useful for surveillance of birth asphyxia. SAA

Additional Comments:

Date: 04 May 2009
Time: 08:12:55

I agree completely with that the strict definition of asphyxia which is favoring the obstetric people made an artifactual decrease in asphyxia. We introduced the term of "depressed" baby for those not fulfilling the criteria for asphyxia depending on clinical, cord gas, Apgar, and later behavior. We found an increase in depressed babies that compensates for the decrease in asphyxia.

UserName: NIJEM SAID ,MD
Institution: prince hamza hospital-jordan
telephone: 00962795901414
email: nijemsaidmd@yahoo.ca

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