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PubMed2006

[Neonatal mortality in a regional perinatal hospital in Merida, Yucatan, 1995-2004 I. Analysis of the gross, specific rates].

OBJECTIVE: To evaluate the neonatal mortality and the specific neonatal mortality rates by groups of birthweight and gestacional age, at the Ignacio García Téllez National Medical Center which is a reference tertiary perinatal center of the Social Security Mexican Institute for the Yucatan Peninsula, along the period of 1995-2004. MATERIAL AND METHODS: A cohort of 46,297 live newborns was studied with birtweight of 500 grams or more, that were discharged between January 1st 1995 and December 31st 2004. Birthweight, gestational age, length of hospitalization, condition at discharge were captured in a data base. Triennial analysis of mortality was done. RESULTS: The proportion of neonates with birthweight <2,500 g increased and 19% neonates <1,000 g 50%, the increment was 21% for preterm neonates, 46% for immature, and 40% for those extremely immature. The early neonatal mortality rate diminished from 7.0 to 6.9, the late mortality from 3.0 to 2.2, the neonatal from 10.0 to 9.2/1,000 live newborn, the survival increased 232% in neonates with birthweight between 500-749 g, 25% between 750-999 g, 5.8% between 1,000-1,249 g, 8.2% between 1,250-1,499 g. The neonatal mortality decreased 31.8% from the expected, because the adjusted neonatal mortality rate was 13.5 compared with the observed 9.2/1,000 live newborn. CONCLUSIONS: There was a significant increase of the survival with lesser birthweight and gestational age, although it was not reflected in the brut neonatal mortality rate because there was an increase of the risk population.

Birth Weight↗
PubMed2003

Identification of causes of neonatal mortality using the ICD-10 classification: a study in neonatal intensive care units in Alexandria Governorate (MOHP).

In most developing countries, neonatal care has remained static or neglected for decades where neonatal mortality was 38/1000 live births compared to 6/1000 in developed countries. According to the World Health Organization (who) neonatal causes of death were infections (34%), asphyxia (28%), problems linked with preterm birth (23%) and congenital anomalies (10%). In Alexandria govemorate (A.R.E.) causes of death of,admitted neonates in neonatal intensive care units (NICU) were not recorded. The aim of the present study is to identify causes of neonatal deaths based on the International classification of diseases-10 (ICD-10) among admitted neonates in the NICU in MOHP hospitals in Alexandria so as to set preventive strategies to decrease the neonatal mortality. A descriptive cross-sectional study was conducted on 2424 neonates admitted through one year (April 2001-March 2002) in eight hospitals of MOHP. Certain modifications in the routinely collected monthly reports were necessary and a new computer program was developed in the Alexandria information center. Results revealed that hyaline membrane disease was the 1st cause of neonatal deaths (16.5%) followed by causes related to prematurity (15.8%). It was also the 1st causes of death of preterm neonates (27.5%). Birth asphyxia and congenital anomalies were the 1st and 2nd causes of death among full term neonates (21.7% each). Single dose of corticosteroid injection could be recommended for mothers expected to have a premature labor to decrease the incidence of hyaline membrane disease among preterm neonates.

Birth Weight↗
PubMed2003

The burden of disease from neonatal mortality: a review of South Asia and Sub-Saharan Africa.

OBJECTIVE: To assess the burden of neonatal mortality in two developing regions. DESIGN: Review of secondary data collated through literature review. SETTING: Community and facility based studies and national health surveys. POPULATION: Neonatal (<28 days) population of South Asia and Sub-Saharan Africa. METHODS: Data on neonatal mortality were gathered from peer-reviewed literature, reports of the Demographic and Health Surveys and websites of country-based organisations. The base year for this study is 1995. For each country, a weighted mean neonatal mortality rate was calculated and the total number of neonatal deaths estimated. Country data were summarised over each region to estimate annual regional neonatal deaths and rates. The burden of disease from neonatal mortality was determined using a summary measure of health--healthy life years. MAIN OUTCOME MEASURES: Numbers of deaths and healthy life years (HeaLYs). RESULTS: Neonatal mortality rate for South Asia ranged from 41.9 to 56.9 per 1000 live births for 1995. Sri Lanka was an exception with a neonatal mortality rate between 16.3 and 18.6 per 1000 live births. The estimated regional neonatal mortality rate for South Asia was 46.27 per 1000 live births for 1995. There was a significant lack of data from Sub-Saharan Africa, resulting in highly variable neonatal mortality rates, ranging from 13 per 1000 live births in Kenya to 108 per 1000 live births in Senegal. The mean regional neonatal mortality for Sub-Saharan Africa for 1995 was estimated at 38.8 per 1000 live births. CONCLUSION: The burden of neonatal mortality in only these two regions of the developing world represents more than 2 million annual deaths. A call for greater investments in neonatal research and health programs is a logical extension to this review of evidence.

Adult↗
PubMedDate not supplied

Perinatal and neonatal mortality and morbidity in Lusaka, 1976.

A prospective study of perinatal and neonatal mortality and morbidity at the University Teaching Hospital (UTH), Lusaka for 1976 is presented. The early neonatal mortality of the babies born in hospital was 28.7 per 1000 live-births; it was 239.96 per 1000 admissions of those born outside the hospital. The still-birth rate in the hospital-born babies was 25.2 per 1000 deliveries; the perinatal mortality was 53.3 per 1000 deliveries; and the neonatal mortality in the hospital-born was 31.1 per 1000 live-births. The cause of death were asphyxia, infections could injury, respiratory distress syndrome, congenital malformation and intracranial haemmorrhage. If the perinatal and neonatal mortality and morbidity are to be reduced, much effort and co-operation of all concerned with the health of the expectant mother, and her child are required. Records of birth-weights, stillbirth, and causes of deaths in the University Teaching Hospital (UTH) for the year 1976 have been analysed. The aim is to provide a basis for future comparisons and improvement of the care given to newborns.

Female↗
PubMedDate not supplied

Area variations in birthweight- and cause of death--specific neonatal mortality rates in Italy.

The neonatal mortality rate in Italy is intermediate between the United States and the Northern European countries, but important regional differences exist within the country. On the basis of national data recorded by the Italian National Statistical Institute, birthweight- and cause of death-specific neonatal mortality rates were calculated for the whole country and for Northern, Central, and Southern Italy. The incidence of very low birthweight (500 to 1499 gm) and moderately low birthweight (1500 to 2499 gm) infants is similar in the three areas, whereas the risk of dying in the first month of life is highest in Southern and lowest in Northern Italy. Respiratory distress syndrome/immaturity is the main cause of neonatal death because of very high percent and component rates among very low birthweight infants and (to a lesser extent) among moderately low birthweight infants. Congenital disorders, which mainly affect normal weight newborns, are the second cause of neonatal death. Infants born in Southern Italy run a significantly higher risk of dying in the neonatal period than infants born in Northern Italy in almost all birthweight/cause of death subgroups, with the largest differences for moderately low birthweight infants. A similar but smaller difference is seen when infants born in Central Italy are compared with their Northern counterparts.

Birth Weight↗
PubMedDate not supplied

[Why are babies born at night at increased risk of early neonatal mortality?].

BACKGROUND: Increased perinatal and neonatal mortality rates have been previously reported in night-time births compared with births during the day. This effect has been attributed to decreased quality of medical care during the night. However, alternative explanations exist such as decreased birth-weight of night births. The objective of this study was to further investigate this relationship. MATERIALS AND METHODS: Data from 590,332 low risk births (singleton births, > or = 2500 g birth-weight, no major congenital anomaly) were obtained from the perinatal birth register of Hesse, Germany, 1990-2000. Outcome was defined as either death during labour or within 7 days of life. Night-time births were defined as births between 9.00 p.m. and 6.59 a.m., otherwise day-time births were assumed. Subgroup analyses and logistic regression analyses were performed to assess whether the excess mortality of night-births might be explained by other factors. RESULTS: Mortality rates were increased in night-time births (RR = 1.26; 95% CI = 0.94-1.70). This relationship was more pronounced in spontaneous births (RR = 1.58; 95% CI = 0.96-2.61) and emergency cesarean sections (RR = 1.76; 95% CI = 1.10-2.82). Significance persisted after adjusting for numerous potential confounders. CONCLUSION: Our results confirm an increased mortality risk for night-time births which could not be explained by other accessible risk factors. This suggests that the increased risk at night might be attributable to a reduced availability to provide appropriate medical care in delivery units at night. DISCUSSION: As mainly the presence of staff is decreased during the night, introduction of better designed shifts can be expected to reduce neonatal mortality.

Cesarean Section↗
PubMed1991

Neonatal mortality patterns in an urban hospital.

Neonatal mortality rate is perhaps the most reliable indicator of the perinatal outcome. An assessment of perinatal outcome can be made through knowledge of causes of death. This study was carried out to evaluate the neonatal deaths in our hospital. Live births (n = 7309) and deaths (n = 328) during a 6 months period were retrospectively analyzed. These were grouped into non-preventable and potentially preventable causes of death. The single most important factor contributing to the mortality was respiratory distress (29.3%) followed by sepsis (24.4%) and birth asphyxia (16.2%). The non-preventable causes of mortality (e.g., lethal congenital malformations, extremely low birth weight) accounted for 10.4% of the total mortality. The idealized neonatal mortality rate was 4.6/1000 live births, while the salvageable death rate was 40.2/1000 live births. The mortality increased significantly if the birth weight fell below 2 kg. The salvageable deaths could perhaps be prevented through better antenatal and intranatal care, ventilatory support and prevention of sepsis.

Cause of Death↗
PubMedDate not supplied

Strategies for reduction of neonatal mortality.

Infant mortality rates in developed countries have shown significant decreases in recent years. Two-thirds of infant mortality still occurs in the neonatal period and our aim in this study was to review the causes of these neonatal deaths and see where further improvements may be possible. A 6-yr review of all neonatal deaths of live-born infants over 500 g birthweight from 1991 to 1996 was made. The 1989 amended Wigglesworth classification was used to categorize cause of death and other perinatal variables were also recorded. Results show there were 34,375 births and 153 neonatal deaths. Classification of these deaths by Wigglesworth found 78 (51 per cent) due to congenital malformations, 58 (38 per cent) due to prematurity, 6 (4 per cent) due to asphyxia and 11 (7 per cent) due to specific other causes. The corrected neonatal mortality was 2.18. Neural tube defects alone accounted for 10 per cent of the total neonatal mortality. Fifty-five out of 58 infants who died due to prematurity had birthweight < 1000 g and survival rates in this group compared well to international standards. We conclude that a reduction in neonatal mortality is possible but is most likely to result from community focused measures such as increased use of pre- and peri-conceptional folate.

Asphyxia Neonatorum↗
PubMed2003

Impact of ECMO on neonatal mortality in Michigan (1980-1999).

PURPOSE: Although extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving intervention, the effect of ECMO on neonatal mortality has never been evaluated. In this study, we examined the relationship between increased ECMO utilization and its effect on the neonatal mortality rate in the state of Michigan. METHODS: Neonatal mortality data were obtained from the Michigan State Department of Community Health. Data included total annual live births, total neonatal deaths, and deaths from respiratory causes in neonates > or =35 weeks' gestational age (ie, potential ECMO candidates). Pooled ECMO patient data from Michigan's 3 ECMO centers were obtained from the Extracorporeal Life Support Organization (ELSO) Registry. Associations between ECMO volume and neonatal mortality rates were assessed using simple linear regression. A scatterplot of ECMO volume and mortality rates was created, and the resulting fitted regression lines were superimposed on the plots. Statistical significance of the associations (ie, difference in slope of the regression line from zero) were based on a standard 2-sided Wald test for the regression slope parameter. RESULTS: From 1980 through 1999, 1,061 neonates were treated with ECMO in Michigan, and 875 (82.5%) survived. When annual neonatal mortality rate (from all causes) and the rate from respiratory causes versus ECMO volume (cases per year) are superimposed with fitted regression lines, both are significantly different from zero (P =.041 and P =.002, respectively). The model predicts that for every 100 neonates treated with ECMO in Michigan, 38 lives are saved. The model also can be used to predict the annual neonatal mortality rate in Michigan if ECMO had not been utilized. CONCLUSIONS: A strong association exists between ECMO volume and observed reductions in neonatal mortality seen in Michigan over the last 2 decades. This is the first study to show an association between ECMO and neonatal mortality rate at the population level.

Extracorporeal Membrane Oxygenation↗
PubMed1982

Neonatal mortality in Utah.

A cohort study of neonatal mortality (N = 106) in white singleton births (N = 14,486) in Utah for January-June 1975 was conducted. Using membership and activity in the Church of Jesus Christ of Latter-day Saints (LDS or Mormon) as a proxy for parental health practices, i.e., tobacco and alcohol abstinence, differential neonatal mortality rates were calculated. The influence of potential confounding factors was evaluated. Low activity LDS members were found to have an excess risk of neonatal death five times greater than high activity LDS, with an upper bound of a two-sided 95% confidence interval of 7.9. The data consistently indicate a lower neonatal mortality rate for active LDS members. Non-LDS were found to have a lower rate than either medium or low activity LDS.

Birth Weight↗
PubMed1999

Relationship between ambient sulfur dioxide levels and neonatal mortality near the Mt. Sakurajima volcano in Japan.

We examined the association between neonatal mortality and ambient sulfur dioxide (SO2) levels in the neighborhood of Mt. Sakurajima, Yamashita public health district of Kagoshima City, during the period between 1978 and 1988. The analysis using Poisson regression models showed that the monthly average level of SO2 was positively associated with the neonatal mortality (P = 0.002). When the SO2 levels were categorized into four groups to estimate the relative risk (RR) of neonatal mortality using the lowest exposure category as a reference, the RR increased with elevated exposure levels (P for trend < 0.001) and was the highest in the group with the highest level of exposure (RR = 2.2, 95% confidence interval; 1.2-4.1). Other than SO2, we also examined the number of eruptions, the amount of ashfall, and the average level of suspended particulate matter. None of these factors was associated with neonatal mortality. Although the present study suggests that increase in SO2 levels has had an adverse effect on neonatal mortality in the neighborhood of Mt. Sakurajima, it is difficult to determine the source of the SO2. Further studies are necessary to elucidate the mechanisms of the excess neonatal mortality probably associated with the volcanic SO2 levels.

Air Pollutants↗
PubMedDate not supplied

The use of logit models to investigate social and biological factors in infant mortality. IV: Post-neonatal mortality.

Infant mortality data for England and Wales, cross-classified by mother's age, parity and social class have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular analysis. This paper describes the application of logit models using the methodology presented by Murrells et al. to investigate post-neonatal deaths.

Adolescent↗
PubMed1997

Does gestational age in combination with birthweight provide better statistical adjustment of neonatal mortality rates than birthweight alone?

Between-area comparisons of neonatal mortality rates should be adjusted for differences in the underlying mortality risk. The traditional approach to this problem is to adjust neonatal mortality rates statistically for between-area differences in the birthweight distributions. However, in other types of perinatal research, birthweight is usually considered in combination with gestational age. For between-area comparisons of neonatal mortality rates, some researchers have argued that ad-justment by gestational age in addition to birthweight might not be necessary. This present study used graphical methods based on a non-parametric version of Poisson regression to underline the importance of examining neonatal mortality rates by both gestational age and birthweight. Six years of data from a whole-population database (Queensland Perinatal Data Collection) were used. The analysis also illustrates the value of non-parametric modelling in perinatal epidemiology.

Birth Weight↗
PubMed1984

The use of standardized neonatal mortality ratios to assess the quality of perinatal care in Colorado.

Neonatal mortality in Colorado in the 3-year period 1977-1979 has been analyzed by means of standardized neonatal mortality ratios derived from birth weight-specific mortality for every obstetric facility. The standardized neonatal mortality ratios adjusted for the percentage of neonatal deaths due to untreatable disorders are presented as one possible method for comparing the neonatal outcome in obstetric populations of dissimilar risk. We have suggested that facilities with adjusted standardized neonatal mortality ratios significantly above 1 are those that might benefit from an in-depth review of perinatal services.

Birth Weight↗
PubMed2006

Early neonatal mortality: effects of interventions on survival of low birth babies weighing 1000-2000g.

OBJECTIVE: In order to improve our newborn care, we instituted several changes along with training of medical and nursing staff and compared survival rates in babies < 2000g before and after these changes. We also measured Perinatal Mortality Rate (PMR) and Neonatal Mortality Rate (NMR) in general, percentage of Low Birth Weight (LBW) babies and causes of early neonatal deaths at Lady Dufferin Hospital (LDH). METHODS: It was an intervention study design. All admissions to NICU between 1998 and 2000 were entered in the register. Data included high risk obstetric factors, gestational age, birth weight, APGAR score, gender, need for resuscitation, diagnosis, complications and outcome. Data of rest of the babies was recorded from operation theatre, labour room and postnatal ward registers in a separate register. RESULTS: Of 783 perinatal deaths, 488 were stillbirths and 295 were early neonatal deaths; 2498/14867 (17%) babies were LBW. The main causes of early neonatal mortality included prematurity and related complications (35%), congenital malformations (23%), sepsis 19%), and birth anoxia (16%). Most (27/295 77%) deaths occurred in babies weighing <2500g. Deaths due to prematurity and related complications in babies weighing between 1000-1499g decreased from 17/33 (51%) in 1997 (to 13/33 (39%) 9/45 (20%), 2/38 (5%) in 1998-99 and 2000 respectively. Sepsis related deaths decreased in babies weighing between 1500 to 1999g from 5/57(8.7%) in year 1997 to 7/77 (9%), 3/76 (4%), 4/96 (4%) in 1998, 99, and 2000 respectively. The PMR/NMR decreased from 58/22.4 in year 1997 to 39/15.6, 44.4/18.6, 38.2/12.3 for year 1998, 1999 and 2000 respectively. CONCLUSION: There was a significant reduction in mortality in LBW babies after training of medical and nursing staff. Reduction in overall PMR & NMR was also due to decrease in mortality in LBW babies.

Hospital Mortality↗
PubMed1993

Birth weight and illness severity: independent predictors of neonatal mortality.

BACKGROUND: Low birth weight is a major determinant of neonatal mortality. Yet birth weight, even in conjunction with other demographic markers, is inadequate to explain the large variations in neonatal mortality between intensive care units. This variation probably reflects differences in admission severity. The authors have recently developed the Score for Neonatal Acute Physiology (SNAP), an illness severity index specific for neonatal intensive care, and demonstrated illness severity to be a major determinant of neonatal mortality. OBJECTIVE: To define the relative contributions of birth weight and illness severity to the risk of neonatal mortality and to identify other significant independent risk factors. METHODS: Logistic regression was used to analyze data from a cohort of 1621 consecutive admissions to three neonatal intensive care units (92 deaths), to test six alternative predictive models. The best logistic model was then used to develop a simple additive clinical score, the SNAP Perinatal Extension (SNAP-PE). RESULTS: These analyses demonstrated that birth weight and illness severity are powerful independent predictors across a broad range of birth weights and that their effects are additive. Below 750 g, there is an interaction between birth weight and SNAP. Other factors that showed independent predictive power were low Apgar score at 5 minutes and small size for gestational age. Separate derivation and test samples were used to demonstrate that the SNAP-PE is comparable to the best logistic model and has a sensitivity and specificity superior to either birth weight or SNAP alone (receiver-operator characteristic area .92 +/- .02) as well as excellent goodness of fit. CONCLUSION: This simplified clinical score provides accurate mortality risk estimates for application in a broad array of clinical and research settings.

Birth Weight↗
PubMed2000

[Neonatal mortality in 1998 in the municipality of Botucatu].

Considering that neonatal mortality is an indicator of the quality of the care provided to pregnant women, at childbirth as well as to the new born, authors developed the present study, whose aim was to analyze the neonatal mortality during the year of 1998 at the municipality Botucatu-SP. The coefficient of neonatal mortality was of 8.3/1000 born alive and the coefficient of precocious neonatal mortality was of 7.3/1000 born alive, confirming the importance of decease in the first week of life. Results showed that approximately 3/4 of the deceases can be reduced through precocious diagnosis and treatment as well as adequate care to birth or partially reduced through appropriate pregnancy control measures, evidencing that in order to decrease the rates of neonatal death, investments must be made to improve the quality of the care to pregnant women, parturients and the new born.

Brazil↗