Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan

Objective

To evaluate the prevalence, sex distribution and causes of neonatal mortality, as well as its risk factors, in an urban Pakistani population with access to obstetric and neonatal care.

Methods

Study area women were enrolled at 20–26 weeks’ gestation in a prospective population-based cohort study that was conducted from 2003 to 2005. Physical examinations, antenatal laboratory tests and anthropometric measures were performed, and gestational age was determined by ultrasound to confirm eligibility. Demographic and health data were also collected on pretested study forms by trained female research staff. The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth. All neonatal deaths were reviewed using the Pattinson et al. system to assign obstetric and final causes of death; the circumstances of the death were determined by asking the mother or family and by reviewing hospital records. Frequencies and rates were calculated, and 95% confidence intervals were determined for mortality rates. Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death. Logistic regression models were used to compute adjusted odds ratios.

Findings

Birth outcomes were ascertained for 1280 (94%) of the 1369 women enrolled. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Preterm birth, Caesarean section and intrapartum complications were associated with neonatal death. Some 45% of the deaths occurred within 48 hours and 73% within the first week. The primary obstetric causes of death were preterm labour (34%) and intrapartum asphyxia (21%). Final causes were classified as immaturity-related (26%), birth asphyxia or hypoxia (26%) and infection (23%). Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths. The Caesarean section rate was 19%. Almost all (88%) neonates who died received treatment and 75% died in the hospital.

Conclusion

In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions. These results suggest that, to decrease neonatal mortality, improved health service quality is crucial.     

Causes of pediatric mortality and case-fatality rates in eight Médecins Sans Frontières-supported hospitals in Africa

Setting:

Eight pediatric hospital in-patient wards in remote, rural and/or insecure areas in Africa.

Objectives:

To describe, in children aged <5 years, 1) overall and individual mortality rates, 2) the 10 most common causes of mortality, and 3) their case-fatality rates.

Design:

Retrospective analysis of routinely collected standardized program data for 2010.

Results:

During 2010, 21 357 children aged <5 years were admitted and 1520 died, resulting in an overall in-patient mortality rate among under-fives of 7%. This remained the same after considering the three most common causes of mortality per hospital. One hospital with a neonatal unit showed a mortality rate of 14%. Of the 10 most common causes of mortality in the eight hospitals, severe malaria, acute lower respiratory tract infection and neonatal infection counted for about 77% of total deaths. Ranking the 10 most common causes of mortality according to case-fatality rates, septicemia, meningitis, low birth weight with pathology, neonatal infection and neonatal asphyxia were the most common (case-fatality rates 15–40%).

Conclusion:

Despite widely different contexts, mortality rates for pediatric in-patients were consistently under 10%. To further reduce mortality, emphasis should be placed on treating sepsis and introducing implementable and/or adapted care packages for neonatal-related pathologies.     

Macrosomic Births in a Tertiary Public Hospital: A Survey of Maternal Characteristics and Fetal Outcome

Background

Macrosomic fetuses are high risk with their delivery process being associated with potential risk to both mother and baby The aim of this study is to determine the incidence of macrosomic births and the associated maternal characteristics and to ascertain the fetal outcome.

Methods

It was a retrospective survey of maternal characteristics and pregnancy outcome of macrosomic births. Comparison was made with the next selected normal birth weight delivery during the study period.

Results

There were 8607 deliveries during the period (3 years) reviewed. Of this, 306 were macrosomic deliveries, a frequency of 3.6%. The mean weight for macrosomic babies was 4.23kg (range 4.01 – 5.62kg). There was a higher mean maternal weight and gestational age of mothers with macrosomic deliveries compared to mothers in the control group, (85.87 ± 19.39kg vs 74.92 ± 19.11kg P<0.01; and 41.51±1.46 vs 39.02±1.29, P<0.001). Caesarean delivery was significantly associated with macrosomic births compared to controls, p<0.0001, odds ratio 3.977. Also, asphyxia and shoulder dystocia occurred more in macrosomic babies, 10.4% vs 2.9% and 2.28% vs 0.65%, P<0.001. The majority of the asphyxiated babies amongst macroomic births were following vagina delivery compared to caesarean delivery, (65.6% vs 34.4%) p= 0.001. There were 3 cases of still birth in the macrosomic deliveries, but no maternal deaths were encountered.

Conclusion

Macrosomic births could be tragic. Although delivery outcome seems better with a caesarean section, good fetal outcome can only be assured on the premise of astute labour and delivery management.     

Distribution of birth weight for gestational age in Japanese infants delivered by cesarean section

Background

Neonatal anthropometric charts of the distribution of measurements, mainly birth weight, taken at different gestational ages are widely used by obstetricians and pediatricians. However, the relationship between delivery mode and neonatal anthropometric data has not been investigated in Japan or other countries.

Methods

The subjects were selected from the registration database of the Japan Society of Obstetrics and Gynecology (2003–2005). Tenth centile, median, and 90th centile of birth weight by sex, birth order, and delivery mode were observed by gestational age from 22 to 42 weeks among eligible singleton births.

Results

After excluding 248 outliers and 5243 births that did not satisfy the inclusion criteria, 144 980 births were included in the analysis. The distribution of 10th centile curves was skewed toward lower birth weights during the preterm period among both first live births and second and later live births delivered by cesarean section. More than 40% of both male and female live births were delivered by cesarean section at 37 weeks or earlier.

Conclusions

The large proportion of cesarean sections influenced the skewness of the birth weight distribution in the preterm period.Key words: birth weight, distribution, gestational age, cesarean section, preterm     

Perinatal Mortality and Associated Risk Factors: A Case Control Study

Background

Perinatal mortality is reported to be five times higher in developing than in developed nations. Little is known about the commonly associated risk factors for perinatal mortality in Southern Nations National Regional State of Ethiopia.

Methods

A case control study for perinatal mortality was conducted in University hospital between 2008 and 2010. Cases were stillbirths and early neonatal deaths. Controls were those live newborns till discharged from the hospital. Subgroup binary logistic regression analyses were done to identify associated risk factors for perinatal mortality, stillbirths and early neonatal deaths.

Results

A total of 1356 newborns (452 cases and 904 controls) were included in this analysis. The adjusted perinatal mortality rate was 85/1000 total delivery. Stillbirths accounted for 87% of total perinatal mortality. The proportion of hospital perinatal deaths was 26%. Obstructed labor was responsible for more than one third of perinatal deaths. Adjusted odds ratios revealed that obstructed labor, malpresentation, preterm birth, antepartum hemmorrhage and hypertensive disorders of pregnancy were independent predictors for high perinatal mortality. In the subgroup analysis, among others, obstructed labor and antepartum hemorrhage found to have independent association with both stillbirths and early neonatal deaths.

Conclusion

The perinatal mortality rate was more than two fold higher than the estimated national perinatal mortality;and obstructed labor, malpresentation, preterm birth, antepartum hemmorrhage and hypertensive disorders of pregnancy were independent predictors. The reason for the poor progress of labor and developing obstructed labor is an area of further investigation.     

A prospective study of maternal,fetal and neonatal deaths in low- and middle-income countries

Objective

To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths.

Methods

A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum.

Findings

Between 2010 and 2012, 214 070 of 220 235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100 000 live births, ranging from 69 per 100 000 in Argentina to 316 per 100 000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97–11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26–5.67) and 7-day (RR: 3.94; 95% CI: 2.74–5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54–9.77).

Conclusion

Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.     

Traffic-Related Air Pollution and Perinatal Mortality: A Case–Control Study

Background

Ambient levels of air pollution may affect the health of children, as indicated by studies of infant and perinatal mortality. Scientific evidence has also correlated low birth weight and preterm birth, which are important determinants of perinatal death, with air pollution. However, most of these studies used ambient concentrations measured at monitoring sites, which may not consider differential exposure to pollutants found at elevated concentrations near heavy-traffic roadways.

Objectives

Our goal was to examine the association between traffic-related pollution and perinatal mortality.

Methods

We used the information collected for a case–control study conducted in 14 districts in the City of São Paulo, Brazil, regarding risk factors for perinatal deaths. We geocoded the residential addresses of cases (fetal and early neonatal deaths) and controls (children who survived the 28th day of life) and calculated a distance-weighted traffic density (DWTD) measure considering all roads contained in a buffer surrounding these homes.

Results

Logistic regression revealed a gradient of increasing risk of early neonatal death with higher exposure to traffic-related air pollution. Mothers exposed to the highest quartile of the DWTD compared with those less exposed exhibited approximately 50% increased risk (adjusted odds ratio = 1.47; 95% confidence interval, 0.67–3.19). Associations for fetal mortality were less consistent.

Conclusions

These results suggest that motor vehicle exhaust exposures may be a risk factor for perinatal mortality.     

Nursing diagnoses of newborns with sepsis in a Neonatal Intensive Care Unit

Objectives

to elaborate the Nursing Diagnoses of newborns with sepsis in a neonatal intensive care unit and characterize the profile of the neonates and their mothers.

Method

a cross-sectional and quantitative study, with a sample of 41 neonates. A physical examination and consultation of the hospital records were undertaken, using an instrument. The elaboration of the Nursing Diagnoses followed a process of diagnostic inference and was based on the North American Nursing Diagnosis Association 2012-2014.

Results

the mothers were around 25 years old, had a low average number of pre-natal consultations, and various complications during the pregnancy; and the newborns were predominantly premature and with very low birth weights. Five Nursing Diagnoses predominated, and all the neonates presented Risk of Shock and Risk of fluid volume imbalance.

Conclusion

the Nursing Diagnoses of the neonates with sepsis can guide the formulating of specific assistential plans. The study contributes to the generation of new knowledge and found various relationships between the Nursing Diagnoses and the variables selected in the characterization of the neonates, which deserve to be elucidated in greater detail based on further research on the issue.     

Maternal height as an independent risk factor for neonatal size among adolescent bengalees in kolkata, India

Background

Low Birth Weight is a major public health problem in developing countries. The causes of LBW are multifactorial including complication during pregnancy, genetic, environmental, social-cultural, demographic and nutritional variables. Comparison of anthropometric risk factors for neonatal size of adolescent mothers are lacking from West Bengal. Therefore, this study was undertaken to identify maternal anthropometric characteristics, which most strongly influence neonate weight and length among Bengalee mothers.

Methods

A hospital based cross-sectional study was undertaken during 2004 in a Government general hospital in South Kolkata, India. A total of 76 adolescent (age<20years) pregnant women were enrolled from obstetric ward who were admitted for delivery. Due to 4 perinatal deaths; a total of 72 adolescent mother- baby pairs were included in this analysis. Anthropometric measurements were undertaken immediately after delivery following stabilization as well maternal body mass index (BMI) was calculated using standard formula.

Results

The prevalence of low birth weight (LBW) in the present study was 52.8%. The results revealed that 30.6% of mothers were undernourished (BMI<19.8 kg/m²). It was noted that about 64% of undernourished mothers delivered LBW baby. Linear regression analyses of neonatal weight and length as dependent variables revealed that in both cases, maternal height had the most significant impact. It showed 12.9% (birth weight) and 16.1% (birth length) of variation. Moreover, the proportion of LBW was 75%, 52.3% and 25% among short (height ≤145 cm), average (146–155cm) and tall (>155cm) mothers (x²=6.855, p<0.01), respectively. Short mothers had 2.74 and 9.0 fold greater risk of delivering LBW baby than average and tall mothers. In contrast, mean birth weight and length of baby was lower in short mother than their counterparts.

Conclusion

This study revealed that maternal height had the strongest significant impact on neonate size. This strong association could have serious health implications for Bengalee adolescent mothers. However, since this is a preliminary finding, it needs validation using a larger sample of adolescent mothers.     

Birth attendants as perinatal verbal autopsy respondents in low- and middle-income countries: a viable alternative?

Objective

To assess the feasibility of using birth attendants instead of bereaved mothers as perinatal verbal autopsy respondents.

Methods

Verbal autopsy interviews for early neonatal deaths and stillbirths were conducted separately among mothers (reference standard) and birth attendants in 38 communities in four developing countries. Concordance between maternal and attendant responses was calculated for all questions, for categories of questions and for individual questions. The sensitivity and specificity of individual questions with the birth attendant as respondent were assessed.

Findings

For early neonatal deaths, concordance across all questions was 94%. Concordance was at least 95% for more than half the questions on maternal medical history, birth attendance and neonate characteristics. Concordance on any given question was never less than 80%. Sensitivity and specificity varied across individual questions, more than 80% of which had a sensitivity of at least 80% and a specificity of at least 90%. For stillbirths, concordance across all questions was 93%. Concordance was 95% or greater more than half the time for questions on birth attendance, site of delivery and stillborn characteristics. Sensitivity and specificity varied across individual questions. Over 60% of the questions had a sensitivity of at least 80% and over 80% of them had a specificity of at least 90%. Overall, the causes of death established through verbal autopsy were similar, regardless of respondent.

Conclusion

Birth attendants can substitute for bereaved mothers as verbal autopsy respondents. The questions in existing harmonized verbal autopsy questionnaires need further refinement, as their sensitivity and specificity differ widely.     

Factors influencing rising caesarean section rates in China between 1988 and 2008

Objective

To identify factors driving the rapid increase in caesarean section in China between 1988 and 2008.

Methods

Data from four national cross-sectional surveys (1993, 1998, 2003 and 2008) and modified Poisson regression were used to determine whether changes in household income, access to health insurance or women’s education accounted for the rise in caesarean sections in urban and rural areas.

Findings

In 2008, 64.1% of urban women and 11.3% of women in the poorest rural region reported giving birth by caesarean section. A fast rise was occurring in all socioeconomic groups. Between 1993 and 2008, the risk of caesarean section had increased more than threefold in urban areas (relative risk, RR: 3.63; 95% confidence interval, CI: 2.61–5.04) and more than 15-fold in rural areas (RR: 15.46; 95% CI: 10.46–22.86). After adjustment for improvements in income, education and access to health insurance over the study period, the RR dropped minimally in urban areas (RR: 3.07; 95% CI: 2.32–4.07), which suggests that these factors do not explain the rise; in rural areas, the adjusted RR dropped to 7.18 (95% CI: 4.82–10.69), which shows that socioeconomic change is only partly responsible for the rise. Socioeconomic region of residence was a more important driver of the caesarean section rate than individual socioeconomic status.

Conclusion

The large variation in caesarean section rate by socioeconomic region – independent of individual income, health insurance or education – suggests that structural factors related to service supply have influenced the increasing rate more than a woman’s ability to pay.     

Infant mortality in the Flemish Region of Belgium 1999-2008: a time-to-event analysis

Background

When calculating life expectancy, it is usually assumed that deaths are uniformly distributed within each of the age intervals. As most of the infant deaths are neonatal deaths, this calls for a better assessment for that age group.

Methods

The Flemish unified death and birth certificates database for all calendar years between 1999 and 2008 was used. A Kaplan-Meier survival analysis on a yearly basis was performed to assess the mean time-to-event and to compare survival curves between both genders.

Results

Over the last years, a slight though not steady decrease of the infant mortality rate is observed. In 2008, the probability among live births of dying before their first anniversary is 4.6‰ in boys and 3.5‰ in girls. The large majority (about 85%) of these have died in their year of birth. The mean survival time of deaths in their year of birth was found to centre around 1 month (about 30 days), which results in a ''mean proportion of the calendar year lived'' (k1) close to 0.09. Among those who died in the year after their year of birth yet before their first anniversary, no such concentration in time of the deaths is observed. Differences between the gender groups are small and generally not statistically significant.

Conclusion

Statistics Belgium, the federal statistics office, imputes a value for k1 equal to 0.1 for infant deaths in their year of birth when calculating life expectancy. Our data fully support this value. We think such refinement is generally feasible in calculating life expectancy.     

Increased Risk of Death among Uninsured Neonates

Objective

To estimate the contribution of health insurance status to the risk of death among hospitalized neonates.

Data Sources

Kids'' Inpatient Databases (KID) for 2003, 2006, and 2009.

Study Design

KID 2006 subpopulation of neonatal discharges was analyzed by weighted frequency distribution and multivariable logistic regression analyses for the outcome of death, adjusted for insurance status and other variables. Multivariable linear regression analyses were conducted for the outcomes mean adjusted length of stay and hospital charges. The death analysis was repeated with KID 2003 and 2009.

Principal Findings

Of 4,318,121 estimated discharges in 2006, 5.4 percent were uninsured. There were 17,892 deaths; 9.5 percent were uninsured. The largest risks of death were five clinical conditions with adjusted odds ratios (AOR) of 13.7–3.1. Lack of insurance had an AOR of 2.6 (95 percent CI: 2.4, 2.8), greater than many clinical conditions; AOR estimates in alternate models were 2.1–2.7. Compared with insureds, uninsureds were less likely to have been admitted in transfer, more likely to have died in rural hospitals and to have received fewer resources. Similar death outcome results were observed for 2003 and 2009.

Conclusions

Uninsured neonates had decreased care and increased risk of dying.     

Low infant mortality among Palestine refugees despite the odds

Objective

To present data from a 2008 infant mortality survey conducted in Jordan, Lebanon, the Syrian Arab Republic, the Gaza Strip and the West Bank and analyse infant mortality trends among Palestine refugees in 1995–2005.

Methods

Following the preceding birth technique, mothers who were registering a new birth were asked if the preceding child was alive or dead, the day the child was born and the date of birth of the neonate whose birth was being registered. From this information, neonatal, infant and early child mortality rates were estimated. The age at death for early child mortality was determined by the mean interval between successive births and the mean age of neonates at registration.

Findings

In 2005–2006, infant mortality among Palestine refugees ranged from 28 deaths per 100 000 live births in the Syrian Arab Republic to 19 in Lebanon. Thus, infant mortality in Palestine refugees is among the lowest in the Near East. However, infant mortality has stopped decreasing in recent years, although it remains at a level compatible with the attainment of Millennium Development Goal 4.

Conclusion

Largely owing to the primary health care provided by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East and other entities, infant mortality among Palestine refugees had consistently decreased. However, it is no longer dropping. Measures to address the most likely reasons – early marriage and childbearing, poor socioeconomic conditions and limited access to good perinatal care – are needed.     

Iron and folic acid supplements and reduced early neonatal deaths in Indonesia

Objective

To examine the relationship between antenatal care, iron and folic acid supplementation and tetanus toxoid vaccination during pregnancy in Indonesia and the risk of early neonatal death (death in days 0–6 of life).

Methods

We analysed pooled data on neonatal survival in singleton infants born in the 5 years before each of the Indonesian demographic and health surveys of 1994, 1997 and 2002–2003. Only the most recently born infant of each mother was included. Multivariate Cox proportional hazards models were used to identify factors linked to early neonatal death.

Findings

Of the 40 576 infants included, 442 experienced early neonatal death. After adjustment, the risk of early neonatal death was significantly reduced for infants of mothers who received either any form of antenatal care (hazard ratio, HR: 0.48; 95% confidence interval, CI: 0.31–0.73), any quantity of iron and folic acid (HR: 0.53; 95% CI: 0.36–0.77) or ≥ 2 tetanus toxoid injections (HR: 0.66; 95% CI: 0.48–0.92). When we analysed different combinations of these measures, iron and folic acid supplementation provided the main protective effect: early neonatal deaths were still significantly reduced among infants whose mothers received iron and folic acid supplements but no other form of antenatal care (HR: 0.10; 95% CI: 0.01–0.67), or the supplements but < 2 tetanus toxoid injections (HR: 0.46; 95% CI: 0.29–0.73). Subsequent analysis showed that 20% of early neonatal deaths in Indonesia could be attributed to a lack of iron and folic acid supplementation during pregnancy.

Conclusion

Iron and folic acid supplementation during pregnancy in Indonesia significantly reduced the risk of early neonatal death and could also do so in other low- and middle-income countries.     

Child Deaths From Injury in the Special Wards of Tokyo,Japan (2006–2010): A Descriptive Study

Background

There has been increasing interest in the formal review of child deaths in Japan. In this study we examined the causes and scene information regarding child deaths from injury in Tokyo, the capital of Japan, as preparation for implementation of a full-scale review of child deaths.

Methods

Documents on deaths from injury (excluding homicides) investigated by the Tokyo Medical Examiner’s Office during the period from 2006 through 2010 were reviewed. Deaths of children younger than 18 years (N = 217) were selected as the study sample. We examined the cause of and information on the death and were particularly interested in whether a case had preventable factors.

Results

Overall, 67% of the cases were deaths from unintentional injury. The main cause of death among children younger than 1 year was asphyxia, and the proportions of deaths from traffic accidents were higher in older age groups. Thirty percent of deaths from injury were due to suicide, and all cases of suicide were among children older than 10 years. Although analysis of preventable factors was difficult in some cases, owing to limited information on the death scene, 87% of deaths from unintentional injury, excluding those involving traffic accidents, had preventable factors.

Conclusions

Most unintentional child deaths from injury appear to be preventable. Development of a system to collect detailed information on the scene at the time of death will help decrease child deaths in Japan.Key words: child fatality review, injury, mortality statistics, prevention     

Trends,causes, and risk factors of mortality among children under 5 in Ethiopia, 1990–2013: findings from the Global Burden of Disease Study 2013

Background

Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990–2013.

Methods

We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used.

Results

Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1–4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013.Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n?=?97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap.

Conclusions

LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.

     

Urinary Phthalate Metabolites in Relation to Preterm Birth in Mexico City

Background

Rates of preterm birth have been rising over the past several decades. Factors contributing to this trend remain largely unclear, and exposure to environmental contaminants may play a role.

Objective

We investigated the relationship between phthalate exposure and preterm birth.

Methods

Within a large Mexican birth cohort study, we compared third-trimester urinary phthalate metabolite concentrations in 30 women who delivered preterm (< 37 weeks of gestation) with those of 30 controls (≥ 37 weeks of gestation).

Results

Concentrations of most of the metabolites were similar to those reported among U.S. females, although in the present study mono-n-butyl phthalate (MBP) concentrations were higher and monobenzyl phthalate (MBzP) concentrations lower. In a crude comparison before correcting for urinary dilution, geometric mean urinary concentrations were higher for the phthalate metabolites MBP, MBzP, mono(3-carboxylpropyl) phthalate, and four metabolites of di(2-ethyl-hexyl) phthalate among women who subsequently delivered preterm. These differences remained, but were somewhat lessened, after correction by specific gravity or creatinine. In multivariate logistic regression analysis adjusted for potential confounders, elevated odds of having phthalate metabolite concentrations above the median level were found.

Conclusions

We found that phthalate exposure is prevalent among this group of pregnant women in Mexico and that some phthalates may be associated with preterm birth.     

Perfluorinated chemicals and fetal growth: a study within the Danish National Birth Cohort

Background

Perfluorooctanesulfonate (PFOS) and perfluorooctanoate (PFOA) are man-made, persistent organic pollutants widely spread throughout the environment and human populations. They have been found to interfere with fetal growth in some animal models, but whether a similar effect is seen in humans is uncertain.

Objectives

We investigated the association between plasma levels of PFOS and PFOA in pregnant women and their infants’ birth weight and length of gestation.

Methods

We randomly selected 1,400 women and their infants from the Danish National Birth Cohort among those who completed all four computer-assisted telephone interviews, provided the first blood samples between gestational weeks 4 and 14, and who gave birth to a single live-born child without congenital malformation. PFOS and PFOA were measured by high performance liquid chromatography–tandem mass spectrometer.

Results

PFOS and PFOA levels in maternal plasma were on average 35.3 and 5.6 ng/mL, respectively. Only PFOA levels were inversely associated with birth weight (adjusted β = −10.63 g; 95% confidence interval, −20.79 to −0.47 g). Neither maternal PFOS nor PFOA levels were consistently associated with the risk for preterm birth or low birth weight. We observed no adverse effects for maternal PFOS or PFOA levels on small for gestational age.

Conclusion

Our nationwide cohort data suggest an inverse association between maternal plasma PFOA levels and birth weight. Because of widespread exposure to these chemicals, our findings may be of potential public health concern.     

Music and 25% glucose pain relief for the premature infant: a randomized clinical trial

OBJECTIVE:

to analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture during music and 25% glucose interventions, and to assess their association with neonatal and therapeutic variables.

METHOD:

a randomized clinical trial with 80 premature infants; 24 in the Experimental Group 1 (music), 33 in the Experimental Group 2 (music and 25% glucose), 23 in the Positive Control Group (25% glucose). All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2; 25% glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture.

RESULTS:

60.0% of premature infants had moderate or maximum pain; pain scores and intervention groups were not statistically significant. Statistically significant variables: Experimental Group 1: head and chest circumference, Apgar scores, corrected gestational age; Experimental Group 2: chest circumference, Apgar scores, oxygen therapy; Positive Control group: birth weight, head circumference.

CONCLUSION:

neonatal variables are associated with pain in premature infants. Brazilian Registry of Clinical Trials: UTN: U1111-1123-4821.