Incidence of neonatal asphyxia and associated risk factors: a systematic review and cumulative meta-analysis

To analyze the incidence of neonatal asphyxia and its associated related risk factors and provide reference for reducing the incidence and mortality of neonatal asphyxia.

PubMed, Web of Science, CNKI, and Wanfang were searched for cross-sectional/case-control studies (inception-December 31, 2024). After dual-independent screening (PROSPERO: CRD420251118897), 18 studies (n = 737,839 neonates) were included. Quality was assessed using AHRQ. Random/fixed-effects models were applied based on I² thresholds. Temporal trends were explored via sequential meta-analysis by publication year. Sensitivity and publication bias analyses were conducted.

A total of 18 studies was included, involving 737,839 neonates, and the overall quality of the literature was acceptable. The combined incidence of neonatal asphyxia and its 95% CI was 7% (5%, 8%). Factors associated with neonatal asphyxia included instrumental delivery, primiparity, preterm birth, and low birth weight. The pooled ORs and 95% CIs for meta-analyzed risk factors of neonatal asphyxia (instrument-assisted delivery, primiparity, preterm birth, and low birth weight) were 3.10 (1.79, 5.38), 3.51 (2.15, 5.74), 2.18 (1.54, 3.09), and 2.85 (2.33, 3.49), respectively. According to the order of publication, cumulative Meta-analysis showed that the OR values and 95% CI of instrumental delivery, primiparity, preterm birth, and low birth evolved had a trend over time.

The incidence of neonatal asphyxia remains an important public health concern. Findings suggest that neonates born following instrumental delivery, or with primiparity, preterm birth, or low birth weight could be considered for more careful monitoring.