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PubMed1989

Comparison of neonatal mortality rates between transports to tertiary and intermediate neonatal intensive care units.

The differential of neonatal mortality rates between infant transports to tertiary and to intermediate neonatal intensive care units (NICUs) was examined based on 8,391 one-time infant transports from community hospitals to tertiary or intermediate NICUs in Southern California in the three-year period 1981-1983. Among the demographic, birth and delivery, and diagnostic characteristics studied, nine were identified to be related significantly to the higher neonatal mortality rate among transports to tertiary NICUs: birthweight, gestational age, necessity of intubation, multiple clinical conditions, presence of cardiac, neurologic, and genitourinary problems, anomalies, and syndromes. Adjusting for differences in the number of cases with necessity of intubation and the presence of the five clinical problems reduced the neonatal mortality ratio of tertiary to intermediate NICUs from 1:56 to 1:01, while adjustment for birthweight and gestational age differences reduced the ratio from 1.56 to 1.54. This analysis indicates that the difference of neonatal mortality between the two levels of NICUs can be explained to a larger extent by the higher proportion of infants requiring intubation with serious clinical problems. Birthweight and gestational age played only a minor role in this respect.

Apgar Score↗
PubMed1993

Neonatal mortality in Meerut district.

A study of neonatal mortality in Meerut district revealed an infant mortality rate of 50.1 per 1000 live births. Neonatal mortality accounted for 37.8% of infant mortality with a neonatal mortality rate of 19.0 per 1000 live births. 90.5% of these neonates were delivered at home largely by untrained personnel (57.2%). Only 28.6% of these neonates were treated by qualified doctors and only 30.9% of their mothers were fully immunized against tetanus. At least 2/3rd of neonatal mortality was due to exogenous factors with tetanus neonatorum and septicaemia being the principal causes of mortality each accounting for a mortality rate of 4.7 per 1000 live births.

Cause of Death↗
PubMed2000

The importance of preterm births for peri- and neonatal mortality in rural Malawi.

Peri- and neonatal mortality remain high in developing countries, especially in sub-Saharan Africa. In the present study, we quantified and identified the most important predictors of early mortality in rural Malawi. Data were obtained from a community-based cohort of 795 pregnant women and their 813 fetuses, followed prospectively from mid-pregnancy. In this group, peri- and neonatal mortality rates were 65.3 deaths per 1000 births and 37.0 deaths per 1000 live births respectively. When controlled for month of birth, maternal age and selected socio-economic variables, preterm birth was the strongest independent predictor of both peri- and neonatal mortality (adjusted odds ratios 9.6 for perinatal and 11.0 for neonatal mortality; 95% confidence intervals: [4.4, 21.0] and [3.7, 32.7] respectively). Weaker risk factors for mortality included a maternal history of stillbirth and abnormal delivery. Preterm delivery was associated with primiparity and peripheral malaria parasitaemia of the mother, and it accounted for 65% of the population-attributable risk for perinatal and 68% of the neonatal mortality. Successful intervention programmes to reduce peri- and neonatal mortality in Malawi have to include strategies to predict and prevent prematurity.

Developing Countries↗
PubMed1983

Neonatal deaths in Alabama. II. Policy and research implications derived from a comparison of birth weight-specific state and medical center neonatal mortality rates.

An analysis of Alabama's recent neonatal mortality rate was performed to answer questions pertaining to projected changes in the neonatal mortality rate in the next decade. With current technology these questions include: (1) Can the current decline in the neonatal mortality rate continue? (2) Which infants not now surviving are potentially able to be saved? (3) What types of new programs may further reduce the neonatal mortality rate? (4) For which infants may research provide technology leading to further reductions in the neonatal mortality rate? In this analysis, birth weight-specific neonatal mortality rates for Alabama were compared with the lowest birth rate-specific neonatal mortality rates achieved in perinatal centers. Specific causes of neonatal death for each birth weight group were determined. Data suggest that 20% of current neonatal deaths would be preventable with available technology through expanded regionalization of perinatal care for infants born weighing less than 2,500 gm. Since lethal congenital anomalies cause the majority of neonatal deaths in infants born weighing greater than 2,499 gm, there is apparently little room for an improved neonatal mortality rate in this group. Without successful research leading to a reduction in preterm delivery rates, a reduction in lethal congenital anomalies or better survival of low-birth weight infants. Alabama's neonatal mortality rate is likely to level off at five to six per 1,000.

Alabama↗
PubMedDate not supplied

Neonatal mortality clusters: a new tool for classifying neonatal outcomes.

BACKGROUND: A method for assessing general hospital neonatal care performance is needed that is simple, is easy to use, and requires minimal data. METHODS: All neonatal deaths in Washington State obstetric hospitals from 1980 to 1983 were assigned to 10 mutually exclusive neonatal mortality clusters, a new classification method derived from information available on the death certificate. RESULTS: More than one-third (35.3 percent) of all neonatal deaths fell within one of the seven clusters considered to represent potentially preventable causes of death. The rate of possibly preventable deaths was much higher in level III hospitals than in level II or level I hospitals, a finding similar to that observed in other states using different analytic approaches. CONCLUSIONS: Neonatal mortality clusters offer a less complex method of classifying neonatal deaths and assessing hospital performance than other currently used techniques.

Birth Weight↗
PubMed1991

Proportionality of small for gestational age babies as a predictor of neonatal mortality and morbidity.

Neonatal mortality and morbidity of 2609 babies who weighed less than the fifth centile for gestational age were studied in order to evaluate the relationship between the type of intrauterine growth retardation and the short-term prognosis after birth. Of these babies, 1175 had both a birthweight and head circumference below the fifth centile ('proportionately small'); the others, whose body weight was below but head circumference above the fifth centile, were defined as 'disproportionately small'. The former group showed a consistently higher risk of death during the neonatal period. Morbidity defined by birth asphyxia, respiratory distress and neonatal infections was higher in those proportionately small babies who were delivered at term. The picture reversed for hyperbilirubinaemia, which was more frequent among disproportionately small babies. Proportionality, defined on the basis of the correspondence between birthweight and head circumference centiles, appears to be a simple and non-invasive clinical method to identify babies who are at higher risk of adverse outcome.

Asphyxia Neonatorum↗
PubMed2004

Racial/ethnic disparities in neonatal mortality--United States, 1989-2001.

Neonatal mortality (i.e., death at age <28 days) accounts for approximately two thirds of infant deaths in the United States. During 1989-2001, neonatal mortality rates (NMRs) declined; however, 2002 preliminary data indicated an increase. To characterize trends in neonatal mortality by gestational age and race/ethnicity, CDC analyzed linked birth/infant death data sets for 1989--1991 and 1995-2001 (2002 linked data were not available). This report summarizes the results of that analysis, which indicated that 1) extremely preterm infants (i.e., born at <28 weeks' gestation) accounted for 49%-58% of neonatal deaths during 1989-2001 and 2) racial/ethnic disparities persisted despite NMR declines among infants of all gestational ages. Public health practitioners, researchers, and clinicians can use these results to determine the efficacy of prevention programs at a national level and consider new studies and programs aimed at reducing preterm births and NMR disparities among racial/ethnic populations.

Ethnicity↗
PubMedDate not supplied

Lethal congenital anomalies as a cause of birth-weight-specific neonatal mortality.

The percentage of neonatal mortality caused by lethal congenital anomalies and the distribution of specific anomalies in various birth-weight groups are presented. State vital statistics data and autopsy-confirmed data from a single hospital are compared. Of neonates who died, less than 5% who were born weighing between 500 and 999 g died of a congenital anomaly, and nearly 45% who were born weighing more than 2,500 g died of a congenital anomaly. Most deaths associated with congenital anomalies in infants born weighing more than 2,500 g are cardiac in origin. Twenty-three percent of all neonatal deaths in Alabama are attributed to a lethal congenital anomaly. Use of these data to define limits to future improvements in neonatal mortality by standard medical care is discussed.

Abnormalities, Multiple↗
PubMed1994

Risk factor analysis of peri-neonatal mortality in rural Guatemala.

Peri-neonatal mortality is a serious health problem in Guatemala, especially in rural areas where most deliveries occur at home and are overseen by traditional birth attendants (TBAs) who function in the role of midwives. The three aims of the work reported here were to identify important predictors of peri-neonatal mortality within a rural area of Guatemala; to assess the effects of traditional and modern health care providers on such mortality; and to find ways of identifying high-risk women who might benefit from transfer to a hospital or clinic. For these purposes a case-control study was conducted of 120 women in the rural department of Quetzaltenango who had lost their babies from the 20th week of pregnancy through the 28th day of life. These women and 120 controls were interviewed in their homes by trained physicians, using questionnaires in Spanish or the appropriate Indian dialect, and the results were analyzed through a series of statistical tests. It was found that the complications of pregnancy and delivery with the greatest statistical significance were prematurity, malpresentation, and prolonged labor. Population-based attributable risks of these complications demonstrated that they accounted for significant proportions of the observed peri-neonatal mortality. While these conditions cannot be eliminated, within the rural Guatemalan context it appears that early referral of women with these complications to more specialized care settings could result in improved delivery outcomes.

Adolescent↗
PubMed2000

[Neonatal mortality in the Czech Republic 1998-1999].

OBJECTIVE: To evaluate neonatal mortality rate (NMR) in 1998 and 1999 years in the Czech Republic. DESIGN: Retrospective epidemiological study of all alive newborns born in 1998 and 1999 in the Czech Republic. SETTINGS: 12 perinatological centers of nine regions of Bohemia and Moravia. METHODS: All alive, died, died with congenital defects newborns were registered and results of neonatal mortality rate and specific neonatal mortality rate were calculated. The main causes of death were divided into four groups (intraventricular hemorrhage grade III-IV, infection, acute respiratory failure and others) and evaluated comparatively. In 1999 the NMR of newborns with birth weight below 500 g and their survival were introduced for the first time in the Czech Republic. RESULTS: The fluent decrease of NMR during nineties was stopped in 1999. Increase of NMR from 2.8@1000 in 1998 to 3.0@1000 in 1999 was mainly caused by arise of specific neonatal mortality rate in newborns weighing > or = 2000 g. Comparing 1998 and 1999 years, two times more these newborns without serious congenital defects died in 1999 (28 vs. 56). Specific neonatal mortality rate of extremely low birth weight newborns further decreased (359@1000 vs. 279@1000) especially in the newborns with birth weight between 500-749 g (543@1000 vs. 373@1000). The most frequent main causes of death still has been intraventicular haemorrhage grade III-IV and infection in very low birth weight newborns, and serious congenital defects and infection in newborns weighing > or = 1500 g. The concentration of very low birth weight newborns to perinatological centers by transfer in uterus was 81% in 1998 and 83% in 1999. The differences in neonatal mortality rates between nine regions of Bohemia and Moravia has been getting equal but has been still great in specific neonatal mortality rate of extremely low birth weight newborns between the best and worst regions (147@1000 vs. 458@1000). There were registered 19 newborns weighing < or = 500 g surviving more than 24 hours after delivery in the Czech republic. Specific neonatal mortality rate of these newborns was 316@1000 and 527@1000 survived. CONCLUSION: Reserves for further lowering of NMR are improving the care after extremely low birth weight newborns in the regions with below average results and decreasing the mortality of newborns with birth weight > or = 2000 g by introducing of group B streptococcus prophylaxis, improving prenatal diagnostics of serious congenital defects and early and more quality postnatal transport of newborns suffered from acute respiratory failure to centers disposing of the latest methods of treatment.

Birth Weight↗
PubMed1998

Cause-specific trends in neonatal mortality among black and white infants, United States, 1980-1995.

OBJECTIVE: Although neonatal mortality has been declining more rapidly than postneonatal mortality in recent decades, neonatal mortality continues to account for close to two-thirds of all infant deaths. This report uses U.S. vital statistics data to describe national trends in the major causes of neonatal mortality among black and white infants from 1980 to 1995. METHODS: Mortality rates were estimated as the number of deaths due to each cause (based on International Classification of Diseases, 9th Revision, codes) divided by the number of live births during the same time period. Linear regression models and smoothed rates were used to describe trends. RESULTS: During the study period, neonatal mortality declined 4.0% per year for white infants and 2.2% per year for black infants, and the black-white gap increased from 2.0 to 2.4. By 1995, disorders relating to short gestation and low birth weight were the number one cause of neonatal death for black infants and the number two cause for white infants, had the highest black-white disparity (4.6, up from 3.3 in 1980), and accounted for almost 40% of excess deaths to black infants (up from 24% in 1980). Congenital anomalies were the number two cause of neonatal death for black infants and the highest ranked cause for white infants in 1995, and it is the only cause for which there was not a substantial excess risk to black infants. CONCLUSIONS: Large declines in neonatal mortality have been achieved in recent years, but not in the black-white gap, which has increased. Declines were slower for black than white infants overall and for almost all causes. Prevention of preterm delivery and low birth weight continue to be a priority for reducing neonatal mortality, particularly among black infants. Although congenital anomalies do not contribute substantially to the black-white gap, their diagnosis, treatment, and prevention is critical to reducing overall neonatal mortality.

Black People↗
PubMed1996

The effects of patient volume and level of care at the hospital of birth on neonatal mortality.

OBJECTIVE: To examine the effects of neonatal intensive care unit (NICU) patient volume and the level of NICU care available at the hospital of birth on neonatal mortality. DESIGN: Birth certificate data linked to infant death certificates and to infant discharge abstracts were used in a logistic regression model to control for differences in each patient's clinical and demographic risks. Hospitals were classified by the level of NICU care available (no NICU: level I; intermediate NICU: level II; expanded intermediate NICU: level II+: tertiary NICU: level III) and by the average patient census in the NICU. SETTING: All nonfederal hospitals in California with maternity services. PATIENTS: All births in nonfederal hospitals in California in 1990 (N=594104), 473209 (singletons only) of which were successfully linked with discharge abstracts. Of these infants, 53229 were classified as likely NICU admissions. MAIN OUTCOME MEASURES: Death within the first 28 days of life, or within the first year of life, if continuously hospitalized. RESULTS: Patient volume and level of NICU care at the hospital of birth both had significant effects on mortality. Compared with hospitals without an NICU, infants born in a hospital with a level III NICU with an average NICU census of at least 15 patients per day had significantly lower risk-adjusted neonatal mortality (odds ratio, 0.62; 95% confidence interval, 0.47-0.82; P=.002). Risk-adjusted neonatal mortality for infants born in smaller level III NICUs, and in level II+ and level II NICUs, regardless of size, was not significantly different from hospitals without an NICU, and was significantly higher than hospitals with large level III NICUS. CONCLUSIONS: Risk-adjusted neonatal mortality was significantly lower for births that occurred in hospitals with large (average census, >15 patients per day) level III NICUs. Despite the differences in outcomes, costs for the birth of infants born at hospitals with large level III NICUs were not more than those for infants born at other hospitals with NICUs. Concentration of high-risk deliveries in urban areas in a smaller number of hospitals that could provide level III NICU care has the potential to decrease neonatal mortality without increasing costs.

California↗
PubMed2000

[Dynamics and structure of neonatal mortality in Bulgaria - Part II. Dynamics and structure of neonatal deaths in the university maternity hospital "Maichin Dom"].

AIM OF THE STUDY: To analyse the state and the structure of the neonatal lethality in the largest perinatal center of Bulgaria 'Maichin dom' during the last five years, and to compare them with the national data on neonatal mortality. MATERIAL AND METHODS: A retrospective study on the evolution of neonatal lethality in the recent 5 years and on its structure during the last 2 years was fulfilled using the data of the Department of Neonatology of the University hospital 'Maichin dom' concerning the infants' lethality. The results were compared to the national data on infants' mortality (in 28 days of life) and presented graphically. RESULTS: The level of neonatal lethality in the University hospital increased invariably until 1997, when it reached the highest peak (12.7@1000), after that it decreased to 10.3@1000 in 1998. This tendency is predominantly due to the early neonatal mortality, which raised from 6.7@1000 in 1994 to 8.5@1000 in 1998, and remained at the same level in the last two years. The leading causes of neonatal lethality in the perinatal center are the congenital malformations--40.6@1000, which is higher than in the country. The congenital anomalies of central nervous system account to 75@1000 of all lethal malformations. The perinatal asphyxia is the second cause of death--34.7@1000, which is considerably less than in the country--41.3@1000. The neonatal respiratory distress syndrome is the third main cause of death in the neonatal period--9.4@1000 in the hospital; 10.9@1000--in the country. The neonatal lethality is mainly due to the premature infants--82.5@1000 in 1997 and 90.6@1000 in 1998. The relative portion of the term infants considerably decreased in these two years--from 17.5@1000 to 9.4@1000. These numbers are 100 times less than the data of the whole country. CONCLUSIONS: The evolution of the neonatal lethality in the University hospital 'Maichin dom' has a similar tendency of the neonatal mortality in Bulgaria, the increase being mostly due to the early neonatal mortality. The leading causes of death are the congenital malformations and predominantly the central nervous system defects. The perinatal asphyxia is the second most frequent lethal cause with a relative portion which is less than that in the country. The lethality of the premature infants in the hospital is 6 times less than that in the country and the neonatal lethality of term infants is practically discriminated.

Bulgaria↗
PubMed1994

Contribution of genetic disorders to neonatal mortality in a regional intensive care setting.

We examined the contribution of chromosomal abnormalities, mendelian disorders, and birth defects to mortality in a regional neonatal intensive care unit by medical record review of neonatal deaths in that unit. Of a total of 296 infant deaths during the 5-year period June 1986 to May 1991, 69 (23.3%) had a genetic disorder. By diagnostic category, 18.8% had a chromosomal abnormality, 10.1% had a mendelian condition, 42% had a single primary defect in development, and 29% had an unrecognized pattern of malformation. The rate of autopsy and genetic evaluation differed markedly between these diagnostic categories. A comparison was made of underlying cause of death determined from medical records with underlying cause as classified by vital statistics nosologic procedures. No death certificate was on file for two of the deaths; for the remaining 67, 27 (40.3%) had an erroneous or misleading underlying cause of death as determined from vital statistics. The important contribution of genetic disorders to neonatal mortality in this high-risk population and the relative underrecognition of these disorders by vital statistics sources indicate that efforts aimed at reducing neonatal mortality will require a full range of preventive health activities, including preconception, prenatal and perinatal assessment, and counseling. Improved data collection techniques need to be developed to understand the contribution of this group of conditions to total neonatal mortality.

Cause of Death↗
PubMed1976

Determinants of the neonatal mortality.

A recent sharp decline in the neonatal mortality in our medical center prompted a critical analysis of viral statistics of the newborn service during the years 1966 through 1973. The mean neonatal mortality for the entire period was 15.4 per 1,000 live births, and 11.0 in the period 1972 through 1973. The annual neonatal mortalities bore a direct relationship to the annual incidences of infants with birth weights of 1,500 gm or less. The reduction in the proportion of infants in the latter weight group during 1972 through 1973 accounted for three quarters of the improvement in the neonatal mortality as compared to that of the previous years. One quarter of the improvement could be attributable to a decrease in mortality that occurred only in infants in the latter weight group during the same period.

Birth Weight↗
PubMed2003

Neonatal mortality in weekend vs weekday births.

CONTEXT: Increases in neonatal mortality for infants born on the weekend were last noted several decades ago. Although the current health care environment has raised concern about the adequacy of weekend care, there have been no contemporary evaluations of daily patterns of births, obstetric intervention, and case mix-adjusted neonatal mortality. OBJECTIVE: To compare the neonatal mortality of infants born on weekdays and weekends. DESIGN, SETTING, AND PARTICIPANTS: Case series of 1 615 041 live births (weight >or=500 g) in California between 1995-1997 to determine patterns of births, cesarean deliveries, and neonatal deaths. Analyses were stratified by birth weight and delivery method. To assess the role of weekend differences in case mix, observed and birth weight-adjusted odds ratios (ORs) for increased weekend mortality were estimated using logistic regression. MAIN OUTCOME MEASURE: Birth weight-adjusted neonatal mortality. RESULTS: There was a 17.5% decrease in births on weekends, accompanied by a decrease in the proportion of cesarean deliveries from 22% on weekdays to 16% on weekends. Weekend decreases in births were least pronounced in smaller infants, resulting in a weekend concentration of high-mortality, very low-birth-weight (<1500 g) births. Observed neonatal mortality increased from 2.80 per 1000 weekday births to 3.12 per 1000 weekend births (OR, 1.12; 95% confidence interval [CI], 1.05-1.19; P =.001) for all births, and from 4.94 to 6.85 (OR, 1.39; 95% CI, 1.25-1.55; P<.001) for cesarean deliveries. After adjusting for birth weight, the increased odds of death for infants born on the weekend were no longer significant. CONCLUSIONS: The provision of optimal care regardless of the day of week is an important goal for perinatal medicine. Comparing the neonatal mortality of infants born on weekdays and weekends provides a straightforward assessment of this goal. After controlling for birth weight, we found no evidence that the quality of perinatal care in California was compromised during the weekend.

Birth Weight↗
PubMed1984

Perinatal mortality in rural India: intervention through primary health care. II Neonatal mortality.

Early neonatal mortality is unacceptably high in most developing countries. A large majority of births in rural areas of these countries occur at home, attended by relatives or traditional birth attendants and without easy access to skilled professional care. Under these circumstances cause of death has to be based on lay descriptions of terminal events. Analysis of cause of death shows that 74% of the early neonatal deaths are amenable to intervention. Admittance to hospital of the "at risk" neonates is not practicable. Intervention through primary health care can be effective if based on scientific principles and offered through female community health workers. Objectives of domiciliary care given by these workers should be to educate and guide the mother to protect the delicate newborn from the effects of adverse environmental conditions, to ensure adequate nutrition, and to prevent infections. Interventions supporting beneficial traditional cultural practices as well as simple techniques for care of the newborn are discussed.

Adult↗
PubMedDate not supplied

The importance of extreme prematurity and low birthweight to US neonatal mortality patterns: implications for prenatal care and women's health.

OBJECTIVE: In order to frame the appropriateness of neonatal mortality reduction efforts that begin only after pregnancy is recognized, this study examined the relative contributions of different gestational age and birthweight groups to total neonatal mortality and to racial disparities in neonatal mortality in the United States. METHODS: Using the national linked birth/infant death data set for the 1988 cohort, the relative contributions of different birthweight and gestational age groups to national neonatal mortality rates were calculated. The relative contributions of these groups to the racial disparity in neonatal mortality were also assessed. RESULTS: Very low birthweight infants (< 1,500 g) accounted for 1.2% of all births, but 64.2% of all neonatal deaths. The very low birthweight rate for whites was 0.93%, while that for blacks was 2.79% with the contribution of this group to neonatal mortality higher for blacks than whites. Infants less than 1,000 g contributed more than 80% of the racial disparity in neonatal mortality. CONCLUSION: Neonatal mortality patterns in the United States have become highly dependent on infants with gestational ages that approach the second trimester. Preventing neonatal mortality by enhancing care only after pregnancy has been recognized, therefore, may be limited. Strategies that link prenatal care to broader initiatives to improve the health of women regardless of pregnancy status may be more effective.

Cohort Studies↗