Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil

Objectives

To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate.

Changes in infant morbidity associated with decreases in neonatal mortality

Neonatal mortality and morbidity among infants surviving to 1 year of age in eight geographic areas have been compared to determine whether recent decreases in mortality have affected the risk of infants having congenital anomalies or developmental delay. Mortality was obtained from birth and death records in 1976 and either 1978 or 1979; morbidity through home interviews with mothers of random samples of infants and developmental observations on the children. It is concluded that the decrease in mortality was not offset by increases in children with defects. Neonatal mortality decreased by 18% in this 2- to 3-year period; risk of congenital anomalies or developmental delay (all types combined) declined by 16% among the surviving infants. The reduction in risk was concentrated in the minor congenital anomalies or developmental delay category; the proportion of children with severe or moderate congenital anomalies or developmental delay did not change. Decreases occurred at every birth weight including the very low birth weights of 1,500 g or less, a subgroup with especially high mortality and morbidity resulting from perinatal events.     

Racial differences in neonatal mortality. What causes of death explain the gap?

To examine further the differences in birth-weight-specific neonatal mortality rates between ethnic groups, we studied causes of death for infants of white, black, United States-born Hispanic, and Mexican-born Hispanic women using linked California birth-death records from 1981 to 1983. Black infants of low birth weight had considerably lower neonatal mortality rates from respiratory distress syndrome and congenital abnormalities. In the normal birth-weight category, however, black neonatal mortality rates for most conditions were higher than those for whites. The greatest differences between Mexican-born Hispanic and white neonatal mortality rates were seen for other respiratory conditions and trauma/hypoxia/asphyxia. These differences were most marked in the 1500- to 2499-g and greater than or equal to 2500-g birth-weight categories. Attempts to lower the neonatal mortality rate for black infants of normal birth weight may require providers to focus on both broad preventive measures and improved perinatal management. In contrast, improvements in perinatal management among Mexican-born Hispanics may produce improvement in the neonatal mortality rate for this group.     

Postponed neonatal death in the premature infant

Improved obstetrical and neonatal care has increased survival for many small premature infants. However, there remains a distinct group who die of complications later in infancy. The autopsy findings associated with these "postponed neonatal deaths" were the subject of our retrospective study of 18 premature infants (mean estimated gestational age, 28.6 +/- 0.6 weeks) who survived from 4 weeks to 4 months of age (mean, 70 +/- 11 days). All 18 infants required prolonged artificial ventilatory support and parenteral nutrition. The major findings at autopsy were similar in all cases and included bronchopulmonary dysplasia, hepatic cholestasis and fibrosis, abnormalities of endochondral ossification, and diffuse cerebral gliosis and infarction. Infection was the most common cause of death, and most of the infants died with acute bronchopneumonia. These postponed neonatal deaths, while they do not appear in standard neonatal mortality statistics, represent a problem of concern.     

浙江省2000~2009年5岁以下儿童死亡率及死因研究

目的：通过对浙江省2000~2009年5岁以下儿童的死亡率和死亡原因分析,掌握浙江省5岁以下儿童死亡率的变化趋势,提出降低儿童死亡率的对策。方法：采用分层随机整群抽样方法抽取浙江省30个市/县/区,抽样区内所有5岁以下儿童为研究对象,采用描述性统计和卡方检验,从年龄和户籍等多角度分析儿童的死因及死亡率。结果：浙江省5岁以下儿童死亡率呈现下降的趋势,从2000年的14.83‰ 降到2009年的 9.49‰。2009年农村5岁以下儿童死亡率高于城市（9.14‰ vs 6.50‰,P<0.01）,流动人口5岁以下儿童死亡率高于本地人口（12.12‰ vs 6.42‰,P<0.01）。早产和低出生体重是2009年5岁以下儿童的首位死因,其中婴儿组前三位死因分别为早产/低出生体重、先天性心脏病和出生窒息,幼儿组前三位死因分别为溺水、交通意外和意外跌落。结论：2009年浙江省5岁以下儿童死亡率在城乡之间、本地和流动人口之间存在差异。不同年龄组儿童间主要死亡原因不同,为了降低婴儿期儿童死亡率,重点在预防早产、低出生体重和先天异常,对幼儿期儿童,要努力减少意外伤害的发生。     

Social deprivation and the causes of stillbirth and infant mortality

AIMS—To investigate the relation between social deprivation and causes of stillbirth and infant mortality.METHODS—Stillbirths and infant deaths in 6347 enumeration districts in Wales were linked with the Townsend score of social deprivation. In 1993-98 there were 211 072 live births, 1147 stillbirths, and 1223 infant deaths. Poisson regression analysis was used to estimate the magnitude of effect for associations between the Townsend score and categories of death by age and the causes of death. The relative risk of death between most and least deprived enumeration districts was derived.RESULTS—Relative risk of combined stillbirth and infant death was 1.53 (95% CI 1.35 to 1.74) in the most deprived compared with the least deprived enumeration districts. The early neonatal mortality rate was not significantly associated with deprivation. Sudden infant death syndrome showed a 307% (95% CI 197% to 456%) increase in mortality across the range of deprivation. Deaths caused by specific conditions and infection were also associated with deprivation, but there was no evidence of a significant association with deaths caused by placental abruption, intrapartum asphyxia, and prematurity.CONCLUSIONS—Collaborative public health action at national and local level to target resources in deprived communities and reduce these inequalities in child health is required. Early neonatal mortality rates and deaths from intrapartum asphyxia and prematurity are not significantly associated with deprivation and may be more appropriate quality of clinical care indicators than stillbirth, perinatal, and neonatal mortality rates.     

Sudden infant death syndrome and infant mortality in Aboriginal and non-Aboriginal infants

The aim of this study was to investigate sudden infant death syndrome (SIDS) in the context of total infant mortality for Aboriginal and non-Aboriginal infants. Deaths for infants born in Western Australia from 1980 to 1988 inclusive were ascertained from a total population data base. Infant mortality rates and rates by period and cause of death were calculated for both populations. Aboriginal infants had a mortality rate three times that for non-Aboriginal infants (23.6 cf. 7.9 per 1000 live births) and both populations showed a similar rate of decline in mortality over the study period. There were differences in the proportion of deaths occurring neonatally and postneonatally in the two populations. In terms of SIDS, 21% of the deaths in Aboriginal infants occurred neonatally compared with 7% for non-Aboriginal infants. The overall cause of infant death distribution differed significantly between the two populations ( P < 0.001). During the study period, Aboriginal infants showed a significant increase in deaths due to SIDS and a significant decrease in those due to birth defects and low birthweight. These results suggest it would be useful to review the pathology and diagnosis of sudden unexplained death in infancy.     

世界部分国家和地区婴儿死亡原因及死亡率的演变

儿童健康是发展中国家卫生政策制定中的核心问题之一,婴儿死亡率的降低是一个国家健康水平进步的必然结果,因而婴儿死亡率是衡量一个国家、地区妇幼保健质量及社会发展水平的重要指标之一。了解婴儿的死因及死亡率对于制定相应的卫生政策,提高预防和治疗疾病的水平至关重要。     

Social deprivation and the causes of stillbirth and infant mortality.

AIMS: To investigate the relation between social deprivation and causes of stillbirth and infant mortality. METHODS: Stillbirths and infant deaths in 6347 enumeration districts in Wales were linked with the Townsend score of social deprivation. In 1993-98 there were 211 072 live births, 1147 stillbirths, and 1223 infant deaths. Poisson regression analysis was used to estimate the magnitude of effect for associations between the Townsend score and categories of death by age and the causes of death. The relative risk of death between most and least deprived enumeration districts was derived. RESULTS: Relative risk of combined stillbirth and infant death was 1.53 (95% CI 1.35 to 1.74) in the most deprived compared with the least deprived enumeration districts. The early neonatal mortality rate was not significantly associated with deprivation. Sudden infant death syndrome showed a 307% (95% CI 197% to 456%) increase in mortality across the range of deprivation. Deaths caused by specific conditions and infection were also associated with deprivation, but there was no evidence of a significant association with deaths caused by placental abruption, intrapartum asphyxia, and prematurity. CONCLUSIONS: Collaborative public health action at national and local level to target resources in deprived communities and reduce these inequalities in child health is required. Early neonatal mortality rates and deaths from intrapartum asphyxia and prematurity are not significantly associated with deprivation and may be more appropriate quality of clinical care indicators than stillbirth, perinatal, and neonatal mortality rates.     

Infectious diseases: preventable causes of infant mortality

After almost a century of improvement, the rate of decrease in US infant mortality rates began to level off during the period of 1982 to 1984. Rates actually increased in some states. Because much of the decline in infant mortality in this century can be attributed to advances in infectious disease treatment and prevention programs, we evaluated the current impact of infectious diseases on infant mortality. The National Center for Health Statistics mortality data for 1980 contains information on as many as 20 causes of death for a given individual. Using these data, we found that infectious diseases contributed to 12.5% of all infant deaths and to almost 400,000 years of potential life lost because of infant deaths. Infectious diseases contributed to 9% of deaths of low birth weight infants and to more than 18% of all deaths in the postneonatal period. Compared with white infants, a higher proportion of nonwhite infants died of causes related to infectious diseases. For black infants, the mortality rate related to infectious diseases was twice that for white infants. These data indicate that infectious diseases still are a major contributor to infant mortality, one of the 15 areas targeted for prevention by the federal government, and the data suggest that programs for reducing infant mortality should place increased emphasis on preventing infectious diseases.     

Prader-Willi syndrome in Victoria: mortality and causes of death

Aim: The aim of this study was to describe the rates, predictors and causes of mortality in a population sample of individuals with Prader–Willi syndrome (PWS). Methods: One hundred sixty‐three individuals with PWS (90 males and 73 females, ages: 3 weeks to 60 years) were identified from the Victorian PWS Register. Information on demographics, age at diagnosis, genetic mechanism, age at which obesity developed and last known body mass index measurement were extracted. Notification and causes of death were obtained through linkage with Australian national and state of Victoria death indexes. Survival analysis was used to estimate the probability of survival and the effect of obesity on survival. Mortality rate ratios were calculated to investigate the effect of the factors listed above on mortality. Results: Fifteen deaths were recorded (nine males and six females), corresponding to an 87% probability of survival to 35 years. The probability of survival was significantly lower for individuals with known obesity (P= 0.03), but there was no strong evidence for an effect on survival for the other factors studied. Cardiac or respiratory conditions were common causes of death after the age of 15 years. Conclusions: The effect of known obesity on the probability of survival and the causes of death reported in this and other studies suggest an important association between obesity and early death in adults with PWS. This finding highlights the critical nature of preventative and intervention strategies aimed at minimising the effects of hyperphagia in individuals with PWS.     

Ways of combatting the high infant mortality rate in Turkey

Turkey's infant mortality rate stood at 95/1000 live births in 1982. A wide range of strategies is needed to address this situation, including better nutrition, immunization, sanitation facilities, safer drinking water, increased motivation for family planning, and improved maternal-child health services. 80% of deliveries take place at home, and 70% of women in a recent survey reported they received no health care services during their last pregnancy. The majority of women are uninformed about the principles of care involved in illnesses such as diarrhea. Respiratory diseases and infectious and parasitic diseases account for 40% of all infant deaths in Turkey. There is an urgent need for applied research to analyze the low level of utilization of Turkey's health center infrastructure. Improved management training in the health sector could establish a continuous feedback system to help local health personnel identify problem areas. The Turkish and International Children's Center could play a key role in improving the flow of information, ideas, and expertise between research groups and the health sector. problematic is the fact that key health policy documents are not available in Turkish. The World health organization (WHO) has agreed to work with the Children's Center to determine the extent and nature of WHO's role in health development in Turkey.     

Evolution of bereavement counselling in sudden infant death syndrome, neonatal death and stillbirth

Abstract There have been changing attitudes to death and grief in Western society in recent centuries. During the twentieth century complex medical and social changes have resulted in changing attitudes to and experiences with death. Specifically, the impact of death in childhood is reviewed. In recent decades sudden and unexpected death associated with stillbirth, the newborn and infants appears to have a more profound affect on the bereaved parents than in the past when the overall death rates in childhood were higher. The evolution of parent support groups developed since the 1960s to alleviate the psychological trauma of unexpected and sudden death in childhood has been traced. These groups were founded initially for support with sudden infant death syndrome and later extended to include families with stillbirth and neonatal death.