Risk Factors and Short-Term Outcomes of Birth Asphyxia among Newborns at a Tertiary Hospital: A Prospective Cohort Study

Abstract

Background: Birth asphyxia remains a leading cause of neonatal mortality and long-term neurodevelopmental disability in sub-Saharan Africa. Identifying modifiable maternal, intrapartum and neonatal risk factors is essential to inform prevention strategies. This study determined the risk factors and short-term outcomes of birth asphyxia among newborns at a tertiary hospital in Tanzania. Methods: A prospective cohort study was conducted between January 2024 and December 2025. A total of 192 neonates diagnosed with birth asphyxia (5- minute Apgar score <7 and/or need for resuscitation beyond initial steps) were enrolled and followed until discharge or death. Maternal, antepartum, intrapartum and neonatal variables were recorded. Outcomes assessed included in-hospital mortality and major morbidities. Multivariable logistic regression identified independent predictors of mortality. Results: Birth asphyxia occurred in 192 of 4,820 live births during the period (incidence 39.8 per 1,000 live births). Mean gestational age was 38.4 ± 2.6 weeks; mean birth weight was 2,940 ± 612 g. Risk factors identified included prolonged labour in 76 (39.6%), obstructed labour in 38 (19.8%), pre-eclampsia/eclampsia in 32 (16.7%), antepartum haemorrhage in 22 (11.5%), meconium-stained liquor in 78 (40.6%) and inadequate antenatal care in 86 (44.8%). Hypoxic-ischaemic encephalopathy developed in 124 neonates (64.6%), with stage II in 56 (29.2%) and stage III in 28 (14.6%). In-hospital mortality was 29.7% (57 of 192). Independent predictors of mortality were HIE stage III (aOR 9.84, 95% CI 4.12–23.52), 5- minute Apgar <4 (aOR 6.86, 95% CI 2.94–16.04), birth weight <2500 g (aOR 3.42, 95% CI 1.52–7.68) and need for mechanical ventilation (aOR 4.62, 95% CI 2.04–10.46). Conclusion: Birth asphyxia is common at this Tanzanian tertiary centre, with mortality of nearly 30%. Modifiable obstetric and antenatal-care factors contribute substantially, underscoring the urgency of improving emergency obstetric care, antenatal coverage, intrapartum monitoring and neonatal resuscitation training.