Press Release
International Project on Birth Asphyxia Starts to Protect Maternal-Childhood Health

Milan, June 12, 2007 - An important study project on birth asphyxia, promoted by the WHO in cooperation with Chiesi Foundation, which is providing some economic and organizational support, will start within 2007 and will last nearly 3 years. This unprecedented initiative points to protecting maternal-childhood health in developing countries, and was presented to the Press today by the WHO and by a group of world-known neonatologists, who met in Milan to define the last technical details of the "WHO study on birth asphyxia at community level".

Children health is one of the most impressive examples of social-health disparity in the world: out of the 4 millions-a-year neonatal deaths, 98% occur in the poorest countries and 23% of them are due to birth asphyxia, i.e. to a lack of oxygen in fetus blood, caused by the fetus' own inability to breath spontaneously at birth. Because of this reason, nearly 1 million children die every year and as many may develop brain damage like vision or hearing impairment and cerebral palsy, even if this situation could often be solved or mitigated when early faced with right devices. This is the size of a health emergency that is unfortunately underestimated - and often even unrecognized in developing countries. Epidemiology of birth asphyxia, especially in the poorest areas, isn't well known, most of all because of the lack of a uniform definition and of specific diagnostic criteria which would permit the identification of the problem even without sophisticated instruments.

"Reduction of this burden is essential in improving childhood and maternal survival", states Ornella Lincetto, neonatologist at the WHO Department of Making Pregnancy Safer. "A newborn who cannot breath has to be urgently resuscitated. The efforts of WHO are aimed at providing to every delivering woman and her baby the assistance of a skilled attendant, with adequate instruments available; and this especially important for poor people, among whom the highest number of maternal-neonatal deaths occurs. With this project we aim at creating a reliable, specific diagnostic tool, which may enable health workers to quickly recognize birth asphyxia cases at community level, in settings where medical assistance is lacking, in order to improve therapeutic approach". With the co-operation of three WHO Departments (Child and Adolescent Health, Making Pregnancy Safer and Reproductive Health and Research) and thanks to the grant of the Chiesi Foundation, some researchers of developed countries share their own experience with their colleagues of developing ones, to identify causes and physiopathological bases of birth asphyxia. The aim of this study is to develop a diagnostic tool, whose sensibility (i.e. the capability of recognising the highest number of cases) and specificity (i.e. the capability of distinguishing birth asphyxia from other diseases) would allow the early identification - even in poor settings - of those newborns that should be resuscitated. Moreover, such a tool will enable the recognition of birth asphyxia cases through easily visible clinical signs, to be recorded even by local trained - but not specialized - health workers.

The bases of birth asphyxia may be considered to be labour-related or due to maternal health difficulties such as malnutrition, infections and anaemia, that unfortunately are still widespread in many countries of Asia and Africa. "With rather easy tools, birth asphyxia can be largely prevented", says Ola Didrik Saugstad, professor of paediatrics at the Rikshospitalet, Oslo University, Norway. "Identifying and treating women at risk is crucial, in order to send them to specialized centres for delivery. It's also necessary to train health workers and to develop transport systems for pregnant women at risk and diseased newborns. In low income countries, the causes of birth asphyxia are often different from those in developed countries: more studies on these populations are necessary to identify specific risk factors".

The WHO - Chiesi Foundation project will start within 2007 in Pakistan, where it will last for 2 years, and during which at least 2,000 newborns will be evaluated. In a second phase WHO intends to spread this observational study to other countries, starting from the South African Republic, which represents a setting potentially different from the Asiatic one; the study should probably start 2008 and go on for 2 years as well. In a first step, the diagnostic tool will be validated in a hospital setting and, successively, it will be applied to assess birth asphyxia incidence at community level.

"This will be the first in-depth study on birth asphyxia in Pakistan, where preliminary data indicate that 35% of first-week deaths can be associated with such a condition, and will give information on the extension and severity of the problem, on potential interventions and on their concrete feasibility and acceptability", says Zulfiqar Ahmed Bhutta, professor and responsible of the Department of Paediatrics, Aga Khan University, Karachi, Pakistan. "All children born in the hospital, of 2 Kg weight or more, will be evaluated with the gold standard and with the diagnostic tool to be validated; after its validation, the epidemiological study will go on in two settings of the country at a community level".

"The Chiesi Foundation has been interested for a long time in the WHO efforts to define a diagnostic and clinical tool for birth asphyxia" says Paolo Chiesi, President of the Foundation. "This global project endorses both the support to the pulmonary - neonatology research and the attention to social initiatives towards the poor countries, two lines of action that are deeply rooted in the Chiesi Foundation's tradition. That's why we enthusiastically joined the initiative, so rich in scientific importance and human significance".

Birth Asphyxia - Causes in high and low income countries - PDF format
Birth Asphyxia - Summary of the previous meeting and protocol overview - PDF format

Top