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PubMed2002

The impact of neonatal mortality on subsequent survival in rural Ethiopia.

In countries where most deliveries occur at home and most available information is hospital-based, accurate information on neonatal mortality is difficult to obtain. This study was conducted in a rural community in Ethiopia that has been under monthly demographic surveillance since 1987. The analysis in this paper was based on data collected in the 1st decade (1987-96) and this database was used to calculate mortality incidence rates and analyse survival. The overall neonatal mortality rate was 27/1000 live births (95% CI 24.5-29.5). The rates in the early and late neonatal periods were 20 and 8/1000 live births, respectively (95% CIs 18.0-22.9 and 6.6-9.4). The mortality incidence rates show that, every day, three of every 1000 newborns die in their 1st week of life. Neonatal mortality accounted for 43% of infant mortality. If all neonates survived the 1st week of life, life expectancy would increase by 1 year. Increased risk of neonatal mortality was found to be associated with living in a rural lowland area, twin births and male gender. This paper also addresses the need for further identification of the complex environmental and behavioural risk factors for neonatal mortality and for instituting appropriate and affordable interventions to reduce neonatal mortality.

Developing Countries↗
PubMed1998

Neonatal mortality in the Czech Republic during the transition.

"This paper examines how neonatal mortality has changed in the Czech Republic during the [1990s], examining trends in the distribution of birth weights and in birth weight specific neonatal mortality. It examines how these have varied in different parts of the country and, to ascertain the scope for further improvement, it compares them with corresponding values from Sweden, a country with one of the lowest neonatal mortality rates in Europe."

Biology↗
PubMedDate not supplied

Sociodemographic factors associated with weekend birth and increased risk of neonatal mortality.

OBJECTIVE: To learn whether weekend risk of neonatal mortality is related to selected sociodemographic factors. DESIGN: A retrospective cohort design. Logistic regression was used to obtain odds ratios, and analysis of variance and chi-square to identify differences in values and incidence of key variables. SAMPLES: The data were derived from matched Texas birth and infant death certificates from 1999 through 2001. MAIN OUTCOME MEASURES: A subset of deaths up to 28 days of life attributable to conditions originating in the perinatal period. These deaths were called neonatal mortality-p. RESULTS: Women who were White, married, had Medicaid assistance, and had private prenatal care were less likely to deliver on weekends. Odds of neonatal mortality-p increased 36.5% when a birth took place on the weekend. The weekend crude odds of neonatal mortality-p increased for all racial/ethnic groups, but the differences were not statistically significant. CONCLUSIONS: The likelihood of delivering on the weekend increases with certain sociodemographic factors. This fact is important because the risk of neonatal mortality is higher among weekend births.

Adult↗
PubMed2007

Impact of newborn skin-cleansing with chlorhexidine on neonatal mortality in southern Nepal: a community-based, cluster-randomized trial.

OBJECTIVE: Hospital-based data from Africa suggest that newborn skin-cleansing with chlorhexidine may reduce neonatal mortality. Evaluation of this intervention in the communities where most births occur in the home has not been done. Our objective was to assess the efficacy of a 1-time skin-cleansing of newborn infants with 0.25% chlorhexidine on neonatal mortality. METHODS: The design was a community-based, placebo-controlled, cluster-randomized trial in Sarlahi District in southern Nepal. Newborn infants were cleansed with infant wipes that contained 0.25% chlorhexidine or placebo solution as soon as possible after delivery in the home (median: 5.8 hours). The primary outcome was all-cause mortality by 28 days. After the completion of the randomized phase, all newborns in study clusters were converted to chlorhexidine treatment for the subsequent 9 months. RESULTS: A total of 17,530 live births occurred in the enrolled sectors, 8650 and 8880 in the chlorhexidine and placebo groups, respectively. Baseline characteristics were similar in the treatment groups. Intention-to-treat analysis among all live births showed no impact of the intervention on neonatal mortality. Among live-born infants who actually received their assigned treatment (98.7%), there was a nonsignificant 11% lower neonatal mortality rate among those who were treated with chlorhexidine compared with placebo. Low birth weight infants had a statistically significant 28% reduction in neonatal mortality; there was no significant difference among infants who were born weighing > or = 2500 g. After conversion to active treatment in the placebo clusters, there was a 37% reduction in mortality among low birth weight infants in the placebo clusters versus no change in the chlorhexidine clusters. CONCLUSIONS: Newborn skin-wiping with chlorhexidine solution once, soon after birth, reduced neonatal mortality only among low birth weight infants. Evidence from additional trials is needed to determine whether this inexpensive and simple intervention could improve survival significantly among low birth weight infants in settings where home delivery is common and hygiene practices are poor.

Anti-Infective Agents, Local↗
PubMedDate not supplied

[No solution for neonatal mortality in sub-saharan Africa? Evaluation and perspectives in the urban environment of Niamey, Niger].

Niger has one of the highest mortality rates of infants (222/1000) and children under five years old (318/1000), with 15% of them suffering from malnutrition. Yet, neonatal mortality was not considered as the top priority of public health in Niger, where 85 to 90% of the deliveries succeed without any medical care and 70% of the population live more than 10 kilometers from the nearest medical center. Also, in the African countries which have adopted expensive neonatal care centers following the occidental model, the lethality rate is high and maintenance is difficult. Thus, alternative strategies should be considered to reduce the neonatal mortality, according to the local possibilities. This was carried out in Niamey, the capital of Niger. A retrospective study of the activities in the pediatric and obstetric wards was carried out from 1985 to 1992. This was associated with a descriptive prospective survey of a sample of 149 pregnant women followed from the first prenatal consultation to the end of the neonatal period. Results showed that possibilities exist in Niamey to reduce neonatal mortality. The concentration of medical personnel was high compared to the rest of the country, and the health infrastructure was diversified. However, the knowledge of neonatal care was lacking. Use of prenatal care was high and deliveries at home without medical assistance concerned only 14.3% of the total births. Mortality observed in the obstetrical ward (6.7/1000) corresponded to less than a quarter of the estimated neonatal mortality (28.6/1000). Neonatal mortality in the pediatric ward was high (43.8%), predominantly on the first day of admittance (45% of the deaths), especially for the low birth weights (under 2,500 g) (62.4%). These figures underline the necessity to improve the care of the newborns and to link prenatal prevention, obstetrical care and pediatrics. The prospective survey showed that although the ratio of prenatal visits per woman was high (3.8), the quality of the care was inadequate. Correct newborn care was rare and no examination could detect or prevent complications during the short stay of less than 24 hours in the obstetrical ward. To lower the neonatal mortality, service could be improved concerning the material conditions of prenatal consultations, reorientation of prenatal consultations towards detection, correct treatment of the risk factors of neonatal mortality, obstetrical screening and care, and training of the midwives. The adoption of inexpensive measures was suggested, including the training of pediatric nurses in each maternity ward, screening and treatment of newborns at risk in small units integrated within the obstetrical ward, and the requirement of a consultation before the traditional feast of giving names, which occurs on the seventh day of life in Niger. These measures were considered as priorities before considering construction of expensive neonatal centers and assume the participation of the public health personnel and policy makers. Some of these suggestions are now being implemented.

Health Priorities↗
PubMed2005

Fetal and neonatal mortality among twin gestations in a Canadian population: the effect of intrapair birthweight discordance.

The purpose of this study was to examine the association between intrapair birthweight discordance and fetal and neonatal mortality. This was a historical cohort study, using the Statistics Canada linked birth-infant death file. Twin births in Canada (excluding Ontario) for the period 1986-1997 were studied. Outcome measures were fetal and neonatal mortality. Among 59,034 twin births, 53% had 0 to 9% birthweight difference; 30% had 10 to 19% discordance; 11% had 20 to 29% discordance; and 6% had > or = 30% discordance. Maternal age, parity, sex discordance, and gestational age were important factors affecting birth weight discordance. Fetal death rates were 0.95, 1.26, 3.14, and 11.10%, respectively, in infants with a birthweight discordance of 0 to 9, 10 to 19, 20 to 29, and > or = 30%. Corresponding figures for neonatal death rates were 1.90, 2.32, 3.05, and 8.86%, respectively. Adjustment for important confounding variables including the actual birthweight and gestational age substantially reduced the birthweight discordance-related risk of fetal and neonatal mortality, but the results remained statistically significant and clinically important. The birthweight discordance-related risk of fetal and neonatal mortality was higher in smaller twins than in larger twins and higher in infants with gestational age > or = 37 weeks than those < 37 weeks. Birthweight discordance is an important risk factor for fetal and neonatal mortality, and the birthweight discordance-related risk of fetal and neonatal mortality is higher in smaller twins than in larger twins and higher in term twins than in preterm twins.

Adult↗
PubMedDate not supplied

Weekend birth and higher neonatal mortality: a problem of patient acuity or quality of care?

OBJECTIVE: To address the differences in neonatal mortality among births to teenage mothers on weekdays and weekends. DESIGN: A retrospective descriptive design. Rates of neonatal mortality linked to maternal risk factors, low birth weight, gestational age, day of the week of the birth, and ethnicity/race were examined. PATIENTS/PARTICIPANTS: The population consisted of all recorded births to teenage mothers (< 20 years of age) in Texas in 1999 and 2000 (N = 111,749). These births were linked to death certificates for a subset of neonatal deaths within the same time period (n = 397). MAIN OUTCOME MEASURES: The outcome of interest was any death attributed to conditions originating in the perinatal period and recorded as such on the infant death certificate. RESULTS: Neonatal mortality was higher among the births on weekends than those during the week. Maternal risks and patient acuity levels of mothers and babies were not consistently higher on weekends. However, when risk factors were present, weekend births were more dangerous for Hispanics than for other ethnic or racial groups. CONCLUSIONS: Differences in patient acuity did not satisfactorily explain higher neonatal mortality rates on weekends. Thus, quality of care indicators such as lower hospital staffing and reduced availability of services on weekends may be critical sources of unnecessary neonatal deaths.

Adolescent↗
PubMed1985

Factors affecting the sex differential in neonatal mortality: the role of respiratory distress syndrome.

We investigated factors affecting the sex differential in neonatal mortality rate using linked birth and death certificates of more than 300,000 infants born in Georgia between 1974 and 1977. The neonatal mortality rate was higher in male infants than in female infants (relative risk = 1.23, p less than 10(-8)) and was most pronounced for infants weighing between 1501 and 2500 gm (relative risk = 1.78, p less than 10(-8)). This differential persisted after adjustment was made for effects of several prenatal and labor-related factors. The male excess in neonatal mortality rate was most prominent during the first week of life and was found for several perinatal disorders. Respiratory distress syndrome-related mortality showed the largest male excess (relative risk = 1.57, p less than 10(-8)) and was most pronounced in infants weighing between 1501 and 2500 gm (relative risk = 2.78, p less than 10(-8)), in whom it accounted for roughly 60% of the excess. Since previous studies have shown that male infants have a higher incidence of respiratory distress syndrome but not a higher case-fatality rate, we suggest that slower lung maturation among male fetuses is a major contributing factor to the sex differential in neonatal mortality.

Birth Certificates↗
PubMed1982

Neonatal mortality risk in relation to birth weight and gestational age: update.

Neonatal mortality risk for all birth weight-gestational age categories has been prepared based on data from an inborn population at the University of Colorado Health Sciences Center for the years 1974 to 1980. There were 14,413 live births and 252 neonatal deaths during this six-year period, reflecting fairly current clinical practices. Based on birth weight alone, neonatal mortality was 0.47% for infants weighing greater than 2,500 gm; based on gestational age alone, mortality was 0.28% for infants greater than 34 weeks. A chart of neonatal mortality risk has been constructed based on birth weights and gestational ages of all these infants. The zones of mortality risk have been color matched to equivalent areas of mortality for the 1958 to 1969 data previously published from the Center for easy comparison. These two populations have also been compared on a graph plotting the predicted mortality at the estimated gestational age and its fiftieth percentile birth weight. This may be useful for consultation by perinatal obstetricians who must make decisions about transfer and care of high-risk mothers before delivery occurs. Where comparisons can be made with other perinatal centers, there is a remarkable similarity in neonatal survival rates, indicating that continuing communication between obstetric perinatologists and neonatologists is a prime factor in reducing mortality, rather than specific new therapeutic procedures at any single clinical center.

Birth Weight↗
PubMed2006

Reduction in neonatal mortality in Chile between 1990 and 2000.

OBJECTIVE: Our objective with this article was to describe the declining trend in neonatal mortality in Chile between 1990 and 2000 and examine potential causal factors. METHODS: Descriptive analysis of data that were provided by the Chilean Ministry of Health on all approximately 2,900,000 births occurred in Chile between 1990 and 2000. Total neonatal mortality rates (<28 days), and birth weight-specific and gestational age-specific mortality rates from 1990 to 2000 were analyzed by year. Public health interventions that were implemented during the 1990s were reviewed to assess their potential influence on the observed trends in neonatal mortality. RESULTS: The neonatal mortality rate between 1990 and 2000 decreased from 8.3 to 5.7 per 1000 live births. This decline was not associated with decreases in the proportion of low birth weight and preterm infants but rather with declines in birth weight-specific and gestational age-specific mortality rates. Examination of the trends in birth weight-specific and gestational age-specific mortality rates showed that a marked proportional decrease in mortality rates was achieved among infants who weighed <1500 g and were delivered before 32 weeks. It is plausible, both biologically and temporally, that the observed trends in the reduction in birth weight-specific and gestational age-specific mortality rates are associated with the introduction of specific sector-wide interventions that aim to improve newborn care in very preterm and low birth weight infants. CONCLUSIONS: Important reductions in newborn mortality in developing countries are possible with the implementation of effective neonatal care interventions.

Birth Weight↗
PubMed2006

Delayed breastfeeding initiation increases risk of neonatal mortality.

BACKGROUND: Breastfeeding promotion is a key child survival strategy. Although there is an extensive scientific basis for its impact on postneonatal mortality, evidence is sparse for its impact on neonatal mortality. OBJECTIVES: We sought to assess the contribution of the timing of initiation of breastfeeding to any impact. METHODS: This study took advantage of the 4-weekly surveillance system from a large ongoing maternal vitamin A supplementation trial in rural Ghana involving all women of childbearing age and their infants. It was designed to evaluate whether timing of initiation of breastfeeding and type (exclusive, predominant, or partial) are associated with risk of neonatal mortality. The analysis is based on 10,947 breastfed singleton infants born between July 2003 and June 2004 who survived to day 2 and whose mothers were visited in the neonatal period. RESULTS: Breastfeeding was initiated within the first day of birth in 71% of infants and by the end of day 3 in all but 1.3% of them; 70% were exclusively breastfed during the neonatal period. The risk of neonatal death was fourfold higher in children given milk-based fluids or solids in addition to breast milk. There was a marked dose response of increasing risk of neonatal mortality with increasing delay in initiation of breastfeeding from 1 hour to day 7; overall late initiation (after day 1) was associated with a 2.4-fold increase in risk. The size of this effect was similar when the model was refitted excluding infants at high risk of death (unwell on the day of birth, congenital abnormalities, premature, unwell at the time of interview) or when deaths during the first week (days 2-7) were excluded. CONCLUSIONS: Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour. Breastfeeding-promotion programs should emphasize early initiation as well as exclusive breastfeeding. This has particular relevance for sub-Saharan Africa, where neonatal and infant mortality rates are high but most women already exclusively or predominantly breastfeed their infants.

Breast Feeding↗
PubMed1999

Changes of neonatal mortality rate between 'pre' and 'post' surfactant period.

The objective of this study was to determine how the neonatal mortality rate has changed since surfactant (S) therapy was introduced in our Neonatal Intensive Care Unit (NICU), and to evaluate the efficacy of surfactant therapy in respiratory distress syndrome (RDS) patients. Incidences of risk babies such as outborns, prematurity, low birth weight infants and RDS, and neonatal mortality rates were compared between 'pre' (control, 1988 to 1991, n=4,861) and 'post' S period (study, 1993 to 1996, n=5,430). In RDS patients of 'post' S period, neonatal mortality rate was compared between S-treated and non-treated patients, and chest X-ray and ventilatory parameters were compared between pre- and post-72 hr of surfactant treatment. Surfactant therapy showed short term effects, judging by the decrease of early neonatal deaths and improvement of chest X-ray and ventilatory parameters in RDS patients. The overall neonatal mortality rate had a tendency to decrease in spite of increased incidences of risk babies in 'post' S period but it was less than expected. The reasons were thought to be that we had a high proportion of risk babies, and there was some bias in patient selection for surfactant therapy and its use. In conclusion, with the active prevention of risk baby delivery and appropriate use of surfactant, better results could be expected.

Biological Products↗
PubMed2001

Neonatal mortality of low-birth-weight infants in Bangladesh.

OBJECTIVE: To ascertain the role of low birth weight (LBW) in neonatal mortality in a periurban setting in Bangladesh. METHODS: LBW neonates were recruited prospectively and followed up at one month of age. The cohort of neonates were recruited after delivery in a hospital in Dhaka, Bangladesh, and 776 were successfully followed up either at home or, in the event of early death, in hospital. FINDINGS: The neonatal mortality rate (NMR) for these infants was 133 per 1000 live births (95% confidence interval: 110-159). The corresponding NMRs (and confidence intervals) for early and late neonates were 112 (91-136) and 21 (12-33) per thousand live births, respectively. The NMR for infants born after fewer than 32 weeks of gestation was 769 (563-910); and was 780 (640-885) for infants whose birth weights were under 1500 g. Eighty-four per cent of neonatal deaths occurred in the first seven days; half within 48 hours. Preterm delivery was implicated in three-quarters of neonatal deaths, but was associated with only one-third of LBW neonates. CONCLUSION: Policy-relevant findings were: that LBW approximately doubles the NMR in a periurban setting in Bangladesh; that neonatal mortality tends to occur early; and that preterm delivery is the most important contributor to the NMR. The group of infants most likely to benefit from improvements in low-cost essential care for the newborn accounted for almost 61% of neonatal mortalities in the cohort.

Bangladesh↗
PubMed2002

Irish neonatal mortality--12 years on.

All Paediatricians in Ireland were requested to fill a questionnaire which dealt with data pertaining to all live-born infants over 500 g birth weight who died within the first 28 days of life in 1999. Deaths were categorized according to Wigglesworth Classification into Lethal Malformation, Immaturity (Prematurity), Asphyxia and "Specific". Each hospital and patient was assigned a unique ID number. Data from questionnaires was entered into a database. Results were compared with those previously published by Counahan and Clarke for 1987. Twenty one of the 23 paediatric centres in Ireland replied giving a response rate of 91%. The over-all number of neonatal deaths for 1999 was 186 compared to 310 for 1987. One hundred and two (55%) were < 1500 grams and 61 (33%) < 1000 g. The principal causes of death for 1999 were Congenital Malformations 39%, (n=72), Prematurity 37% (n=69) and Asphyxia 3% (n=5). This compares to figures of 39%, 40% and 8%, respectively for 1987. The overall Neonatal Mortality Rate for 1999 was 3.48/1000 with a Corrected Neonatal Mortality Rate of 2.1/1000. The Neonatal Mortality Rate and Corrected Neonatal Mortality Rate for 1987 were 5.3/1000 and 3.3/1000 respectively. The decrease in Neonatal Mortality in the past 12 years in Ireland is to be applauded. However it can lead to a false sense of security regarding standards of neonatal care. While the death of Extremely Low-Birth-Weight infants can now often be prevented, in many cases it is merely deferred to the post-neonatal period. Furthermore, no national data is available on the long term outcome and neurodevelopmental status of preterm or asphyxiated infants who survive. The possibility of establishing an Irish Neonatal Morbidity Register, aimed at improving the effectiveness and efficiency of medical care for newborn infants, must now be explored.

Cause of Death↗
PubMed2006

The effect of malaria transmission intensity on neonatal mortality in endemic areas.

Estimates of the impact of Plasmodium falciparum infections during pregnancy on neonatal mortality have not taken into account how this varies with the level of malaria endemicity and thus do not indicate the possible effects of malaria control strategies that reduce transmission. We now review the relevant literature, and propose a mathematical model for the association between P. falciparum transmission and neonatal death. The excess risk of neonatal mortality in malaria-endemic areas appears to be insensitive to the intensity of P. falciparum transmission over a wide range of endemicity. Moderate reductions in the overall level of malaria transmission in endemic areas are therefore unlikely to significantly reduce neonatal mortality. The magnitude of the excess risk is very uncertain because existing estimates are heavily dependent on the questionable assumption that the effects are mediated by birth weight. Accurate prediction of the impact of malaria control measures targeted at pregnant women requires direct estimates of malaria-attributable neonatal mortality rates.

Endemic Diseases↗
PubMed1996

Variations in familial neonatal mortality risks in four countries.

This paper investigates variations in the strength and structure of familial association in neonatal mortality risks in four populations; Bolivia, Kenya, Peru, and Tanzania. Exploratory analyses of the structure of the familial association are presented for each population. Random effects logistic models are then used to estimate the strength of familial association in neonatal mortality risks using a standard set of control variables. The results suggest that the strength of familial association in neonatal mortality risks is quite similar in these four populations which would be consistent with a biological explanation for the association. However, some differences were found, particularly in the form of the association in Peru, which may suggest at least a small role of other factors.

Africa, Eastern↗
PubMed1987

Secular changes in early neonatal mortality in Norway, 1967-1981.

Two five-year cohorts, 1967-1971 and 1977-1981, of the Medical Birth Registry of Norway, were utilized to analyze secular trends in early neonatal mortality rates, controlling simultaneously for birth weight, parity, maternal age, and sex. Improvement in the crude early neonatal mortality rate, from 6.5 to 2.9 per 1,000, was partitioned into one portion (18.4%) attributable to changes in the distribution of the birth weight or the other independent variables and another portion (81.6%) attributable to improved survival within each specific subgroup in the multivariate table. The early neonatal mortality rate was found to decrease in all subgroups, the low birth weight groups showing a significantly greater decline than the normal birth weight groups. Women with diabetes, epilepsy, or blood group antibodies were studied in separate analyses. For women with diabetes, the odds ratio of the early neonatal mortality rate between the first and the second periods was found to be three times the odds ratio for women without diabetes, and 2.9% of the total improvement of the crude early neonatal mortality rate was attributable to an improved survival in these infants.

Birth Weight↗
PubMed1989

Socioeconomic differentials and neonatal mortality: racial comparison of California singletons.

The median family income of the zip code of maternal residence was used to estimate the presence and determine the extent of socioeconomic differentials in the neonatal mortality rates of a cohort of 401,399 white and of 66,577 black Californian singletons born from 1982 to 1983. The neonatal mortality rate in the white infants increased from 3.99 in mothers residing in zip codes with a median family income greater than $25,000 to 12.1 for mothers residing in zip codes with a median family income less than $11,000. With decreasing socioeconomic status there was also a significant increase in the percentage of white infants weighing less than 2,500 g (percentage of low birth weight increased from 3.75 to 8.33) and weighing less than 1,500 g (percentage of very low birth weight increased from 0.56 to 1.46). When the source of the socioeconomic difference in white neonatal mortality was partitioned, 77.4% was due to deterioration in the birth weight distribution and 22.6% to deterioration in the birth weight-specific mortality rates. For the black cohort, the neonatal mortality rate increased from 5.9 in the most, to 9.0 in the least affluent strata. Although decreasing residential median family income was associated with an increase in the percent low birth weight (8.19 v 12.86), the percentage of very low birth weight was not significantly different (1.59 v 2.10). When the source of the differential in black neonatal mortality was partitioned, only 29% was due to deterioration of the birth weight distribution, whereas 71% was secondary to less favorable birth weight-specific mortality rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Black or African American↗