Abstract / Summary
Birth asphyxia constitutes a major concern in the pediatric wards due to related increase in morbidity and mortality. Birth asphyxia related complications such as liver dysfunction, among others are well described in the literature, with the liver being at a high risk due to its high metabolic rate and high energy requirements, especially in resource limited setting; Uganda inclusive. This study aimed to determine the incidence of hepatic injury in term asphyxiated neonates admitted in three tertiary hospitals in Uganda. This was a hospital based prospective cohort study, ethical approval number KIU-2025–1672, in which term neonates born with perinatal asphyxia with Apgar Score less than 7 at 5 min of age in three tertiary hospitals in Uganda. Two milliliters of venous blood was obtained from every participant at 3 points (within the 1st, 3rd and 7th day of life). All blood samples were run for liver function tests which included aspartate transferase (AST), alanine transferase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH). The presence of at least three deranged enzymes was diagnostic of hypoxic hepatitis. In this study, we enrolled 421 participants, with slightly more males (53.4%) than females (46.6%). Of the 421 participants, hepatic injury was seen in 214 (50.8%) participants on day one, in 137(32.5%) participants on day three and in 69 (16.4%) participants on day seven. Overall, 222 participants were found to have hepatic injury at least one point over the course of 7 days, therefore the incidence of hypoxic hepatitis was 52.7% with a 95% confidence interval of 48.2–57.5%. The majority of the participants (96.4%) with hypoxic hepatitis had it diagnosed on the first day of life. Only 8 (3.6%) had the diagnosis of hypoxic hepatitis first made on the 3rd day. None of the participants had hypoxic hepatitis first diagnosed on the 7th day of life. The incidence of hypoxic hepatitis was high (52.7% with a 95% confidence interval of 48.2–57.5%) as it was seen in over half of all asphyxiated neonates. We recommend that all neonates with birth asphyxia be routinely screened for hepatic injury. Screening should be done in the first 72 h of life.