Neonatal mortality pattern in rural based medical college hospital

The present study was undertaken to establish priorities in neonatal care and to ascertain the neonatal mortality pattern in a rural based medical college hospital. 123 neonatal deaths out of 1461 live births constituted the study material. The neonatal mortality rate was 84.2/1000 live births. The mortality in preterm, fullterm, and postterm infants was 43.13, 4.02, and 7.02% respectively (P0.001). The mortality in relation to birthweight was 100% (1000 g); 71.43% (1000-1499 g); 37.14% (1500-1999 g); 7.63% (2000-2499 g), and 2.94% (2500 g). Almost 70% of all deaths were due to severe birth anoxia and septicemia (including meningitis), either alone or in combination.     

Infant mortality in a region of Finland, 1968–1982

Infant mortality in a region of Finland with about 450000 people and 5400 annual births was examined during a 15-year period, 1968–1982. Total infant mortality declined from 15.8 per 1000 live births in 1968 to 5.0 in 1982. The lowering of neonatal mortality accounted for the decline, as postneonatal mortality remained at the same level throughout the study period. Despite a decrease of nearly 80%, perinatal disorders remained the leading category of primary causes of death. Mortality from congenital malformations decreased by 50%, mortality from sudden infant death syndrome increased from 0.2 to 0.9 per 1000 live births while mortality from accidents, infectious diseases and other diseases remained minor causes of death with no change in frequency. In the low birth weight category, postponement of deaths from early to late neonatal and postneonatal periods occurred, but total infant mortality in the low birth weight category declined by about 60%. During the last two 3-year periods, decrease in birth weight-specific infant mortality was found in the 500–999 g and >2500 g categories. The reasonably high standard of living, good educational level of mothers, well organized primary maternal and child health services and the rapid advances in obstetric and neonatal care equally available and regionalized, have contributed to the favourable progress in infant mortality in Finland.     

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.     

Perinatal mortality trends in a referral hospital

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992–93 (Group B). The perinatal mortality rate (PMR) in Group A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.     

Perinatal mortality in Ludhiana,Punjab— A seven year hospital study

Perinatal deaths occurring over a seven year period were studied in a teaching hospital in Punjab. Causes of death were analysed as per Wigglesworth's classification. We have further modified this by correlating different gestations and weight groups with causes of death. The perinatal mortality rate (PNMR) in the present study was 74/1000 and showed a downward trend secondary to a statistically significant fall of early neonatal mortality. There was a decline in PNMR among babies of 1500–2000 g. birth weight and 33–36 weeks gestation. Asphyxia and macerated still births were found to be the two main causes of death. Macerated still births were seen more commonly among babies of lower weight at all gestations. the PNMR of babies born to booked mothers was 22/1000 as compared to 152/1000 among unbooked mothers. It was concluded that to bring down the PNMR, economic development alone is not enough. Provision of adequate antenatal care to all mothers, health education and timely referral of high risk mothers is very essential.     

Neonatal mortality rate: Relationship to birth weight and gestational age

A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths [p<0.001]. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths [p<0.001]. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors.     

A study of perinatal mortality rate from rural based Medical College Hospital

The present study conducted in a rural medical college aimed at analysing the perinatal mortality and its determinants in a rural set up. Fiftyeight still births and sixty two early neonatal deaths among 1107 consecutive deliveries gave a perinatal mortality rate of 108.4 per 1000 deliveries. Fifty percent of the total deliveries were unbooked. The perinatal mortality was higher in unbooked cases (16.3%), twins (33.2%) and preterms (33.9%) as compared to that in booked cases (5.3%), singletons (9.6%) and term deliveries (6.7%). Sixty nine percent of the still births were due to causes like obstructed labour, toxemia of pregnancy, antepartum hemorrhage, hand prolapse, and cord prolapse where timely intervention would have reduced the perinatal mortality significantly. Early neonatal deaths were mainly associated with prematurity and were largely due to birth anoxia, intraventricular hemorrhage, aspiration and infections.     

Epidemiology of cerebral palsy in England and Scotland, 1984-9

AIMS—To report on the epidemiology of cerebral palsy in England and Scotland, to provide information on the prevalence of cerebral palsy and the severity of the disability or any co-morbidity.METHODS—Cerebral palsy registers were compiled from multiple sources of ascertainment covering all of Scotland and the counties of Merseyside, Cheshire, Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire in England. All cases of cerebral palsy born in 1984 to 1989, to mothers resident in the area, were included. Denominator number of live births and neonatal deaths for determining birthweight specific prevalence were obtained from birth and death registrations. Learning, manual, and ambulatory disabilities were graded for severity. Any co-existing sensory (hearing or visual) morbidity was also graded for severity.RESULTS—There were 789 411 live births in 1984-9, with 3651 neonatal deaths (neonatal mortality 4.6 per 1000 live births) and 1649cases of cerebral palsy—a cerebral palsy prevalence of 2.1 per 1000 neonatal survivors. The birthweight specific cerebral palsy prevalence ranged from 1.1 per 1000 neonatal survivors in infants weighing ?2500 g to 78.1 in infants weighing <1000 g. There was no significant time trend in prevalence of cerebral palsy in any of the birthweight groups, in contrast to the fall in neonatal mortality observed in all birthweight groups. Of the 1649 cases of cerebral palsy, 550 (33.4%) had severe ambulatory disability (no independent walking), 390 (23.7%) had severe manual disability (incapable of feeding or dressing unaided), 381 (23.1%) had severe learning disability (IQ <50), 146 (8.9%) had severe visual disability (vision <6/60 in the better eye) and 12 had severe hearing disability (>70 dB loss).CONCLUSIONS—Registers fill an important gap left by the lack of routine data on the prevalence of disability in children. The ability to record trends in the prevalence and the severity of the disability should inform those who have responsibility for providing services for children with disabilities.     

Outcome of neonatal necrotising enterocolitis: results of the BAPM/CDSC surveillance study, 1981-84.

Neonatologists in 100 special care baby units in the United Kingdom and Ireland collaborated in a four year surveillance study of neonatal necrotising enterocolitis. The average overall annual reporting rate of necrotising enterocolitis for infants in England and Wales was 0.3/1000 live births, but ranged from 9.5/1000 live births in infants weighing less than 1000 g at birth to 0.2/1000 live births in infants weighing 2500 g or more. There were more deaths among girls, infants who weighed less than 1500 g at birth, those whose bleeding was abnormal or who had low peripheral platelet counts, infants with Gram negative bacteraemia, and very low birthweight infants who developed it during the first few days of life. In both boys and girls, and in all birthweight groups, operation was associated with increased mortality.     

Foetal co-relates and mode of delivery in asphyxia neonatorum

A prospective study was conducted on consequitively born live births for determining the role of certain foetal factors and mode of delivery on asphyxia neonatorum. The difference in the incidence of neonatal asphxia in 1208 singleton births (8.5%) and in the 66 multiple births (9.7%) was statistically significantly (p<0.01). Among the singleton live births a significantly increased incidence of asphyxia was recorded in preterms when compared to term and post term babies collectively (p<0.001). Small for date babies were at a greater risk for asphxia neonatorum when compared to babies weighing appropriate for gestational age (p<0.001). An inverse relationship was observed between birth weight and asphyxia neonatorum. A significant difference was seen in the occurrence of neonatal asphyxia between babies weighing <2000 g. and those weighing more than 2000 g. (p<0.001). The incidence was significantly influenced by mode of delivery, being highest in vaginal breech delivery followed in decreasing frequency by forceps and normal vaginal delivery. Among vaginal breech delivered neonates those weighing ≥2500 g were at the highest risk. Evidence of foetal distress and meconium stained amniotic fluid had a low predictability of asphyxia being 35.0% and 40.0% respectively though both were statistically significant (p<0.001).     

Perinatal and infant mortality in urban slums under I.C.D.S. scheme

Perinatal and infant mortality during the year 1985 was analyzed through a prospective study conducted in 12 Anganwadis (total population of 13,054) located in slum areas of India's Jabalpur city. Overall, the infant mortality rate was 128.7/1000 live births and the perinatal mortality rate was 88.5/1000 live births. 58.5% of deaths occurred in the neonatal period. Causes of neonatal deaths included prematurity, respiratory distress syndrome, birth asphyxia, septicemia, and neonatal tetanus. Postneonatal deaths were largely attributable to dehydration from diarrhea, bronchopneumonia, malnutrition, and infectious diseases. All mortality rates were significantly higher in Muslims than among Hindus. Muslims accounted for 28% of the study population, but contributed 63% of stillbirths and 55% of total infant deaths. This phenomenon appears attributable to the large family size among Muslims coupled with inadequate maternal-child health care. The national neonatal and postneonatal mortality rates are 88/1000 and 52/1000, respectively. The fact that the neonatal mortality rate in the study area was slightly lower than the national average may reflect the impact of ICDS services.     

Early neonatal morbidity and mortality in ‘at-risk’ and ‘normal’ term pregnancies

It is a universally known fact that maternal well-being is related to neonatal health. This case-control study aims to assess the pattern and strength of association of neonatal morbidity and mortality (in first 7 days of life) in relation to the presence of obstetric & medical risk factors in the mother (indicating maternal ill-health). In 250 cases (at-risk pregnancies), 75 (30%) developed neonatal illnesses while 17 (6.8%) perinatal deaths occurred in first seven days. In the same number of controls (uncomplicated pregnancies) there were only two perinatal deaths and lesser number of newborns (45/250, 16.4%) developed neonatal diseases in the first 7 days. Perinatal deaths, (still births and early neonatal deaths), (OR = 9.05; AR = 88.2%) and neonatal illnesses (OR = 2.2 and AR = 45) were strongly associated with presence of maternal risk factors. This study supports the fact that ‘at risk’ pregnancies have highly significant chances of developing early (first 7 days) neonatal morbidity (p < 0.001) and mortality (p < 0.001). Still births also occurred significantly more (p < 0.005) in number among ‘at risk’ (cases) than normal term pregnancies (controls).     

Mortality in 504 infants weighing less than 1501 g at birth and treated in four neonatal intensive care units of South-Belgium between 1976 and 1980

Mortality was studied in 504 infants weighing less than 1501 g at birth and treated in four neonatal intensive care units of South-Belgium between 1976 and 1980. Two hundred and twenty-one babies died during their stay at the hospital, a mortality rate of 438 per 1000 live births. The neonatal mortality rate (mortality during the first 28 days of life) was 373 per 1000 live-births. Thirty-three infants died after the neonatal period, which is 15% of the total number of deaths. Twothirds of these post-neonatal deaths were related to complications of diseases associated with pre-term delivery. Mortality rates were higher in infants of less than 1001 g than in those of 1001–1250 g or 1251–1500 birth weight. In each birth weight category, patients born in their own obstetrical departments and referred infants had similar mortality rates. Longitudinal analysis showed improving mortality rates between 1976 and 1977 in the total population of VLBW infants, between 1977 and 1978 in infants of <1001 g and in 1980 compared to 1976 in the 1251–1500 g group. There were higher incidences of need for ventilatory assistance, patent ductus arteriosus, necrotising enterocolitis and septicaemia in referred patients of <1001 g than in patients born in their own obstetrical departments with comparable birth weight. Artification ventilation was more often required in referred infants of 1251–1500 g. This study confirms the importance of considering at least the complete hospital stay when analysing mortality in VLBW infants. Infants of <1001 g had high mortality, particularly after the neonatal period. This phenomenon was asscciated with complications of morbid conditions related to extreme prematurity.Abbreviations VLBW very low birth weight - PDA patent ductus areeriosus - NEC necrotising enterocolitis     

Burden of morbidities and the unmet need for health care in rural neonates--a prospective observational study in Gadchiroli, India

BACKGROUND: Majority of the neonates in developing countries are born and cared for in rural homes but the available information is mostly hospital based. OBJECTIVES: To estimate: (i) the incidence of various neonatal morbidities and associated case fatality in home-cared rural neonates, (ii) proportion of neonates with indications for health care, and (iii) the proportion who actually receive it. DESIGN: Prospective observational study. SETTING: Rural homes. METHODS: Neonates in 39 study villages in the Gadchiroli district (Maharashtra, India) were observed during one year (1995-96) by 39 trained female village health workers at birth and during neonatal period (0-28 days) by making eight home visits. A physician checked the data and the morbidities were diagnosed by a computer program. Vital statistics in these villages was independently collected. RESULTS: Out of 1016 live births, 95% occurred at home and 763 (75&%) neonates were observed. The agreement between observations by health workers and physician was 92%. Total 48.2& neonates suffered high risk morbidities (associated case fatality >10%), 72.2% suffered low risk morbidities, and 17.9% gained inadequate weight (less than 300 g). Seventeen percent neonates developed clinical picture suggestive of sepsis. Though 54.4% neonates had indications for health care and 38 out of total 40 neonatal deaths occurred in these, only 2.6% received medical attention. The neonatal mortality rate was 52.4/1000 live births. CONCLUSION: Nearly half of the neonates in rural homes developed high risk morbidities ten times the neonatal morbidity rate and needed health care but practically none received it. The magnitude of care gap suggests an urgent need for developing home-based neonatal care to reduce neonatal morbidities and mortality     

Neonatal mortality rate: a hospital study

The 72 neonatal deaths (0-28 days) out of 1533 live births occurring over the January 1-December 31, 1985, period provided the data for this study designed to determine the pattern of neonatal mortality in Varanasi, India. The overall mortality rate was 4.69%. The mortality in preterm (PT) and fullterm (FT) infants was 28.19% and 1.42%, respectively, a statistically significant difference. The overall neonatal mortality in low birth weight infants was 11.65% compared to 1.08% in babies weighing 2500 g or more. The neonatal mortality in PT and FT low birth weight infants was 29.60 and 2.41%, respectively; these differences were statistically significant. Of 72 neonatal deaths, 53 were PT and 19 FT infants. 59.72% of the total deaths were due to severe birth anoxia; septicemia (including meningitis and chest infection) was responsible for 6.94% deaths. Intraventricular hemorrhage was responsible for 25.0% of deaths and was limited only to preterm babies.     

Decreased Prevalence of Hypoplastic Left Heart Syndrome in Malta

Hypoplastic left heart syndrome (HLHS) is the most severe form of congenital heart disease (CHD), which until recently was considered to be fatal. However, surgical intervention is now possible using neonatal heart transplantation or three-stage palliative surgery (Norwood's staged operations). In Malta, during the period 1977–1994, there were four cases of classic HLHS, with an additional three cases of HLHS-like cases. The birth prevalence of classical HLHS was 0.04 per 1000 live births, whereas that of combined HLHS-like cases was 0.06 per 1000 live births for the same period. One neonate with HLHS is expected every 3 or 4 years. Despite a high rate of ascertainment of CHD, the birth prevalence of HLHS in Malta was significantly lower than that quoted in historical studies (p < 0.006) and in the European Congenital Anomalies and Twins Registry (p < 0.002). Malta has the expected birth prevalence of CHD, but the spectrum of CHD exhibits a predominance of lesions causing right ventricular outflow obstruction and a deficit of lesions causing left ventricular outflow tract obstruction. CHD is caused by a genetic–environmental interaction. The low rate of HLHS in Malta appears to be a true divergence from the usual observed spectrum of CHD and may be caused by genetic and/or environmental factors.     

State reporting of live births of newborns weighing less than 500 grams: impact on neonatal mortality rates

The National Center for Health Statistics reports that in 1983 65% of all infant deaths in the United States occurred in the neonatal period. Of these reported neonatal deaths, 17% were of infants weighing less than 500 g at birth. There was, however, variation in state-reported incidence of live births of newborns in this weight cohort (0.2 to 2.2 per 1,000 live births). The states with the lowest neonatal mortality rate have the lowest incidence of birth weights less than 500 g (rho = .77). If it is assumed that mortality for this weight category is nearly 100%, there is marked variation (5% to 32%) in the contribution of this weight cohort to a state's total neonatal mortality rate. Contributing to this variation may be definitions of live birth used by states. The World Health Organization defines a live birth as the product of conception showing signs of life "irrespective of the duration of pregnancy" and this definition is used by 33 states. Only one state (Ohio) includes the gestational criteria of "at least 20 weeks" in its definition of live birth. There is evidence to suggest that definitions are not uniformly used within individual states. For example, in 1983, 20 states did not report any live births with weights less than 500 g among their "other" populations of nonwhite, nonblack residents. Half of these states, however, use the World Health Organization definition of live birth. Despite the exclusionary wording in Ohio's definition of liver birth, 16% of newborns who died in that state had birth weights less than 500 g.(ABSTRACT TRUNCATED AT 250 WORDS)     

Causes of early neonatal mortality.

The early neonatal period extends up to the 7th day of the infant's life. 75% of infant deaths occur within the first 28 days of life, and most of them occur within the first 7 days. In a retrospective study undertaken from June 1, 1987, to May 31, 1990, data was obtained from the Neonatal Care Section of Krishna Hospital, Karad, District Satara, in south western Maharashtra. Most of the villagers wee of low socioeconomic status, and the women had poor educational level. Most of the deliveries in this area are conducted by untrained dais under unhygienic conditions. The early neonatal mortality rate (ENMR) was defined as neonatal death of babies weighing over 1000 g during the first 7 days per 1000 live births. A total of 1013 live births with weight more than 1000 g were included in the study: 533 wee males and 480 females. The incidence of low-birth-weight (=or- 2.5 kg) babies was 77.1%, and that of prematurity (gestational age 37 weeks) was 58.9%. There were 37 neonatal deaths, with an ENMR of 36.6. The chief causes of ENMR were perinatal asphyxia (40.5%), prematurity (29.7%), bacterial infections (27.0%), and congenital malformations (2.8%). The mortality was higher in low-birth-weight as compared to the normal-birth-weight babies. A total of 59% of all births were preterms who contributed to 29.7% of deaths. The high incidence of low-birth-weight babies was attributable to the fact that this hospital received 79.4% of total admissions for delivery of complicated pregnancy referrals from the peripheries. The difference between mortality of babies with birth weight of less than and more than 2.5 kg was statistically significant (p0.05). Regular antenatal checkups, health education of pregnant and lactating mothers, professional child delivery, and timely referral of pregnancy complications to well-equipped hospitals may cut down on early neonatal mortality.     

Disparate black and white neonatal mortality rates among infants of normal birth weight in Chicago: a population study.

To determine the extent to which disparities in risk status and access to tertiary care affect racial differences in neonatal mortality rates among normal birth weight infants, we conducted a vital records study concerning normal weight black (N = 44,399) and white (N = 48,146) singleton births in Chicago. Neonatal mortality rate among black infants was twice that among white infants (3.3 deaths per 1000 births vs 1.5 deaths per 1000 births); the unadjusted black relative risk equaled 2.2 (95% confidence interval, 1.7 to 2.9). Because prematurity, growth retardation, congenital anomalies, low Apgar scores at 5 minutes, teenage mothers, and poverty were more common among black infants, multivariate analyses were performed. The disparity in mortality rate was greatest between black and white infants with none of these risk factors; relative risk for black infants equaled 3.6 (95% confidence interval, 2.0 to 6.7). Approximately 30% of all deaths of black infants were attributable to birth in nontertiary hospitals. When the confounding variables, including hospital of birth, were put into a multivariate logistic-regression model, the adjusted relative risk estimate (odds ratio) for black infants equaled 1.5 (95% confidence interval, 1.1 to 2.0). Traditional risk factors fail to explain the racial disparity in neonatal mortality rate among normal birth weight infants. Level of perinatal care available, or some factor closely related to this level, is an important determinant of neonatal chance of survival for normal birth weight urban black infants.     

Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: population based study

OBJECTIVES: To ascertain the prevalence of newborn encephalopathy in term live births, and also the underlying diagnoses, timing, and outcome at 2 years of surviving infants. DESIGN: Population based observational study. SETTING: North Pas-de-Calais area of France, January to December 2000. PATIENTS: All 90 neonates with moderate or severe newborn encephalopathy. RESULTS: The prevalence of moderate or severe newborn encephalopathy was 1.64 per 1000 term live births (95% confidence interval (CI) 1.30 to 1.98). The prevalence of birth asphyxia was 0.86 per 1000 term live births (95% CI 0.61 to 1.10). The main cause of newborn encephalopathy was birth asphyxia, diagnosed in 47 (52%) infants. It was associated with another diagnosis in 11/47 cases (23%). The timing was intrapartum in 56% of cases, antepartum in 13%, ante-intrapartum in 10%, and postpartum in 2%. In 19% of cases, no underlying cause was identified during the neonatal course. Twenty four infants died in the neonatal period, giving a fatality rate of 27% (95% CI 17% to 36%). Three infants died after the neonatal period. At 2 years of age, 38 infants had a poor outcome, defined by death or severe disability, a prevalence of 0.69 per 1000 term live births (95% CI 0.47 to 0.91). In infants with isolated birth asphyxia, this prevalence was 0.36 per 1000 term live births (95% CI 0.20 to 0.52). CONCLUSIONS: The causes of newborn encephalopathy were heterogeneous but the main one was birth asphyxia. The prevalence was low, but the outcome was poor, emphasising the need for prevention programmes and new therapeutic approaches.