A PROSPECTIVE AUTOPSY STUDY OF MORPHOLOGICAL CENTRAL NERVOUS SYSTEM CHANGES IN BIRTH-ASPHYXIATED BABIES IN IBADAN, NIGERIA

Abstract

BACKGROUND:
Birth asphyxia is the third major cause of neonatal death after infections and preterm births in
developing countries, but there have been no previous post-mortem studies to document the
morphological central nervous system changes among babies with birth asphyxia in this
environment
AIM:
To determine morphological patterns of central nervous system changes following birth
asphyxia and to ascertain the proportional mortality of neonatal deaths due to birth asphyxia.
METHODS:
Fifty cases including foetuses that were stillborn and neonates with Apgar score of less than 7
at 5 minutes that subsequently died during the neonatal period between January 2006 and
February 2007 were autopsied. The gender, gestational age, weight, crown-heel length, the
booking status of the mothers and the underlying clinical condition were noted. The gross and
microscopic central nervous system changes were documented. These indices were subjected
to statistical analysis using Chi-square test.
RESULTS:
The major morphological findings were subarachnoid, subgaleal, intraventricular and
subdural haemorrhages. Important microscopic lesions were germinal matrix haemorrhage,
spongiform change of the white matter, basal ganglia and the cortex. Involvement of the
parasagittal region and cortical spongiform change were more significant in males than
females (p = 0.004) and (p = 0.019) respectively. However caudate nucleus involvement was
more significant in females (p = 0.022). Intraventricular haemorrhage and germinal matrix
haemorrhage were both associated with significantly shorter survival among children with
birth asphyxia (p = 0.004) and (p = 0.004) respectively. The proportionate mortality of
neonatal deaths due to birth asphyxia was 24.9%.
CONCLUSION:
Morphological central nervous system changes following birth asphyxia as documented by
this study do not differ significantly from changes that have been noted from previous studies
done in other countries.

A PROSPECTIVE AUTOPSY STUDY OF MORPHOLOGICAL CENTRAL NERVOUS SYSTEM CHANGES IN BIRTH-ASPHYXIATED BABIES IN IBADAN, NIGERIA