Published in PLOS One on 2026-06-04, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Bahari Yusuf, Tom Ediamu, Simon Odoch, Zeinab Issa Ali, Yasin Ahmed H Abshir, Abdulahi Abdirizak Farah, Abishir Mohamud Hersi, Ahmed Owjama, Hamdi M Yusuf, Zakaria Abdi Said, Theoneste Hakizimana, Walyeldin Elfakey, Grace Ndeezi
Source: PLOS One • DOI 10.1371/journal.pone.0336549
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Birth asphyxia is a major cause of neonatal morbidity and mortality, particularly in low-resource settings. Hypoxia and metabolic derangements that occur during asphyxia predispose neonates to electrolyte abnormalities, which may worsen the clinical course and contribute to poor outcomes. Early recognition and management of such imbalances can improve survival and prevent long-term neurological damage. This study aimed to determine the incidence, predictors, and early outcomes of electrolyte imbalance among term neonates admitted with birth asphyxia in Lira Regional Referral Hospital, Uganda.
A hospital-based prospective cohort study was conducted among term neonates admitted with birth asphyxia, defined as a 5-minute Apgar score <7. Serum sodium, potassium, and calcium levels were measured at admission, and repeated on days 3, 7, and 14 for those still admitted. Clinical information including maternal and perinatal characteristics was recorded. Modified Poisson regression (using SPSS) was performed to identify independent predictors of electrolyte imbalance. Early outcomes, including mortality and length of hospital stay, were documented within the first 14 days.
A total of 152 neonates were enrolled; 52.6% were male. During follow-up, 42 (29.0%) developed hyponatremia, 29 (19.5%) hyperkalemia, and 31 (21.2%) hypocalcemia. Independent predictors of hyponatremia included low Apgar score (0–3), severe hypoxic ischemic encephalopathy (HIE), prolonged intravenous fluid administration (>48 hours), resuscitation at birth, and dehydration. Convulsions, prolonged intravenous fluids, and resuscitation were significantly associated with hypocalcemia, while hyperkalemia was linked to low birth weight and prolonged intravenous fluids (p < 0.05 for all). Mortality was highest among neonates with hyperkalemia, whereas hypocalcemia was significantly associated with prolonged hospital stay (p < 0.05).
Electrolyte imbalances are common among term neonates with birth asphyxia and hypoxic-ischemic encephalopathy, with hyponatremia, hypocalcemia, and hyperkalemia occurring in nearly one-fifth to one-third of cases. These imbalances are predicted by HIE severity, convulsions, prolonged intravenous fluid therapy, and are associated with increased early neonatal mortality, highlighting the need for routine electrolyte monitoring, standardized intravenous fluid protocols, and timely correction of derangements to improve outcomes.
Background
Birth asphyxia is one of the most serious neonatal emergencies, contributing substantially to global morbidity and mortality in the early neonatal period [1]. It is defined by the World Health Organization as the inability to initiate and sustain breathing at birth [2], and is clinically identified using a 5-minute Apgar score of less than seven [3]. Globally, birth asphyxia affects between 2–9 neonates per 1,000 live births [4], with an estimated 4–9 million cases reported annually [2]. It is responsible for approximately 900,000 neonatal deaths worldwide each year and accounts for nearly one quarter of neonatal mortality [5]. The burden is disproportionately higher in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa and South Asia, where more than 98% of neonatal deaths occur [6]. In Uganda, birth asphyxia remains the leading cause of neonatal mortality [7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Bahari Yusuf, Tom Ediamu, Simon Odoch, Zeinab Issa Ali, Yasin Ahmed H Abshir, Abdulahi Abdirizak Farah, Abishir Mohamud Hersi, Ahmed Owjama, Hamdi M Yusuf, Zakaria Abdi Said, Theoneste Hakizimana, Walyeldin Elfakey, Grace Ndeezi. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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