Perinatal mortality in different ethnic groups.

We have analysed the cause of perinatal deaths in four hospitals in the North West Thames region over a six year period commencing January 1980. The Pakistani population had a significantly greater perinatal mortality rate (15.7/1000 births) than the Europeans (11.3/1000 births). This was due to an increased incidence of macerated stillbirths and lethal malformations, the latter resulting from a significantly higher incidence of autosomal recessive disorders, neural tube defects, and renal malformations.     

The range of neural tube defects in southern India.

During a prospective study of 3500 consecutive births from November 1985 to January 1987 at three hospitals, 40 babies were found to have neural tube defects, an extremely high incidence (11.4/1000 births). The defects comprised anencephaly (n = 18), meningomyelocele (n = 11), Arnold-Chiari deformity (n = 3), encephalocele (n = 3), iniencephaly (n = 2), and one each of occipital meningocele, spina bifida occulta, and anencephaly with rachischisis. There were significant differences in incidence between those with consanguineous and nonconsanguineous parents and those whose mothers had previously given birth to malformed infants or who had had miscarriages, and those who had not. Significantly more defects were found among stillborn and low birthweight babies, among girls, and among those whose mothers were aged between 20 and 30 years. Just over a third (14) were breech presentations, and hydramnios was present in 16 (40%).     

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.     

Spectrum of congenital malformations in the newborn

Of 6,274 consecutive live-births during 1975–78, 170 (2.7 percent) infants were diagnosed to have 241 major congenital malformations. The incidence of malformations among preterm was almost twice (5.3 per cent), while two-thirds of infants with internal malformations weighed less than 50th centile for their gestational age at birth. Musculoskeletal defects accounted for one-third of all malformations. Out of systemic defects, central nervous system anomalies were most frequent (12.9 per cent) while other system defects (except respiratory system) had an identical frequency of about 10 per cent. The incidence of neural tube defects was found to be 7 per 1000 total births. Among individual anomalies, club foot, spina bifida, polydactyly, left-to-right cardiac shunt, clef lip ±cleft plate, hydrocele, Down syndrome and congenital dislocation of hips had a frequency greater than 1 per 1000 live-births.     

The changing epidemiology of neural tube defects. United States, 1968-1989.

OBJECTIVE--To describe the recent trends and epidemiologic characteristics of neural tube defects in the United States. RESEARCH DESIGN--Ongoing surveillance data. SETTING--Two birth defect surveillance systems: the nationwide Birth Defects Monitoring Program and the Metropolitan Atlanta (Ga) Congenital Defects Program for 1970 through 1989 and 1968 through 1989, respectively. PARTICIPANTS--Between 1970 and 1989, using discharge diagnoses of approximately 1 million live-born and stillborn infants per year, the Birth Defects Monitoring Program identified 15,503 cases of spina bifida and anencephaly. Between 1968 and 1989, using discharge diagnoses and clinical records until age 1 year of 38,000 infants per year, the Metropolitan Atlanta Congenital Defects Program identified 800 cases of spina bifida and anencephaly. INTERVENTIONS--None. MEASUREMENTS/MAIN RESULTS--Nationwide, neural tube defect rates have declined from 1.3 per 1000 births in 1970 to 0.6 per 1000 births in 1989. In Atlanta, neural tube defect rates have declined from 2.0 per 1000 births in 1968 to 0.6 per 1000 births in 1989. Several changes in the epidemiologic characteristics of neural tube defects were observed: (1) the proportion of spina bifida cases has increased; (2) the proportion of neural tube defect cases compared with the proportion of other unrelated defects has increased; (3) the race ratio of whites to other races for isolated neural tube defect cases has declined in Atlanta; and (4) the rate of isolated neural tube defects in females has also decreased. CONCLUSIONS--The declining rates of neural tube defects can be partially explained by increased widespread prenatal diagnostic techniques, strongly suggesting the role of environmental factors in neural tube defects. In particular, the use of multivitamins and folic acid to prevent the occurrence of neural tube defects needs further evaluation. Nevertheless, the changing clinical and epidemiologic characteristics of cases over time points to the etiologic heterogeneity of these conditions.     

Early Neonatal Sudden Infant Death and Near Death of Fullterm Infants in Maternity Wards

ABSTRACT. In a large Swedish 2 1/2-year population of fullterm infants the incidence of early neonatal sudden death (ENSD) was 0.12 per 1000 newborn infants considered healthy at birth but presenting with sudden cardiovascular collapse between 6 and 100 hours after birth. In the total neonatal mortality the rate of ENSD was 11 %. Well-known risk infants, e.g. prematurity, perinatal asphyxia, difficult delivery or congenital malformations were not included. In an inborn population of 20123 fullterm newborns the rate of ENSD was 0.15 per 1000. In the same population near-missed ENSD occurred in 0.35 per 1000 liveborn infants. Possible causative factors were infections in 4 and anaemia in 2 cases. But in 7 of 13 infants thorough epidemiological examinations and postmortem sterile autopsies did not reveal the cause of death or near death. These are probably cases of sudden infant death syndrome hitherto unrecognized in the first days of life.     

Early neonatal sudden infant death and near death of fullterm infants in maternity wards

In a large Swedish 2 1/2-year population of fullterm infants the incidence of early neonatal sudden death (ENSD) was 0.12 per 1000 newborn infants considered healthy at birth but presenting with sudden cardiovascular collapse between 6 and 100 hours after birth. In the total neonatal mortality the rate of ENSD was 11%. Well-known risk infants, e.g. prematurity, perinatal asphyxia, difficult delivery or congenital malformations were not included. In an inborn population of 20 123 fullterm newborns the rate of ENSD was 0.15 per 1000. In the same population near-missed ENSD occurred in 0.35 per 1000 liveborn infants. Possible causative factors were infections in 4 and anaemia in 2 cases. But in 7 of 13 infants thorough epidemiological examinations and postmortem sterile autopsies did not reveal the cause of death or near death. These are probably cases of sudden infant death syndrome hitherto unrecognized in the first days of life.     

Postmortem findings in term neonates.

Neonatal deaths in infants born at term are relatively rare in the USA, occurring in 0.9/1000 live births. Congenital malformations, perinatal asphyxia, infections and inborn errors of metabolism are the leading causes. Chromosomal malformation syndromes, congenital heart disease, pulmonary hypoplasia and severe neural tube defects comprise the majority of lethal malformations. Several skeletal dysplasias are lethal in the newborn infant. Group B Streptococcus still plays a major role in neonatal mortality while deaths due to other infectious agents have decreased. Hypoxic ischaemic encephalopathy is a significant cause of neonatal death. Inborn errors of metabolism have variable presentations but some, such as the fatty acid oxidation disorders, may present in neonates and cause sudden death.     

Neural tube defects in the middle belt of Nigeria.

Forty-two babies were found to have neural tube defects during a 3-year prospective study in a large cosmopolitan West African city. An incidence of 7/1000 deliveries was noted. The commonest defect was meningomyelocele, in 45 per cent of cases. Other defects comprised anencephaly (5 per cent), Arnold-Chiari malformation (7 per cent), encephalocele (19 per cent), occipital meningocele (14 per cent) and spina bifida occulta (10 per cent). No case of consanguinity was encountered. More defects were found among females and low birth weight infants among those whose mothers were aged between 20 and 30 years, and in mothers with parity of four and above. The commonest associated defect was talipes equinus in 15/42 (36 per cent) infants. Developmental assessments (neurological follow-up status) done at the age of 18 months on five surviving cases of meningomyelocele showed very poor development.     

Sudden infant death syndrome in South Australia 1968-97. Part I: changes over time

OBJECTIVE: To compare the epidemiology of sudden infant death syndrome (SIDS) over three consecutive decades. METHODOLOGY: The birth history, infant's developmental and health history, infant care practices for the infant, death scene investigation and autopsy findings for all infants dying suddenly and unexpectedly in South Australia (SA) between January 1968 and December 1997 were studied. RESULTS: The incidence of SIDS in SA rose through the 1970s and early 1980s with the highest incidence being in infants born in 1986 at 2.4 per 1000 live births (LB). Two factors felt to be dangerous for some infants were identified being left unobserved in the prone position and having the head covered by bed clothes. Publicity about the risk of prone sleeping has been accompanied by a fall in SIDS deaths, to an incidence of 0.5 per 1000 LB in 1997. The incidence in Aboriginal infants, and infants living in lower socio-economic conditions has always been high, but the over-representation of these groups has increased in the last 5 years. CONCLUSION: It no infant under 8 months of age was placed prone or was able to get to prone unobserved before the age when they can easily get back to supine, and no infant was able to get the head completely covered while unobserved, the incidence of SIDS in SA should fall below 0.2 per 1000 LB.     

Congenital malformations at birth among liveborn infants in Afghanistan,a prospective study

In a prospective study of 5,276 consecutive liveborn babies, 291 (5.5%) infants were diagnosed to have 473 congenital malformations. The incidence of major and minor malformations was 2.4 per cent and 3.1 percent respectively. Musculoskeletal defects accounted for 41.7 per cent of major anomalies. Among individual anomalies, congenital dislocation of hips, cleft lip±palate, microcephaly, club feet, polydactyly, hypospadias, Down syndrome and asymmetric crying facies had a frequency greater than 1 per 1000 livebirths. The incidence of neural tube defects was 3 per 1000 total births. The history of parental consanguinity was significantly higher among parents of infants with major congenital malformations as compared to unaffected control infants.     

The Incidence of Congenital Malformations in Various Socioeconomic Groups in Sweden

The incidence of congenital malformations reported to the Register of Births during 1976–77 in various socioeconomic groups were studied combining the informations from the birth register with that from the 1975 census (including occupation of the mother, income of the family, type of family and housing standard). The total population of 190 024 infants were divided into three groups; 6915 infants (3.6 %) were assigned to the most privileged group (group I) and 26430 (13.9 %) to the less privileged group (group III). The total incidence of 5.01 % of any malformation did not differ significantly between the groups. Neither was any variation found for specific malformation types, such as neural tube defects, cleft palate or morbus Down     

河南省早产儿出生状况及早产原因的多中心研究

目的 了解河南省早产儿出生状况及早产原因,为早产防治提供理论依据.方法 对河南省17地市53家医院2019年1月1日至12月31日产科分娩的活产早产儿进行流行病学调查,了解早产儿发生率、胎龄和出生体重分布、产前糖皮质激素使用及早产原因构成等情况.结果 53家医院早产儿发生率为5.84％(12406/212438).胎龄...     

Infant and early childhood mortality in urban slums under ICDS scheme--a prospective study

The infant and early childhood mortality, its causes and associated factors were studied prospectively, in twelve Anganwadi centres, situated in urban slums of Patna from 1st January, 1987 to 31st December, 1987. A strict recording of births and deaths was done by Anganwadi workers, with monthly verifications by authors. The causes of death were established on the basis of clinical and corroborative enquiry from the parents. The birth rate was found to be 29.25, death rate 13.1, infant mortality rate 64.65/1000. Neonatal and post neonatal mortality rates were 49.42/1000 and 15.21/1000, respectively. Mortality in children between 1-3 years (11.3/1000) was higher in comparison to that of 3-6 years (9.1/1000). Low birth weight (25.52%) and perinatal infection (23.52%) were the major causes of infant mortality followed by respiratory infection (11.76) and diarrhea (8.82%). Diarrhea (37.5%), respiratory infection (15.62%) and accidents and burns (12.5%) were major killers in children between 1-6 years. Mortality in males was higher than females in infancy. Risk factors associated with infant mortality included extremes of maternal age (less than 20 and greater than 30 years), multiparity and illiterate mothers.     

Administration of indomethacin for the prevention of periventricular-intraventricular hemorrhage in high-risk neonates

One hundred twenty-two preterm infants were enrolled in a placebo-controlled, double-blind trial using intravenous indomethacin for the prevention of periventricular-intraventricular hemorrhage (PVH-IVH). Before random assignment, data on the infants were stratified according to low-weight (500 to 999 g) or high-weight (1000 to 1500 g) subgroups. Cranial sonography was used to document the absence of PVH-IVH before enrollment and the occurrence of PVH-IVH during the 7-day protocol. Indomethacin, 0.1 mg/kg, or placebo was administered before 12 hours of age and at 24, 48, and 72 hours of age. Five patients receiving indomethacin and six receiving placebo were withdrawn before completion of the study. In the remaining 111 patients, the indomethacin and placebo groups were comparable with respect to gestational ages, maternal complications, Apgar scores, ventilatory requirements, complications of prematurity, and mortality rate. PVH-IVH developed in six of 56 infants who received indomethacin and 11 of 55 infants who received placebo (P = 0.174). Analysis of the individual strata showed that the indomethacin-treated infants in the low-weight subgroup sustained a higher mortality rate (11/17 vs 3/16; P = 0.008) without a reduction in the incidence of PVH-IVH. Infants in the indomethacin-treated high-weight subgroup demonstrated a significantly lower incidence of PVH-IVH (2/39 vs 8/39; P = 0.04), but the frequency of high-grade hemorrhages was comparable for both indomethacin- and placebo-treated groups. In summary, the prophylactic administration of intravenous indomethacin for the prevention of PVH-IVH cannot be recommended for infants less than 1000 g. In preterm infants between 1000 and 1500 g birth weight, indomethacin significantly reduced the incidence of PVH-IVH.     

中国城市早产儿流行病学初步调查报告

目的　通过对我国较大范围的早产儿流行病学调查,提供有关我国的早产儿资料,也为今后更大 规模的全国新生儿流行病学调查奠定基础。方法　对16个省、自治区、直辖市的77所城市医院2002～2003年 6179名早产儿的高危因素、并发症、转归情况进行回顾性调查。结果　产科出生的新生儿中早产儿发生率为 7.8%,新生儿科住院病人中早产儿占19.7%,男女之比为1.67∶1。胎龄32～36周占63.5%。出生体重<1500g 占32.3%。早产儿的高危因素依次为母亲流产史(36.8%),多胎(20.1%),胎膜早破(19.8%)和妊高症 (12.6%)。并发症的发生率依次为:呼吸系统疾病(52.3%),中枢神经系统疾病(33.7%),高胆红素血症 (22.6%),感染性疾病(12.0%),消化系统疾病(10.6%)和循环系统(9.0%)。随胎龄和/或体重增加,总体并发 症发生率呈下降趋势(P<0.001);除缺氧缺血性脑病(HIE)发生率没有随胎龄增加而下降外,其他并发症发生率 均随胎龄增加而逐渐下降(P<0.001)。治愈好转率随早产儿胎龄和体重的增加呈增加趋势(P<0.001)。结论 该调查揭示了早产儿发生的常见原因以及影响早产儿转归的因素,为降低早产儿的发生率和改善早产儿预后提供 了理论依据。     

Neural tube defects in rural Ireland.

The incidence of neural tube defects in a rural area of the west of Ireland from 1974 to 1985 was 2.96 per 1000. The prevalence was unchanged during the 11 years. When compared with a control group there was no increased incidence of anaemia in mothers of affected infants.     

2005年中南地区产科新生儿流行病学调查

目的：通过对我国中南地区城市医院分娩的新生儿的调查,了解我国中南地区新生儿出生情况。方法：抽取我国中南地区的23所医院进行调查。回顾性调查了2005年1月1日至同年12月31日期间出生的产科住院新生儿15582名。结果：（1）新生儿男女性别比为1.16∶1;（2）早产儿发生率为8.11%;（3）极低出生体重儿发生率为0.73%;（4）分娩方式：自然分娩占57.52%,剖宫产占40.82%（其中因社会因素剖宫产占29.91%）,其他产式占1.66%;（5）新生儿窒息发生率为3.78%,其中重度窒息占0.75 %;（6）新生儿死亡率为0.55%,其中早产儿死亡率为5.56%。结论：（1）我国中南地区早产儿发生率和新生儿窒息发生率均较高;（2）我国中南地区剖宫产比例较高,尤其是社会因素所占的比例过高。     

Outcome of low birth weight infants in a West African village

Low birthweight (LBW) infants are at risk of increased mortality, impaired growth, and increased morbidity. We studied the progress of all LBW infants (less than 2.5 kg) born in a West African village where there is a resident pediatrician and midwife. There were 426 live births during the 8 years studied of which 42 (10 per cent) were of LBW. There were 17 infant deaths (IMR = 40/1000). Mean birthweight and gestation of infants dying in the first year were significantly lower than those of all live birth (2.33 kg v. 2.99 kg, P less than 0.001; 36.9 w v. 38.9 w, P less than 0.05). The mean weights of the 32 surviving LBW infants (15 preterm, 17 full term, small for gestational age) were compared with those of 32 full term, appropriate for gestational age matched controls over the first year. Growth velocities of paired groups were identical. The significant differences in weight at 1 year (P less than 0.005) reflected those at birth (P less than 0.001). There were no significant differences in clinic attendance rate or incidence of diarrhoea and respiratory disease between the four groups. We conclude that LBW is a strong risk factor for infant mortality, but not for diarrhoeal and respiratory morbidity in a community with ready access to obstetric and pediatric care.     

Fetal and neonatal mortality of small-for-gestational age infants

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