ORIGINAL  
Niger J Paed 2013; 40 (3): 206 - 210  
Perinatal asphyxia in a specialist  
hospital in Port Harcourt, Nigeria  
West BA  
Opara PI  
DOI:http://dx.doi.org/10.4314/njp.v40i3,1  
Accepted: 7th December 2012  
Abstract Objectives: To find the  
prevalence, and identify risk fac-  
tors and outcome in neonates who  
were admitted into the Braithe-  
waite Memorial Specialist Hospi-  
tal (BMSH) for perinatal as-  
phyxia.  
Method: This was a descriptive  
cross sectional observational  
study of neonates with low Apgar  
scores admitted over a period of  
ten months into the Special Care  
Baby Unit of the BMSH.  
All babies with Apgar scores less  
than six at one minute and for  
whom consent was obtained were  
recruited consecutively. For out-  
born babies with no Apgar score  
recording, a history of poor cry  
from birth with either poor colour,  
respiratory distress, floppiness or  
loss of primitive reflexes were  
used.  
Results: One hundred and fifty  
seven of 630 babies admitted had  
perinatal asphyxia giving a preva-  
lence of 29.4%. Mean gestational  
age of affected babies was  
Sixty two (39.5%) of their mothers  
had no antenatal care (ANC).  
Mode of delivery in 98 (62.4%)  
was caesarian section, of which 80  
(81.6%) were emergencies, many  
of whom had complications before  
presentation. One hundred and  
seven (68.2%) and 38(24.2%) ba-  
bies, had Apgar Score of 4-5 and 0  
-3 in one minute respectively. The  
commonest risk factors were  
cephalopelvic disproportion (CPD)  
in the mothers and abnormal pres-  
entation, predominantly breech in  
the fetus. 31.6% of those with se-  
vere perinatal asphyxia died.  
Conclusion: Prevalence of perina-  
tal asphyxia is high. Lack of ANC,  
CPD and breech presentation were  
contributory factors. There is  
urgent need for maternal education  
on need for ANC, early interven-  
tion and skilled care of babies at  
birth.  
(
)
West BA  
Department of Paediatrics,  
University of Port Harcourt Teaching  
Hospital. Port Harcourt, Rivers State.  
E-mail: peaceibo@yahoo.com.au  
Tel: +2348037078844  
Opara PI  
Department of Paediatrics, Braithewaite  
Memorial Specialist Hospital,  
Port Harcourt. Rivers State  
Key words: perinatal asphyxia,  
newborns, specialist hospital  
3
6.84±3.67 weeks, and mean birth  
weight was 3.0±0.9kg.  
Introduction  
burden of long-term neurological disability and impair-  
ment. Following improvements in primary and obstetric  
3
Perinatal asphyxia is a common neonatal problem and  
contributes significantly to neonatal morbidity and mor-  
tality. According to latest estimates by World Health  
Organization (WHO), of the 130 million infants born  
globally each year, approximately 4 million babies die  
care in most industrialized countries, the incidence of  
birth asphyxia has reduced significantly and less than  
0.1% newborn infants die from perinatal asphyxia. In  
developing countries however, rates of perinatal as-  
phyxia are6-s8till high, and case fatality rates may be 40%  
or higher.  
5
1
before they reach the age of one month . Ninety-eight  
percent of these neonatal deaths take place in the devel-  
oping countries with perinatal asphyxia and birth inju-  
ries together contributing to almost 29% of these  
This story aims to explore the prevalence, recognize risk  
factors and outcome in neonates who were admitted into  
a specialist hospital for perinatal asphyxia.  
1
deaths . Most of the births in developing countries occur  
at home, usually attended by untrained birth attendants.  
Birth asphyxia or more encompassing, perinatal as-  
phyxia is estimated to be the fifth largest cause of under-  
five child deaths (8.5%), after pneumonia, diarrhoea,  
Methodology  
2
neonatal infections and complications of preterm birth .  
This was a descriptive cross-sectional observational  
study of all newborns (0-28 days) with low Apgar scores  
admitted between 1 February to 30 October, 2011 into  
the Special Care Baby Unit (SCBU) of the Braithwaite  
It accounts for an estimated 0.92 -1.2 million neonatal  
deaths annually and is assoc3-i4ated with another 1.1 mil-  
lion intrapartum stillbirths , as well as an unknown  
st  
th  
2
07  
Memorial Specialist Hospital (BMSH) in Port Harcourt.  
The BMSH is the specialist hospital of the Rivers State  
Government, in Nigeria. It serves as a primary and terti-  
ary care centre for the state as well as a referral centre  
for all the 23 Local Government areas of the state. It  
also offers free medical services for all children 0-5  
years and pregnant women.  
3.0 ± 0.9kg (0.7- 5.6kg) while the mean gestational age  
was 36.84 ± 3.67weeks (24 – 44weeks).  
Apgar score recording of 4-5 at one minute (moderate  
perinatal asphyxia) was observed in 107 (68.2%) neo-  
nates, 38 (24.2%) had Apgar score 0-3 at one minute  
(severe perinatal asphyxia) while 12 (7.6%) did not have  
any Apgar score recording. Of 157 neonates with peri-  
natel asphyxia 142(90.4%) were inborn while 15(9.6%)  
where outborn. There were 2255 live birth during the  
period of study giving a hospital base incidence rate of  
perinatal asphyzia in BMSH as 63.0 per 1000 live births.  
Of 2255 babies delivered to 2252 mothers, 2249  
(99.7%) babies were of singleton gestation while 6  
The SCBU of the hospital comprises an inborn ward and  
an outborn ward. Babies whose mothers were booked in  
BMSH or in any of the health centers owned by the  
State Government and delivered in BMSH are admitted  
into the inborn wards. All other babies are admitted into  
the out born ward.  
(
0.3%) of multiple gestation (3 sets of twin deliveries).  
All babies with low Apgar scores. less than six at one  
minute and whose parents/caregivers gave consent for  
inclusion into the study were recruited consecutively  
during the period of study. For outborn babies with no  
Apgar score recording, a history of poor cry from birth  
with either of the following; poor colour, respiratory  
distress, floppiness and loss of primitive reflexes were  
used. The total number of live births for the hospital  
within the period was obtained from the obstetric regis-  
ters in the labour room.  
Of the 2252 deliveries during the study period, 1464  
(64.9%) were referred cases, of which 1389 (94.9%) had  
obstetric complications.  
Ninety five (60.5%) mothers of babies with asphyxia  
had antenatal care: BMSH and affiliated Government  
Health Centres (80; 84.2%) and private hospitals (15;  
15.8%) while 62 (39.5%) did not receive any form of  
antenatal care. Majority of the mothers of infants with  
perinatal asphyxia (140; 89.2%) were between the ages  
of 21-35 years. . Ninety eight (62.4%) were delivered by  
caesarean section, 56 (35.7%) by spontaneous vaginal  
delivery and 3 (1.9%) were instrumental deliveries. Of  
the 98 infants delivered by caesarean section, 80  
(81.6%) were by emergency caesarean sections. Perina-  
tal asphyxia was observed most in infants with breech  
presentation 79 (50.3%) followed by infants with  
9
Other relevant data which were obtained included the  
age, sex, birth weight, gestational age of recruited ba-  
bies, parity, booking status, mode of delivery, place of  
delivery, fetal presentations as well as problems during  
pregnancy, labour and delivery in the mothers. The hos-  
pital based incidence of perinatal asphyxia was calcu-  
lated using the number of babies with perinatal asphyxia  
born in the BMSH and total number of live births in the  
hospital during the period of study.  
cephalic presentation, 73 (46.9%) and face 5 (3.2%).  
Observed Risk Factors for Perinatal Asphyxia  
Data was arranged in frequency tables and analysed us-  
ing the statistical soft ware SPSS version 17.0 and  
Epi-info version 6.04. Analysis of variance was used to  
compute means, ranges and standard deviations of con-  
tinuous variables. Data were presented as tables in sim-  
ple proportion and comparison of subgroups carried out  
There were 221 episodes of observed risk factors of  
which 120 (54.3%) were maternal and 101 (45.7%) were  
fetal risk factors. The maternal, fetal and maternofetal  
risk factors of perinatal asphyxia are shown in Table 1.  
The commonest fetal risk factor observed in neonates  
with perinatal asphyxia was abnormal presentation. Can  
we rephrase this last sentence as: The commonest risk  
factor observed in neonates with perinatal asphyxia was  
abnormal presentation (fetal risk factor).  
2
with Chi-Square (χ ) statistics. The statistical signifi-  
cance at 95% confidence interval was p < 0.05.  
Results  
Characteristics of the Study Population  
A total of 630 neonates (338 males and 292 females)  
were admitted into the SCBU, during the period, of  
which 157 had perinatal asphyxia, giving a prevalence  
rate of 24.9%. Of the 338 male neonates admitted into  
the SCBU, 88 (26.0%) had perinatal asphyxia while of  
2
92 females admitted, 69 (23.6%) had perinatal  
asphyxia with a M:F ratio of 1.3:1. There was no signifi-  
cant difference in the incidence of perinatal asphyxia in  
both sexes (p value = 0.486).  
The age on admission ranged between less than one  
hour and 192hours with a median age of 24.0 hours. The  
mean birth weight of babies with perinatal asphyxia was  
2
08  
Table 1: Observed Risk Factors for Perinatal Asphyxia  
Risk Factors  
AS>3  
Total=107  
No  
AS<3  
Total=38  
No  
NO AS  
Total=12  
No %  
p-value  
%
%
Maternal Factors  
Cephalopelvic disproportion  
Hypertension  
Prolonged Labour  
Prolonged Rupture of membranes  
Peripartum pyrexia  
Diabetes mellitus  
32  
29.9  
15.0  
12.1  
8.4  
3.7  
0.9  
9
8
7
4
2
0
23.7  
21.1  
18.5  
10.5  
5.3  
2
0
3
1
0
0
18.2  
0.0  
27.3  
9.1  
0.0  
0.0  
0.606  
0.220  
0.286  
0.897  
0.778  
1.000  
16  
13  
9
4
1
0.0  
Fetal  
Abnormal presentation  
Maternofetal  
54  
50.5  
24  
63.2  
6
50.0  
0.409  
Meconium stained liquor  
Antepartum haemorrhage  
Prolapsed/ compressed cord  
Precipitate delivery  
8
4
3
7.5  
3.7  
2.8  
1.9  
6
2
0
15.8  
5.3  
0.0  
0
0
0
0
0.0  
0.0  
0.0  
0.0  
0.229  
0.778  
0.653  
1.000  
2
1
2.6  
Clinical Features of neonates with Moderate and Severe Perinatal Asphyxia  
The clinical features of infants with moderate and severe perinatal asphyxia are shown in Table II. Respiratory distress  
and depressed neonatal reflexes were the commonest clinical features observed in neonates with both moderate and  
severe perinatal asphyxia while loss of consciousness was the least. Abnormal tone, convulsion, poor suck and apnea  
were significantly observed more in infants with severe perinatal asphyxia than infants with moderate perinatal  
asphyxia.  
Table 2: Clinical Features of Neonates with Moderate and Severe Perinatal Asphyxia  
Clinical Features  
AS>3  
Total=107  
AS<3  
Total=38  
No AS  
total=12  
No %  
p-value  
No  
73  
%
68.2  
49.5  
10.3  
8.4  
No  
28  
19  
8
9
8
5
6
1
1
2
%
Respiratory distress  
Depressed neonatal reflexes  
Poor suck  
Hypotonia  
Absent neonatal reflexes  
Convulsion  
Apnea  
Lethargy  
Irritability  
Hypertonia  
73.7  
50.0  
21.1  
27.7  
21.1  
13.2  
15.8  
2.6  
9
6
6
4
81.8  
0.563  
1.000  
0.001  
0.006  
0.108  
0.000  
0.041  
1.000  
1.000  
0.001  
0.002  
53  
11  
9
9
4
4
4
2
1
54.5  
54.5  
36.4  
18.2  
45.5  
0.0  
0.0  
0.0  
27.3  
27.3  
8.4  
3.7  
3.7  
3.7  
1.9  
0.9  
0.9  
2
5
0
0
0
3
3
2.6  
5.3  
Loss of consciousness  
1
1
2.6  
Thirty nine babies (24.8%) had features of Hypoxic ischeamic encephalopathy(HIE). Of these, 16 (15.0%) had AS >3, 16 (42.1%)  
had AS < 3 while 7 (58.3%) had no AS recorded. There was a statistically significant association between Apgar scores and  
severity of HIE (p=0.000).  
Outcome of Perinatal Asphyxia  
Discussion  
Table 3 shows the outcome of neonates with moderate  
and severe perinatal asphyxia. Of 107 neonates with  
moderate perinatal asphyxia, 90 (84.1%) were  
Perinatal asphyxia occurs worldwide and contributes  
significantly to neonatal morbidity and mortality with  
very high incidence in developing countries.  
discharged and 14 (13.1%) died while of 38 neonates  
with severe perinatal asphyxia, 25 (65.8%) were dis-  
charged and 12 (31.6%) died (χ =6.74, p value = 0.034).  
The incidence of perinatal asphyxia in this study is  
63/1000 live birthsThis figure is very high when com-  
pared with an incidence of 1-8/1000 live births observ0ed  
2
1
in the US and other technically developed countries. It  
Table 3: Outcome of Perinatal Asphyxia  
however compares favorably with figures in other cen-  
ters around the country and Africa. These figures remain  
high when 1c1ompared with a report by authors several  
Apgar score Discharged  
DAMA  
Died  
No (%)  
No  
(%)  
No (%)  
years ago.  
This was also noted in a study done in  
AS > 3  
AS ≤ 3  
No AS  
90  
25  
9
84.1  
65.8  
75.0  
3
1
0
2.8  
2.6  
0
14 13.1  
12 31.6  
Ilesha, Nigeria, where authors compared the incidence  
of birth asphyxia over two time periods ten years apart  
and concluded that the incidence and severity of birth  
asphyx2ia remained high despite changes in the social  
3
25.0  
Of the 39 neonates with HIE, 21(53.8%) were discharged, 17  
1
(
(
43.6%) died while 1(2.6%) discharged against medical advice  
DAMA) (p=0.000).  
order. This suggests that while there are improvements  
in developed societies in terms of obstetric and neonatal  
2
09  
care, there is a slow change in the prevailing circum-  
stances in developing countries. This has grave implica-  
tions for achieving the Millennium Development Goals.  
Perinatal asphyxia was also observed most among ba-  
bies who had breech presentation. Increased risk of peri-  
natal asphyxia in babies with non-ce6phalic presentation  
1
has been reported in other studies. Infants presenting  
5
, 13-15  
asphyxia was more  
Although in some studies,  
breech have long been well known to encounter greater  
hazards during the process of delivery with greater  
incidence of birth asphyxia, b2i5r-t2h7 trauma and death irre-  
prevalent in m6 ales than females, similar to the study by  
1
Nayeri et al, there was no significant difference in  
incidence of perinatal asphyxia in this study in terms of  
gender.  
spective of mode of delivery.  
This may be because  
fetuses presenting breech are more likely to have other  
associated problems like cord around the neck or even  
congenital anomalies which also predispose them to  
perinatal asphyxia.  
Other risk factors observed in this study included pro-  
longed rupture of membranes, peripartum pyrexia, and  
haemorrhage.17All of these have also been reported by  
other authors.  
Birth asphyxia was common in good sized babies with a  
mean birth weight of 3kg . T3his trend has also been ob-  
1
served by other researchers and has been attributable  
to poor perinatal services in  
maternity homes and hospitals. It is also pertinent to add  
that even where services are available, they may not be  
utilized .  
Most of the clinical features of birth asphyxia seen in  
this study have been well documented. Of these, poor  
suck, convulsion, abnormal tone and apnoea were noted  
to be most commonly associated with increasing sever-  
ity of asphyxia. Respiratory distress was observed in  
more than a third of newborns with both moderate and  
severe birth asphyxia. This may be related to the under-  
Over 90% of the babies with birth asphyxia were born in  
BMSH which is a specialist hospital. This finding con-  
trasts sharply with other findings which report a lower  
incidence i7n babies delivered in specialist/tertiary  
1
hospitals. However, as many as 39.5% of the mothers  
whose babies were asphyxiated did not receive any form  
of ANC, whilst some of those who received ANC did so  
in less specialized hospitals. Over 90% of the mothers  
referred to the centre had complications of pregnancy or  
labour, thus increasing the risks of perinatal asphyxia. It  
can also be postulated as it is common in women in this  
region that even those who receive ANC in specialized  
centres may at time of delivery opt for other places only  
to return with complications. Lack of ANC has been  
associated with1i7n,1c8reased incidence of birth asphyxia in  
several studies.  
2
8
lying hypoxemia and acidosis observed in such babies.  
This study also showed a statistically significant rela-  
tionship between Apgar score and the occurrence of  
hypoxic ischaemic encephalopathy. workers comparing  
the Apgar scoring system with umbilical artery pH in  
predicting neonatal death concluded that the Apgar  
Score has remained as relevant as it was s2e9veral years  
ago, for the prediction of neonatal survival.  
Case fatality rate was higher in severely asphyxiated  
infants. This supports findings by other workers which  
s29how a higher risk of death with very low Apgar scores.  
This study showed an overall case fatality rate of  
16.6% which was slightly lower than that in other  
Nigerian studies. The main difference being that some  
studied only severely asphyxiated infants while our  
study included babies with moderate asphyxia.  
More than half of the babies were delivered by caesarian  
section, most of which were by emergency caesarian  
sections (EMCS), many of them done during labour.  
This implies that there were already peri-partum  
complications. High rates of19E-2M1 CS have been reported  
in other Nigerian studies.  
Previous studies have  
shown that significantly more mothers of babies with  
birth asphyxia than of co1n6,t2r2ols were delivered by emer-  
gency Caesarian section.  
deliveries in our environment.  
There is an aversion to CS  
23- 24  
Non-vaginal delivery  
Conclusion  
is generally viewed as a sign of maternal laziness,  
reproducti5ve failure or a curse from perceived  
Prevalence of perinatal asphyxia is high. Lack of ANC,  
CPD and breech presentation were contributory factors.  
There is urgent need for maternal education on need for  
ANC, early intervention and skilled care of babies at  
birth.  
2
enemies. It is therefore not uncommon that even  
women booked for elective caesarean sections often  
abscond, attempt vaginal delivery and only return when  
an emergency CS is inevitable. This aversion to caesar-  
ian deliveries, inevitably increases the risk of perinatal  
asphyxia and buttresses the fact that a properly trained  
person in neonatal resuscitation preferably a Paediatri-  
cian should be present at every delivery especially the  
high risk ones. Presence of working resuscitation equip-  
ment e.g. suction, proper size ambu bags, endotracheal  
tubes, neonatal laryngoscopes and oxygen supply should  
be made mandatory. The availability of these facilities  
were not explored in the study.  
Authors’ contributions  
West BA: Conception, design and data analysis  
Opara PI: literature review and drafting of the manu  
script  
Conflict of Interest: None  
Funding: None  
2
10  
References  
1
2
3
.
.
.
Lawn JE, Cousens S, Zupan J. 4  
million neonatal deaths:When?  
Where? Why? Lancet 2005;365:  
11. Airede AI. Birth Asphyxia and  
hypoxic-ischaemic encephalopa-  
thy: incidence and severity. Ann  
Trop Paediatr 1991; 11: 331-5  
12. Ogunlesi TA, Oseni SBA. Severe  
birth asphyxia in Wesley Guild  
Hospital, Ilesa: a persistent plague.  
Nigeria Medical practitioner 2008;  
53: 40-43  
22. Onyearugha CN, Ugboma HAA.  
Severe birth asphyxia: Risk factors  
as seen in a tertiary institution in  
the Niger Delta Area of Nigeria.  
Cont, J Trop Med 2010; 4: 11-19  
23. Ezechi OC, Nwokoro CA, Kalu  
BKE, Njokanmma FO, Okeke  
GCE. Caesarean morbidity and  
mortality in a private hospital in  
Lagos, Nigeria. Trop J Obstet Gy-  
naecol 2002; 19: 97-100  
24. Jeremiah I, Enyidah EN, Fiebai P.  
Attitudes of antenatal patients at a  
tertiary hospital in Southern Nige-  
ria towards caesarean sections.  
Journal of Public Health and Epi-  
demiology 2011; 3: 617-621  
25. Aziken M, Omo-Aghoja L, Ok-  
onofua F. Perceptions and attitudes  
of pregnant women towards cae-  
sarean section in urban Nigeria.  
Acta Obstet Gynecol Scand 200;  
86:42-47.  
26. Onah HE, Ikeako LC, Iloabachie  
GC: Factors associated with the  
use of maternity services in Enugu,  
southeastern Nigeria. Soc Sci Med  
2006; 63:1870-1878.  
27. Drenner WE, Bruce RD,  
Hendrickse CH. The characteris-  
tics and perils of breech presenta-  
tion. Am J Obstet Gynecol 1974;  
118: 700-9  
28. Kleigman RM. Asphyxia: Resusci-  
tation. In: Berhman RE, Kleigman  
RM (eds). NTeHlson Essentials of  
Pediatrics. 4 ed. Philadelphia,  
Saunders. 2005; 195-199.  
29. Casey BM, McIntire DD, Levene  
KJ. The continuing value of Apgar  
Score for the assessment of new-  
born infants. New Engl J Med  
2001; 344: 467- 471  
8
91-900.  
Bryce J, Boschi-Pinto C, Shibuya  
K, Black RE: WHO estimates of  
the causes of death in children.  
Lancet 2005, 365:1147-1152.  
Lawn J, Shibuya K, Stein C: No  
cry at birth: global estimates of  
intrapartum stillbirths and intrapar-  
tum-related neonatal deaths. Bull  
WHO 2005, 83:409-417  
Saving Newborn Lives. The state  
of the world’s newborn: a report  
from saving newborn lives. Wash-  
ington DC, Save the children:  
13. Ibrahim S, Parkash J. Birth as-  
phyxia- analysis of 235 cases.  
2002; 52: 553-6  
14. Onyiruka AN. Birth asphyxia in a  
mission hospital, Benin city, Nige-  
ria. Tropical Journal of Ostetrics  
and Gynaecology 2006; 23: 34-39  
15. Ingemarsson I, Herbst A, Thorn-  
gren-Jerneck K. Long term out-  
come after umbilical artery acidae-  
mia at term birth: influence of  
gender and duration of fetal heart  
rate abnormalities. BJOG1997;  
104: 1123–7  
16. Nayeri F, Shariat M, Dalili H,  
Adam LB, Mehrjerdi FZ, Shakeri  
A. Perinatal risk factors for neona-  
tal asphyxia in Vali-e-Asr hospital,  
Tehran- Iran. Iran J Reprod Med  
2012; 10: 137-140  
17. Majeed R, Memon Y, Majeed F,  
Shaikh NP, Rajar UDM. Risk fac-  
tors of Birth asphyxia. J Ayub Med  
Coll Abbottabad. 2007; 19: 67-71  
18. Shaheen F. Clinical audit of peri-  
natal mortality in a teaching hospi-  
tal. Pak J Obstet Gynaecol 1997;  
10: 27-30  
19. Ugwu EOV, Obioha KCE, Okezie  
OA, Ugwu AO. A five year survey  
of Caesarian delivery at a Nigerian  
tertiary hospital. Annals of Medical  
and Health Sciences Research  
2011; 1: 77-83  
4
5
.
.
2
001; 1-44.  
Badawi N, Kurinczuk JJ, Keogh  
JM, Alessandri LM, O’Sullivan F,  
Barton PR, et al. Intrapartum risk  
factors for newborn encephalopa-  
thy: the Western Australian case—  
control study. BMJ 1998;317:  
1
554-8.  
6
7
8
.
.
.
Hall DR, Smith M, Smith J. Mater-  
nal factors contributing to as-  
phyxia neonatorum. J Trop Pediatr  
1
996;42:192-5.  
Kinoti SN. Asphyxia of the new-  
born in east, central and southern  
Africa. East Afr Med J 1993;70:  
4
22-33.  
Mcgil Ugwu GI, Abedi HO, Ugwu  
EN. Incidence of birth asphyxia as  
seen in Central Hospital and GN  
children clinic both in Warri, Ni-  
ger Delta of Nigeria: an eight year  
retrospective review. Global Jour-  
nal of Health Sciences. 2012; 5: 4  
Ref A : Stoll JB, Kliegman RM.  
The Fetus and the Neonatal Infant  
In: Behrman RE, Kliegman RM,  
Jenson HB (eds). Nelson Textbook  
9
.
20. Igberase GO, Ebeigbe PN, Andrew  
BO. High Caesarean Section rates;  
a ten year experience in a tertiary  
hospital in the Niger Delta, Nige-  
ria. Nig J Clin Pract 2009; 12: 294  
-7.  
21. Ezechi OC, Nwokoro CA, Kalu  
BKE, Njokanma FO, Okeke GCE.  
Caesarean morbidity and mortality  
in a private hospital in Lagos, Ni-  
geria. Trop J Obstet Gynaecol  
th  
of Paediatrics. 16 Edition. Phila-  
delphia, WB Saunders Company;  
2
000: 454-9.  
1
0. C. Levene MI, Kornberg J, Wil-  
liams THC. The incidence and  
severity of post asphyxia encepha-  
lopathy in full term infants. Early  
Hum Dev. 1985; 11: 21-8  
2
002; 19: 97-100