Neonatal asphyxia: associated factors among newborns delivered in Sao Tome & Principe

Background Neonatal asphyxia is a leading cause of neonatal morbidity and mortality, particularly in low- and middle-income countries where maternal and fetal healthcare resources are often limited. This study aims to identify the factors associated with neonatal asphyxia among newborns in Sao Tome and Principe, in order to improve clinical practices in maternal and perinatal care. Methods A hospital-based unmatched case-control study was conducted among newborns from randomly selected mothers. Cases were defined as newborns with a 5-minute APGAR score < 7, while controls had a 5-minute APGAR score between 7 and 10. Data were collected from antenatal care pregnancy cards, medical files and face-to-face interviews. Multivariable logistic regression was performed to identify independent risk factors for neonatal asphyxia, with statistical significance set at p < 0.05. Results Among 519 newborns included in the study, the prevalence of neonatal asphyxia was 8.1% (n = 42). Significant risk factors for neonatal asphyxia included maternal status as a student (aOR 5.30 95% CI 1.66─16.97; p=0.005), twin pregnancy (aOR 3.73 95% CI 1.21─11.47; p=0.022), mode of delivery other than normal vaginal deliver (aOR 46.24 95% CI 6.73─317.63; p<0.001), gestational age greater or equal to 41 weeks (aOR 4.57 95% CI 1.72─12.13; p=0.002), birth weight <2500g (aOR 5.34 95% CI 1.75─16.26; p=0.003) and infectious risk (aOR 11.07 95% CI 4.87─25.18; p<0.001). Cesarean section (aOR 0.02 95% CI 0.003─0.188; p<0.001) was found to be a protective factor. Conclusion Neonatal asphyxia was independently associated with maternal occupation as a student and multiple gestation (maternal factors); intrapartum infectious risk and dystocic delivery (intrapartum factors); as well as post-term gestation, and low birth weight (neonatal factors).