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PubMed1979

Effects of low-birth-weight breech delivery on neonatal mortality.

The influence of breech presentation on neonatal mortality was studied in 77 viable low-birth-weight breech deliveries. Neonates were divided into 3 weight groups: 1000-1499 g, 1500-1999 g, and 2000-2499 g. The antepartum and intrapartum characteristics of the 3 weight groups were detailed. The 17 neonates who died were studied to determine if alternative delivery methods would have prevented their deaths. Survival rates were 45% in the 1000-1499-g group, 76% in the 1500-1999-g group, and 97% in the 2000-2499-g group. Cervical head entrapment and fetal bradycardia were ominous intrapartum complications, but severe prematurity with respiratory distress syndrome and fetal hydrops were the primary causes of neonatal death. From these data, it is concluded that 1) intrapartum management and delivery of the low-birth-weight breech presentation infant should be individualized, and 2) cesarean section for routine delivery is not justified.

Adult↗
PubMed2002

The relation between the availability of neonatal intensive care and neonatal mortality.

BACKGROUND: There is marked regional variation in the availability of neonatal intensive care in the United States. We conducted a study to determine whether a greater supply of neonatologists or neonatal intensive care beds is associated with lower neonatal mortality. METHODS: We used the 1996 master files of the American Medical Association and the American Osteopathic Association and 1998 and 1999 surveys of neonatal intensive care units to calculate the supply of neonatologists and neonatal intensive care beds in 246 neonatal intensive care regions. We used linked birth and death records from the 1995 U.S. birth cohort to assess associations between the supply of both neonatologists and neonatal intensive care beds per capita (in quintiles) and the risk of death within the first 27 days of life. RESULTS: Among 3,892,208 newborns with a birth weight of 500 g or greater, the mortality rate was 3.4 per 1000 births. After adjustment for neonatal and maternal characteristics associated with an increased risk of neonatal death, the rate was lower in the regions with 4.3 neonatologists per 10,000 births than in those with 2.7 neonatologists per 10,000 births (odds ratio for death, 0.93; 95 percent confidence interval, 0.88 to 0.99). Further increases in the number of neonatologists were not associated with greater reductions in the risk of death. There was no consistent relation between the number of neonatal intensive care beds and neonatal mortality. CONCLUSIONS: A minority of regions in the United States may have inadequate neonatal intensive care resources, whereas many others may have more resources than are needed to prevent the death of high-risk newborns. The effect of the availability of neonatologists on other health outcomes is not known.

Birth Weight↗
PubMed1991

[Reserves for lowering the neonatal mortality of premature children].

A tendency for a decrease in the rate of neonatal mortality among preterm babies could be followed up in industrialized countries for the current decade. This tendency is less pronounced in the USSR. Therefore newer diagnostic and therapeutic approaches developed in the clinical department of the Scientific and Research Institute of Pediatrics, the USSR Academy of Medical Sciences, could be regarded as reserves for the reduction of neonatal mortality in preterm children. They include the analysis of etiological structure of present-day pyo-septic diseases (monitoring of intrahospital flora, target-oriented treatment-the use of anti-klebsiella plasma); consideration of new aspects of pathogenesis (population structure and the receptor function of the blood defensive cells); metabolite therapy; individualization of antibacterial treatment on the basis of pharmacokinetic assessment; optimized breeding techniques (prolonged probe nutrition); background correction (perinatal encephalopathy, the syndrome of respiratory distress); newer socio-medical approaches (psychotherapy of nursing mothers, "kangaroo" method).

Bacterial Infections↗
PubMed1988

Fetal and neonatal mortality of small-for-gestational age infants. A 15-year study of 381 cases.

Fetal and neonatal mortality of small-for-gestational age (SGA) infants in 1968-1982 were studied in the region of the University Central Hospital of Turku, Finland. During the study period, there were 254 fetal and 127 neonatal deaths in SGA infants. The fetal mortality rate of SGA infants declined from 49.9/1000 to 14.0/1000. The neonatal mortality rate of SGA infants declined from 23.8/1000 to 8.3/1000. The severely SGA infants with a birth weight below the 2.5th percentile had three times higher neonatal mortality rates than SGA infants with a birth weight between the 2.5th and the 10th percentiles. The main causes of fetal deaths were maternal diseases, placental and cord complications and fetal malnutrition, even though there was a decline in all these groups. Malformations remained the main cause of neonatal death during the study period, while there was a decline in deaths due to asphyxia and respiratory distress syndrome (RDS). The high mortality rates of SGA infants emphasize the need for early diagnosis and special attention during pregnancy, delivery and the neonatal period.

Birth Weight↗
PubMed1982

Indirect standardization of neonatal mortality for birth weight.

Recent advances in perinatal medicine, together with the proliferation of regionalized perinatal networks, have increased the need for monitoring of trends and variations in birth weight-specific perinatal mortality rates. Since the United states has no national system of linked birth and death records, the only available method for comparing weight-specific mortality among geographic areas or medical care facilities in through indirect standardization of mortality for birth weight. This paper investigates the characteristics of the Standardized Mortality Ratio (SMR) obtained by indirect standardization using 1974-77 neonatal mortality and birth weight data for 202 geographic areas across the United States. The results show that the SMR is not sensitive to the choice of standard rates even when the area's birth weight-specific mortality rates are not a constant multiple of standard rates. A method for estimating the standard error of the SMR without knowledge of the weight-specific rates is presented and shown to be nearly unbiased. There is also a substantial amount of variation among geographic areas in both neonatal mortality rates, SMRs, and birth weight distributions. Thus, despite certain limitations, the SMR provides a useful summary measure for monitoring trends and variations among geographic areas or medical care facilities in birth outcome.

Birth Weight↗
PubMed2003

Prenatal window of susceptibility to perfluorooctane sulfonate-induced neonatal mortality in the Sprague-Dawley rat.

The critical period for increased neonatal mortality induced by perfluorooctane sulfonate (PFOS) exposure was evaluated in the rat. Timed-pregnant Sprague-Dawley rats were treated by oral gavage with 25 mg/kg/d PFOS/K(+) on four consecutive days (gestation days (GD) 2-5, 6-9, 10-13, 14-17, or 17-20) or with 0, 25, or 50 mg/kg/d PFOS/K(+) on GD 19-20. Controls received vehicle (10 ml/kg 0.5% Tween-20) on these days. Maternal weight gain was reduced in treated animals during dosing, as were food and water consumption. Following a 4-day treatment, litter size at birth was unaffected while pup weight was similarly reduced in the three earliest PFOS groups. All PFOS groups experienced decreases in survival while controls remained near 100%. Neonatal survival decreased in groups dosed later during gestation, approaching 100% with dosing on GD 17-20. Most deaths occurred before postnatal day (PND) 4, with the majority in the first 24 hours. Maternal serum PFOS levels on GD 21 were higher in groups exhibiting higher mortality. Following a 2-day treatment, PFOS groups experienced significant pup mortality by PND 1. Neonatal mortality continued through PND 5, when survival was 98, 66, and 3% for the 0, 25, and 50 mg/kg groups, respectively. Pup weight was reduced in treated groups with surviving litters. Gross dissection and histological examination of lungs revealed differences in maturation between control and treated animals on PND 0. We conclude that exposure to PFOS late in gestation is sufficient to induce 100% pup mortality and that inhibition of lung maturation may be involved.

Abnormalities, Drug-Induced↗
PubMed1992

The influence of presentation and method of delivery on neonatal mortality and infant neurodevelopmental outcome in nondiscordant low-birthweight ( < 2500 g) twin gestations.

The effects of birth order, presentation and method of delivery on neonatal mortality and neurodevelopmental outcome in nondiscordant low birthweight ( < 2500 g) twin gestations were evaluated. Sixty-four sets of twins were included in the study; 29 sets were in vertex/vertex presentation (Group I), 25 sets in vertex/breech (Group II) and in 10 pregnancies the first twin was nonvertex (Group III). The rate of favorable neonatal outcome (survival and normal neurodevelopmental outcome after a 2-year follow-up) was lower in pregnancies in which at least one twin was in nonvertex presentation (50/70 vs. 52/58 P = 0.02). However, after adjustment by multiple logistic regression analysis for the effects of gestational age, birthweight, birth order and educational level of the mother, this difference was not statistically significant (odds ratio = 0.6; 95% confidence interval 0.44 to 5.9; P = 0.5). In pregnancies in which at least one of the twins was in nonvertex presentation, delivery by cesarean section did not affect the rate of favorable neonatal outcome (odds ratio = 1.8; 95% confidence interval 0.48 to 12.9; P = 0.8). The results of this study suggest that in low birthweight twin gestations, method of delivery in relation to fetal presentation has little or no effect on neonatal mortality and subsequent neonatal neurodevelopmental outcome.

Birth Order↗
PubMed1991

Perinatal & neonatal mortality in a hospital.

A total of 7109 consecutive births were studied over four years to assess perinatal and neonatal mortality. The extended perinatal mortality rate was 57 while conventional perinatal mortality rate (PNMR) was 41 per 1000 total births. Perinatal hypoxia (28.7%), immaturity (24.8%), congenital malformations (14.6%) and infections (5.6%) accounted for most perinatal deaths. The ranking of causes of neonatal deaths was immaturity, birth asphyxia, bacterial infections and congenital malformations. Neonatal mortality rate was 31 per 1000 live births and nearly 90 per cent mortality occurred in low birth weight (LBW) neonates. Hyaline membrane disease accounted for 13.4 per cent of early neonatal deaths. The case fatality rate among LBW babies and preterm babies was 10 per cent and 20 per cent respectively. There is a need to identify strategies to reduce the incidence of prematurity and LBW babies. Comprehensive antenatal coverage and adequate care followed by optimal management of infants at birth is likely to reduce PNMR and improve quality of life among the survivors.

Cause of Death↗
PubMedDate not supplied

[Graphic representation of the neonatal mortality risk at a regional perinatal center in Mérida, Yucatán, México].

OBJECTIVE: To determine the neonatal mortality risk according to gestational age and birth weight. MATERIAL AND METHODS: The cohort consisted of 19,668 newborns of Centro Médico Nacional (National Medical Center) Ignacio García Téllez, a tertiary level healthcare institution of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS) of the Yucatan Peninsula. All newborns discharged from the hospital between January 1st, 1995 and October 31st, 1999 were included in the study. Birth weight, gestational age, and conditions upon discharge were recorded. Absolute risk (AR) of mortality was calculated for each week-of-gestation- and birth group. RESULTS: Observed AR in newborns 34 to 44 weeks of gestational age and weighing at least 2,250 g was 0.4, while that for those 26 to 32 weeks of gestational age and weighing between 1000 g was 15%. CONCLUSIONS: AR of neonatal mortality increased inversely proportional to gestational age and birth weight. These data can be used as reference values for our hospital and for comparison with other hospitals. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Birth Weight↗
PubMed2004

Trends in twin neonatal mortality rates in the United States, 1989 through 1999: influence of birth registration and obstetric intervention.

OBJECTIVE: We sought to evaluate the contributions of changes in birth registration, labor induction, and cesarean delivery on trends in twin neonatal mortality rates. STUDY DESIGN: We conducted a population-based, retrospective cohort study of twin live births, using linked birth-infant death data in the United States (1989-1999). Relative risks and 95% confidence intervals that quantified changes in neonatal (0-27 days) mortality rates were derived from ecologic logistic regression models that were fit after aggregation of the data by each state in the United States. RESULTS: The frequency of live born twins who weighed <500 g increased 72%, from 0.7% in 1989 to 1.2% in 1999, of live born twins who weighed 500 to 749 g and 750 to 999 g increased by 55% and 28%, respectively, between 1989 and 1999. Preterm birth rates increased by 19%, from 46.2% in 1989 to 57.2% in 1999. The rate of labor induction increased from 5.8% to 13.9%, and the cesarean delivery rate increased from 49.8% to 56.3%. Between 1989 to 1991 and 1997 to 1999, the crude neonatal mortality rates among twins who weighed >or=500 g declined by 37% (95% CI, 35%-40%) from 21.5 to 13.6 per 1000 twin live births. Adjustments for preterm labor induction, preterm cesarean delivery, term labor induction, term cesarean delivery, and sociodemographic factors had little influence on neonatal mortality rate trends. CONCLUSION: Increases in preterm birth because of obstetric intervention among twins have not led to increases in twin neonatal mortality rates in the United States.

Cause of Death↗
PubMed2006

Infant and neonatal mortality for primary cesarean and vaginal births to women with "no indicated risk," United States, 1998-2001 birth cohorts.

BACKGROUND: The percentage of United States' births delivered by cesarean section has increased rapidly in recent years, even for women considered to be at low risk for a cesarean section. The purpose of this paper is to examine infant and neonatal mortality risks associated with primary cesarean section compared with vaginal delivery for singleton full-term (37-41 weeks' gestation) women with no indicated medical risks or complications. METHODS: National linked birth and infant death data for the 1998-2001 birth cohorts (5,762,037 live births and 11,897 infant deaths) were analyzed to assess the risk of infant and neonatal mortality for women with no indicated risk by method of delivery and cause of death. Multivariable logistic regression was used to model neonatal survival probabilities as a function of delivery method, and sociodemographic and medical risk factors. RESULTS: Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded. The cesarean/vaginal mortality differential was widespread, and not confined to a few causes of death. CONCLUSIONS: Understanding the causes of these differentials is important, given the rapid growth in the number of primary cesareans without a reported medical indication.

Cause of Death↗
PubMed1993

High perinatal and neonatal mortality in rural India.

A prospective study conducted in rural India on pregnant women showed poor utilization of primary health services and very poor maternal care receptivity especially in terms of antenatal care. A very high perinatal mortality rate of 81.3/1000 live births and a neonatal mortality rate of 63.7/1000 live births was observed in the present study. Out of 204 live births, 72.05% of newborn developed complications within 6 weeks of the delivery. Most of the complications were of a minor nature and could be attributed to poor environmental conditions, lack of personal hygiene and ignorance. The study highlights the need for training of grass root level workers for the improvement of perinatal and neonatal care in rural India.

Female↗
PubMed2003

US birth weight/gestational age-specific neonatal mortality: 1995-1997 rates for whites, hispanics, and blacks.

OBJECTIVE: In recent years, gains in neonatal survival have been most evident among very low birth weight, preterm, and low birth weight (LBW) infants. Most of the improvement in neonatal survival since the early 1980s seems to be the consequence of decreasing birth weight-specific mortality rates, which occurred during a period of increasing preterm and LBW rates. Although the decline in neonatal mortality has been widely publicized in the United States, research suggests that clinicians may still underestimate the chances of survival of an infant who is born too early or too small and may overestimate the eventuality of serious disability. So that clinicians may have current and needed ethnic- and race-specific estimates of the "chances" of early survival for newborn infants, we examined birth weight/gestational age-specific neonatal mortality rates for the 3 largest ethnic/racial groups in the United States: non-Hispanic whites, Hispanics, and non-Hispanic blacks. Marked racial variation in birth weight and gestational age-specific mortality has long been recognized, and growing concerns have been raised about ongoing and increasing racial disparities in pregnancy outcomes. Our purpose for this investigation was to provide an up-to-date national reference for birth weight/gestational age-specific neonatal mortality rates for use by clinicians in care decision making and discussions with parents. METHODS: The National Center for Health Statistics linked live birth-infant death cohort files for 1995-1997 were used for this study. Singleton live births to US resident mothers with a reported maternal ethnicity/race of non-Hispanic white, non-Hispanic black, or Hispanic (n = 10 610 715) were selected for analysis. Birth weight/gestational age-specific neonatal mortality rates were calculated using 250 g/2-week intervals for each ethnic/racial group. RESULTS: The overall neonatal mortality rates for whites, Hispanics, and blacks were 3.24, 3.45, and 8.16 neonatal deaths per 1000 live births, and the proportion of births <28 weeks was 0.35%, 0.45%, and 1.39%, respectively. Newborns who weighed <1500 g comprised <2.5% of all births in each racial/ethnic group but accounted for >50% of neonatal deaths. For whites, Hispanics, and blacks, >50% of newborns 24 to 25 weeks of gestational age survived. For most combinations of birth weights <3500 g and gestational ages of <37 weeks, the neonatal mortality rate was lowest among blacks, compared with whites or Hispanics. At these same gestational age/birth weight combinations, Hispanics have slightly lower mortality rates than whites. For combinations of birth weights >3500 g and gestational ages of 37 to 41 weeks, Hispanics had the lowest neonatal mortality rate. In these birth weight/gestational age combinations, where approximately two thirds of births occur, blacks had the highest neonatal mortality rate. CONCLUSIONS: Compared with earlier reports, these data suggest that a substantial improvement in birth weight/gestational age-specific neonatal mortality has occurred in the United States. Regardless of ethnicity/race, the risk of a neonatal death does not exceed 50% (the suggested definition for the limit of viability), except for birth weights below 500 g and gestational ages <24 weeks. Notwithstanding, ethnic/racial variations in neonatal mortality rates continue to persist, both in overall rates and within birth weight/gestational age categories. Blacks continue to have higher proportions for preterm and LBW births, compared with either whites or Hispanics. At the same time, blacks experience lower risks of neonatal mortality for preterm and LBW infants, while having higher risks of mortality among term, postterm, normal birth weight, and macrosomic births.

Black or African American↗
PubMed2000

Comparative trends in cause-specific fetal and neonatal mortality in twin and singleton births in the North of England, 1982-1994.

OBJECTIVE: To examine trends in cause- and birthweight-specific fetal and neonatal mortality rates in twins and singletons. DESIGN: Descriptive analysis based on a regional register. SETTING: The Northern Health Region of England, 1982-1994. SAMPLE: Two hundred and thirty-six fetal and 356 neonatal twin deaths; 2,687 fetal and 2,301 neonatal singleton deaths from a population of 10,734 twins and 505,477 singletons. MAIN OUTCOME MEASURES: Fetal and neonatal autopsy rates, cause- and birthweight-specific fetal and neonatal mortality rates in twins and singletons. RESULTS: The extended perinatal mortality (including stillbirths and neonatal deaths) rate (EPMR) was 55.2 per 1,000 in 1982-1994 in twins compared with 9.9 per 1,000 in singletons. The relative risk for twin compared with singleton deaths was 5.6 (95% CI 5.1-6. 1) being highest for immaturity (12.9, 95% CI 11.1-15.0). A significant decrease in the EPMR occurred in both twins and singletons in 1988-1994 compared with 1982-1987. The EPMR decreased mainly due to a reduction of deaths from antepartum asphyxia in twins and intrapartum asphyxia and trauma in singletons, as well as a reduction in congenital malformations in both groups. In both twins and singletons, birthweight-specific mortality rates improved between 1982-1987 and 1988-1994. CONCLUSION: The higher relative risk for twin deaths remained stable due to a similar decrease in the EPMR for both twins and singletons. The cause-specific relative risk in twins declined for antepartum asphyxia. The mortality rate resulting from lethal congenital malformations decreased in twins and singletons mainly due to earlier detection and subsequent termination of pregnancy.

Birth Weight↗
PubMed1989

The geographical variation in neonatal and post-neonatal mortality in South Africa, 1978-1982.

Early neonatal, neonatal and post-neonatal mortality rates were systematically calculated according to the statistical regions of South Africa for the white and coloured populations over a 5-year period. The geographical variation is wide and the statistical significance in these mortality rates for coloured infants in rural areas of the Cape and the Orange Free State are particularly high and call for urgent attention.

Black or African American↗
PubMed2002

Infant feeding and post-neonatal mortality in Derbyshire, England, in the early twentieth century.

This paper examines influences on post-neonatal mortality in Derbyshire (England) in the early twentieth century, by applying multivariate hazard analysis to a rare individual-level data set. The data allow detailed patterns of breastfeeding and weaning to be examined. The role of feeding is given special attention as a mediator between mortality and the other environmental, social, and demographic factors considered. Twins and illegitimate children were more likely to have been hand-fed, but this could explain only a small fraction of their increased vulnerability. Artificial feeding was associated with increased risks of death from diseases was predominantly the result of the greater likelihood of congenitally weak children being hand-fed. Most of the variation in post-neonatal mortality, particularly from respiratory disease, was explained by environmental influences - population density, altitude, and the presence of mining.

Breast Feeding↗
PubMed2004

Analysis of neonatal mortality:is standardizing for relative birth weight biased?

BACKGROUND: Infant mortality has traditionally been analyzed as a function of birth weight and birth weight-specific mortality. Often, however, when comparing two populations, the population with higher overall mortality has lower mortality at low birth weights and a reversed pattern at higher birth weights. Methods standardizing birth weight, such as the "relative birth weight", have been proposed to eliminate these crossover effects, but such methods do not account for the separate contributions to birth weight of gestational age and fetal "growth." METHODS: Using data for singleton U.S. Blacks (n = 3,683,572) and Whites (n = 18,409,287), we compared neonatal mortality, gestational age, and the difference between the observed birth weight and the optimal birth weight (the weight at which neonatal mortality was lowest) among Black and White infants at the same relative birth weight. RESULTS: At relative birth weights below zero, gestational ages were, on average, 2.4 +/- 1.5 (mean +/- standard deviation) weeks shorter for Blacks than for Whites for the same relative birth weight. At relative birth weights above zero, no differences were observed in gestational age, but the optimal birth weight occurred at a much higher relative birth weight in Whites than in Blacks (4150 vs. 3550 g). CONCLUSIONS: Our results suggest that comparisons of neonatal mortality between groups using "relative" birth weight may be potentially biased by differences in gestational age at low birth weights, and by the distance from the optimal birth weight at higher birth weights.

Journal Article↗
PubMed1985

Trends in neonatal mortality in Benin City, Nigeria.

A total of 18,334 live births and 376 neonatal deaths at the University of Benin Teaching Hospital were analyzed. The neonatal mortality rate has declined significantly from 49.5/1000 in 1974 to 16.4/1000 live births in 1981. The decrease mainly resulted from the reduction of mortality of full size infants (greater than 2500 g) and deaths resulting from perinatal asphyxia. Further reduction may be anticipated if careful attention is paid to the management of breech delivery and if a more intensive care for low birth weight infants is provided.

Age Factors↗