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PubMed1992

Neonatal mortality and the economy revisited.

The association between economic contraction and neonatal mortality previously reported in this Journal is retested using methods and data that respond to criticisms of aggregate time-series work. Results suggest that the risk of neonatal mortality among birth cohorts of black males in the Los Angeles County and Orange County metropolitan areas is increased by unexpectedly low levels of employment in the second trimester. The argument is made that the strength of the effect is probably not sufficient to make the case for stimulating regional economies more compelling.

Cohort Studies↗
PubMed2004

Associations between perinatal interventions and hospital stillbirth rates and neonatal mortality.

BACKGROUND: Previous studies suggest that high risk and low birthweight babies have better outcomes if born in hospitals with level III neonatal intensive care units. Relations between obstetric care, particularly intrapartum interventions and perinatal outcomes, are less well understood, however. OBJECTIVE: To investigate effects of obstetric, paediatric, and demographic factors on rates of hospital stillbirths and neonatal mortality. METHODS: Cross sectional data on all 65 maternity units in all Thames Regions, 1994-1996, covering 540 834 live births and stillbirths. Hospital level analyses investigated associations between staffing rates (consultant/junior paediatricians, consultant/junior obstetricians, midwives), facilities (consultant obstetrician/anaesthetist sessions, delivery beds, special care baby unit, neonatal intensive care unit cots, etc), interventions (vaginal births, caesarean sections, forceps, epidurals, inductions, general anaesthetic), parental data (parity, maternal age, social class, deprivation, multiple births), and birthweight standardised stillbirth rates and neonatal mortality. RESULTS: Unifactorial analyses showed consistent negative associations between measures of obstetric intervention and stillbirth rates. Some measures of staffing, facilities, and parental data also showed significant associations. Scores for interventional, organisational, and parental variables were derived for multifactorial analysis to overcome the statistical problems caused by high intercorrelations between variables. A higher intervention score and higher number of consultant obstetricians per 1000 births were both independently and significantly associated with lower stillbirth rates. Organisational and parental factors were not significant after adjustment. Only Townsend deprivation score was significantly associated with neonatal mortality (positive correlation). CONCLUSIONS: Birthweight adjusted stillbirth rates were significantly lower in units that took a more interventionalist approach and in those with higher levels of consultant obstetric staffing. There were no apparent associations between neonatal death rates and the hospital factors measured here.

Adolescent↗
PubMedDate not supplied

Early neonatal mortality in an intramural birth cohort at a tertiary care hospital.

Early neonatal mortality (ENM) occurring among 12,283 consecutive live births over a period of 3 years were analysed. The early neonatal mortality rate (ENMR) was 26.6/1000 live births. Birth weight less than 2,000 gm, lack of antenatal care, male sex, operative vaginal delivery, prematurity and multiple pregnancy were significantly associated with early neonatal deaths. Birth asphyxia was found to be the most important cause of death, followed by hyaline membrane disease and congenital malformations. Majority of the asphyxia related deaths were due to late intrapartum referral of the mothers. Forty-two per cent of early neonatal deaths occurred in babies weighing less than 1,500 gm. Early identification and referral of high risk mothers and health education would significantly reduce the early neonatal deaths.

Cause of Death↗
PubMed1997

[The structure and analysis of neonatal mortality in twins in 1991-1995 at the State University Hospital Maternity Home, Sofia].

This is a retrospective study on all liveborn children that died in the neonatal period in the University Maternal Hospital, Sofia for a five year period of time. They are divided in two groups-twins and singletons. It is established that neonatal mortality rate as a whole is decreasing while that of twins is increasing. The early neonatal mortality rate of twins is 3.6-4.5 times higher than that of singletons. Inside the group of twins who died in the neonatal period, 63.64% are with birth weight below 1500 g, while in singletons this percentage is 37.07%. Main reasons for death of liveborn twins are respiratory distress syndrome, intracranial haemorrhages and intrapartal asphyxia followed by congenital malformations and inborn infections. Conclusions point out that multiple pregnancy is a high-risk delivery and to decrease the neonatal mortality rate of twins the collective efforts of obstetricians and neonatologists are needed.

Bulgaria↗
PubMed1978

A comparison of 1960 and 1973--1974 early neonatal mortality in selected states.

Linked birth and infant death records from six states provided the opportunity for comparison of 1960 and 1973--1974 early neonatal mortality rates by weight, maternal age and live birth order. The data were analyzed by fitting linear models to the logarithm of the ratio of 1960 to 1973--1974 early neonatal mortality rates. Although there was substantial variability in these ratios by maternal age and birth order, the ratios were nearly constant for birth weights between 1001 and 4500 gm. The decline in mortality among low birth weight infants (2500 gm or less) accounted for over half of the overall decline in early neonatal mortality. The results obtained here are compared with earlier national studies and possible explanations for the decline are discussed.

Adolescent↗
PubMed2004

Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin.

OBJECTIVE: The purpose of this study was to evaluate neonatal mortality rates among discordant twins, classified according to the birth weight of the smaller twin. STUDY DESIGN: We compared neonatal mortality rates among three groups of discordant twins (>25%), distinguished by the birth weight of the smaller twin being <10th, 10th to 50th, or >50th percentile. RESULTS: Among the 10,683 pairs of twins who were studied, the respective proportions of the three groups were 62.4%, 32.9%, and 4.7%. The neonatal mortality rate was significantly higher among pairs in which the smaller twin weighed <10th birth weight percentile (29. vs 11.1 and 11 per 1000; odds ratio, 2.7; 95% CI, 1.3, 5.7). This difference results from the higher mortality rates among the smaller but not among the larger twins. CONCLUSION: Severely discordant twin pairs in whom the smaller twin is also small for gestational age are at an increased risk of neonatal death. Identification of this group is an imperative step in the management of birth weight discordance in twin gestations.

Birth Weight↗
PubMed1987

Intra-urban variations of neonatal and post-neonatal mortality in a developing city.

Numerous surveys at the national and regional level have demonstrated that large inequalities in infant health status exist in Southern Africa. Few studies have assessed infant mortality at the intra-urban scale of geographic analysis. Comparisons between infant mortality rates from different areas are made even more meaningful if the data are divided into two primary categories based on period-of-death; these being the neonatal and post-neonatal components. This study presents the results of a survey undertaken in Metropolitan Cape Town (population 1.6 million) during 1982. The aim was to determine the spatial variation of neonatal and post-neonatal mortality at the suburb (or community) level within the city. Overall, a total of 36,789 live births and 928 infant deaths were recorded; 53.4% in the neonatal period and 46.6% in the post-neonatal period. The mean infant mortality rate was 25.2 per 1000 live births; the neonatal mortality rate and post-neonatal mortality rate being 13.5/1000 and 11.7/1000, respectively. A marked range in death rates was evident for both components. For the neonatal category it was 0.0-49.9/1000 and 0.0-40.0/1000 for the post-neonatal period. The generally low post-neonatal mortality rate among the 69 suburbs studied has made the neonatal component the dominant contributor to the infant mortality rate. However, in the lowest socio-economic areas the post-neonatal mortality rate was responsible for over 60% of infant deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Health↗
PubMed2003

The effect of birth weight discordance on twin neonatal mortality.

OBJECTIVE: To estimate the association between birth weight discordance and neonatal mortality controlling for the effects of fetal growth, and to understand the differences in the incidence of mortality between larger and smaller infants. METHODS: This analysis is based on the National Center for Health Statistics matched multiple birth data set file containing all twin births in the United States from 1995 through 1997. Birth weight discordance was grouped into four levels (15-19%, 20-24%, 25-29%, and 30% or more). Generalized estimating equations were used to obtain adjusted odds ratios and 95% confidence intervals to estimate the mortality risk associated with discordance after adjusting for fetal growth. RESULTS: Mortality was 11 times higher among highly discordant smaller twins (30% or more) compared with nondiscordant smaller twins (43.4 and 3.8 per 1000, respectively). Risk estimates ranged from 1.08 (95% confidence interval 0.85, 1.38) among 15-19% discordant twins to 2.05 (95% confidence interval 1.66, 2.51) among 30% or more discordant twins. Larger twins had similar risk estimates. After accounting for the association between fetal growth and discordance, mortality risk was substantially higher among smaller and larger twins who were highly discordant (30% or more). In addition, there was little difference in the magnitude of risk estimates between highly discordant smaller and larger twins. CONCLUSION: After controlling for fetal growth, smaller and larger twins affected by higher levels of birth weight discordance (25% or more) remain at disproportionate risk for neonatal mortality when compared with other smaller or larger twins. Additionally, smaller twins do not have an elevated risk compared with larger twins after adjusting for their different fetal growth distributions.

Birth Weight↗
PubMedDate not supplied

[Comprehensive approach to decrease of neonatal mortality].

Due to united efforts of public health at many levels neonatal mortality in Samara decreased from 17.3 to 7.1% during 5 years. Irish program "Positive Maternity" and outpatient perinatology programs helped decrease the incidence of severe gestosis to 15.9 per 10,000 deliveries. Services engaged in family planning, andrological care, and treatment of couples have been created. Resuscitation of newborns is realized in accordance with the Swiss Government Program on Maternity and Childhood Protection and the USA Protocol of Newborn Resuscitation. Introduction of the Placenta-Fetus-Newborn program is in progress. Six-year activities of a visiting neonatological team decreased neonatal mortality from respiratory distress syndrome almost 3-fold. Activities of Center for Surgical Correction of Congenital Defects are constantly updated. The rate of detection of congenital defects by ultrasonic examination is now as high as 75%. The realization of programs and activities of institutions are financed through obligatory medical insurance, public health budget, and purposeful programs.

Adult↗
PubMed1997

[Characteristics of neonatal mortality in the State of Rio de Janeiro, Brazil, in the 1980's: a spatio-temporal analysis].

OBJECTIVE: The spatial distribution of neonatal mortality by age-group (0-23 hours, 1-6 days and 7-27 days) in the State of Rio de Janeiro, Brazil, for two periods of time 1979-81 and 1990-92, is analysed. METHODOLOGY: A methodology was used to perform the spatial analysis which took the counties of Rio de Janeiro as the spatial units and "first-nearest-neighbors" as the neighborhood criterion. For the purpose of detecting anisotropy, the connection matrix was defined through "first-nearest-neighbors" in a particular direction. To understand the spatial behavior of neonatal mortality, social and environmental indicators and indicators of medical assistance by county for both periods of time were constructed. RESULTS AND CONCLUSIONS: At the beginning of the 80's, the neonatal mortality for the age group 7-27 days showed the presence of clusters in the East and Southeast in direct association with the poorest conditions of life in the State, characteristics that had vanished by the next decade. Spatial dependence for the mortality rates for the first day of life, for 1991, was identified clusters in two different regions beings detected, followed by a positive correlation with "number of private hospital beds per inhabitant". Some of the cluster counties were, in particular, death receivers from neighboring counties and showed hospital case fatality rates much greater than the overall mean rate.

Anisotropy↗
PubMed1984

Cesarean birth and neonatal mortality in very low birth weight infants.

The authors attempted to relate neonatal mortality to method of delivery in a series of 345 infants, weighing 700 to 1500 g, who were born in King County, Washington, from 1977 to 1979. Overall, 38% of infants delivered vaginally died as opposed to 32% of those with cesarean births. However, after adjustment for birth weight, presentation, and place of delivery, cesarean birth was not associated with reduction in mortality. Even among those infants with a breech presentation, a group believed (on the basis of previous studies) to particularly benefit from cesarean birth, the data failed to show any mortality reduction. Based on the results of this study of very low birth weight singleton infants, it appears that the reduced neonatal mortality associated with cesarean birth, if present at all, is small in magnitude.

Birth Weight↗
PubMed1996

The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites.

BACKGROUND: Surfactant therapy reduces morbidity and mortality among premature infants with the respiratory distress syndrome (RDS). Fetal pulmonary surfactant matures more slowly in white than in black fetuses, and therefore RDS is more prevalent among whites than among blacks. We reasoned that the increased use of surfactant after its approval by the Food and Drug Administration (FDA) in 1990 might have reduced neonatal mortality more among whites than among blacks. METHODS: We merged vital-statistics information for all 1563 infants with very low birth weights (500 to 1500 g) born from 1987 through 1989 or in 1991 and 1992 to residents of St. Louis with clinical data from the four neonatal intensive care units in the St. Louis area; we then compared neonatal mortality during two periods, one before and one after the FDA's approval of surfactant for clinical use (1987 through 1989 and 1991 through 1992). RESULTS: The use of surfactant increased by a factor of 10 between 1987 through 1989 and 1991 through 1992. The neonatal mortality rate among all very-low-birth-weight infants decreased 17 percent, from 220.3 deaths per 1000 very-low-birth-weight babies born alive (in 1987 through 1989) to 183.9 per 1000 (in 1991 through 1992; P = 0.07). This decrease was due to a 41 percent reduction in the mortality rate among white newborns with very low birth weights (from 261.5 per 1000 to 155.5 per 1000; P = 0.003). In contrast, among black infants, the mortality rate for very-low-birth-weight infants did not change significantly (195.6 per 1000 and 196.8 per 1000). The relative risk of death among black newborns with very low birth weights as compared with white newborns with similar weights was 0.7 from 1987 through 1989 and 1.3 from 1991 through 1992 (P = 0.02). The differences in mortality were not explained by differences in access to surfactant therapy, by differences in mortality between black and white infants who received surfactant, or by differences in the use of antenatal corticosteroid therapy. CONCLUSIONS: After surfactant therapy for RDS became generally available, neonatal mortality improved more for white than for black infants with very low birth weights.

Adrenal Cortex Hormones↗
PubMed2006

[Neonatal mortality in Londrina, Paraná State, Brazil, in 1994, 1999, and 2002].

Despite technological progress in recent decades, neonatal mortality accounts for some two-thirds of infant deaths where the infant mortality rates are low. This study analyzes neonatal deaths in Londrina, Paraná, Brazil, during three periods, beginning with 1994, the year when pediatric and neonatal intensive care beds were created in the city. The data were collected from live birth certificates in the National Information System on Live Births (SINASC) and individual analysis of neonatal death certificates. Births declined in the city, but the low birthweight rate increased from 7.7 to 8.8% and the preterm birth rate from 6.3 to 8.4%. Multiple births also increased. Caesarian sections varied from 48 to 52%. The percentage of deaths from congenital malformations increased. The vast majority of neonatal deaths are preventable, mainly by providing specialized care during pregnancy. The neonatal mortality rate has declined recently, from 10.1 to 6.4 per 1,000 live births. The authors conclude that neonatal care is improving in Londrina.

Birth Weight↗
PubMed2003

The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997.

OBJECTIVE: The purpose of the study was to explore the associations of placenta previa with preterm delivery, growth restriction, and neonatal survival. STUDY DESIGN: A retrospective cohort study was performed of live births in the United States (1989-1991 and 1995-1997) that used the national linked birth/infant death records from 22,368,235 singleton pregnancies. The diagnosis of previa was restricted to those live births that were delivered (> or =24 weeks) by cesarean delivery. We evaluated gestational age and birth weight-specific risk of neonatal deaths (within the first 28 days) in relation to placenta previa. Fetal growth was assessed in centiles of birth weight (<3rd, 3rd-4th, 5th-9th, 10th-90th, and >90th centile), adjusted for gestational age. All analyses were adjusted for the confounding effects of the year of delivery, maternal age, gravidity, education, prenatal care, marital status, and race/ethnicity. RESULTS: Placenta previa was recorded in 2.8 per 1000 live births (n = 61,711). Neonatal mortality rate was 10.7 with previa, compared with 2.5 per 1,000 among other pregnancies (relative risk, 4.3; 95% confidence interval, 4.0,4.8). At 28 to 36 weeks, babies born to women with placenta previa weighed, on average, 210 g lower than babies born to women without placenta previa (P <.001). Compared with babies born to women without previa, the risk of death from placenta previa was lower among preterm babies (<37 weeks of gestation), with a crossover at 37 weeks where the mortality rate was higher for babies born to women with placenta previa than for babies born to women without placenta previa. This crossover also persisted in an analysis by birth weight and term births (delivered at > or =37 weeks of gestation). Mortality rates for term births were higher among babies born to women with placenta previa than among babies born women without placenta previa who were at the 10th to 90th centile (relative risk, 1.9; 95% confidence interval, 1.3, 2.8), and those at >90th centile (relative risk, 3.6; 95% confidence interval, 1.3, 9.6). Among preterm births, however, placenta previa was not associated with increased neonatal mortality by fetal growth centiles. CONCLUSION: The risk of neonatal mortality was higher for babies born to women with placenta previa than for babies born to women without placenta previa who were delivered at > or =37 weeks of gestation. Pregnancies that are diagnosed with placenta previa must be monitored carefully, especially as they approach term.

Adult↗
PubMed1992

Disparate black and white neonatal mortality rates among infants of normal birth weight in Chicago: a population study.

To determine the extent to which disparities in risk status and access to tertiary care affect racial differences in neonatal mortality rates among normal birth weight infants, we conducted a vital records study concerning normal weight black (N = 44,399) and white (N = 48,146) singleton births in Chicago. Neonatal mortality rate among black infants was twice that among white infants (3.3 deaths per 1000 births vs 1.5 deaths per 1000 births); the unadjusted black relative risk equaled 2.2 (95% confidence interval, 1.7 to 2.9). Because prematurity, growth retardation, congenital anomalies, low Apgar scores at 5 minutes, teenage mothers, and poverty were more common among black infants, multivariate analyses were performed. The disparity in mortality rate was greatest between black and white infants with none of these risk factors; relative risk for black infants equaled 3.6 (95% confidence interval, 2.0 to 6.7). Approximately 30% of all deaths of black infants were attributable to birth in nontertiary hospitals. When the confounding variables, including hospital of birth, were put into a multivariate logistic-regression model, the adjusted relative risk estimate (odds ratio) for black infants equaled 1.5 (95% confidence interval, 1.1 to 2.0). Traditional risk factors fail to explain the racial disparity in neonatal mortality rate among normal birth weight infants. Level of perinatal care available, or some factor closely related to this level, is an important determinant of neonatal chance of survival for normal birth weight urban black infants.

Black or African American↗
PubMed1994

[Neonatal mortality in residents of an urban locality in the southern region of Brazil].

Neonatal mortality rates in Maringá, Paraná State, Brazil, in 1990 are characterized in terms of several variables. Information concerning these events was provided by death certificates, hospital archives, home interviews, health center files and necropsy records. Neonatal mortality rates were 19.4 per 1,000 live births. Most of the deaths occurred: the first week of life (92.0%); newborns with less than 37 weeks of gestation (79.8%); low birth weight infants (74.1%); male newborns (56.3%); and cesarean section births (54.2%). The underlying causes of death were codified in accordance with the "International Diseases Classification"-9th revision. Perinatal Causes together with Congenital Anomalies accounted for 94.0% of these deaths in addition also to being responsible for 83.2% of neonatal deaths; prematurity was considered the main cause, accounting for 15.8% of deaths while being the most frequent cause associated with newborn deaths (59.0%).

Birth Weight↗
PubMed2006

Trend and causes of neonatal mortality in the Kassena-Nankana district of northern Ghana, 1995-2002.

OBJECTIVES: To describe the trend and causes of neonatal deaths in a rural district in northern Ghana. METHODS: Descriptive analysis of data collected from the Navrongo Demographic Surveillance System and verbal autopsies conducted on all neonatal deaths from 1995-2002. RESULTS: Of 1118 recorded neonatal deaths 1068 (95.5%) could be analysed. Only 13.2% of deaths occurred at the health facility; 62.7% occurred in the early neonatal period, with prematurity (38%) and birth injuries (19%) as leading causes. Infectious causes (66%) were the major contributors to late neonatal deaths. Infanticide accounted for 4.9% of all neonatal deaths. The cause-specific mortality rate for neonatal tetanus remained under 2.5% throughout the 8-year period. Overall, the neonatal mortality rate declined at an average of 2.5 per 1000 live births per year: Down by nearly 50% from 40.9 (95%C.I. 34.1-46.8) in 1995 to 20.5 (95%C.I.17.3-22.7) in 2002. CONCLUSION: The various health interventions undertaken in this district have had the collateral effect of causing decline in neonatal mortality. Neonatal mortality could be further reduced by preventing and treating neonatal infections, having skilled attendance at delivery and the elimination of infanticide. Data from demographic surveillance sites may be useful in monitoring trends in child mortality.

Birth Injuries↗
PubMedDate not supplied

Post-neonatal mortality by rurality and Indigenous status in Queensland.

AIM: To compare post-neonatal mortality among urban and rural Indigenous babies in Queensland. METHODS: Registrations of deaths at ages 28 days to 12 months were linked to routine data from the Queensland Perinatal Data Collection. RESULTS: Indigenous babies were 2.52 times more likely to die during the post-neonatal period than non-Indigenous babies (95% confidence interval: 1.99, 3.20). The differential remained when urban and rural areas were examined separately: the differential was 2.53 (1.81, 3.54) in urban areas and 2.26 (1.58, 3.23) in rural areas. CONCLUSION: The key demographic variable that determines post-neonatal mortality in Queensland is Indigenous status, not rurality. This has important policy implications because it means that interventions to reduce the disparity in mortality between Indigenous and non-Indigenous babies should be delivered in urban as well as rural areas. Better routine data are needed and in particular clinical classification of deaths, so that interventions can be monitored and avoidable factors identified.

Cause of Death↗