Cause-specific neonatal mortality in a neonatal care unit in Northern Tanzania: a registry based cohort study

ABSTRACT: BACKGROUND: The current decline in under-five mortality shows an increase in share of neonatal deaths. In order to address neonatal mortality and possibly identify areas of prevention and intervention, we studied causes of admission and cause-specific neonatal mortality in a neonatal care unit at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania. METHODS: A total of 5033 inborn neonates admitted to a neonatal care unit (NCU) from 2000 to 2010 registered at the KCMC Medical Birth Registry and neonatal registry were studied. Clinical diagnosis, gestational age, birth weight, Apgar score and date at admission and discharge were registered. Cause-specific of neonatal deaths were classified by modified Wigglesworth classification. Statistical analysis was performed in SPSS 18.0. RESULTS: Leading causes of admission were birth asphyxia (26.8%), prematurity (18.4%), risk of infection (16.9%), neonatal infection (15.4%), and birth weight above 4000 g (10.7%). Overall mortality was 10.7% (536 deaths). Leading single causes of death were birth asphyxia (n = 245, 45.7%), prematurity (n = 188, 35.1%), congenital malformations (n = 49, 9.1%), and infections (n = 46, 8.6%). Babies with birth weight below 2500 g constituted 29% of all admissions and 52.1% of all deaths. Except for congenital malformations, case fatality declined with increasing birth weight. Birth asphyxia was the most frequent cause of death in normal birth weight babies (n = 179/246, 73.1%) and prematurity in low birth weight babies (n = 178/188, 94.7%). The majority of deaths (n = 304, 56.7%) occurred within 24 hours, and 490 (91.4%) within the first week. CONCLUSIONS: Birth asphyxia in normal birth weight babies and prematurity in low birth weight babies each accounted for one third of all deaths in this population. The high number of deaths attributable to birth asphyxia in normal birth weight babies suggests further studies to identify causal mechanisms. Strategies directed towards making obstetric and newborn care timely available with proper antenatal, maternal and newborn care support with regular training on resuscitation skills would improve child survival.     

Early neonatal mortality in an intramural birth cohort at a tertiary care hospital

Early neonatal mortality (ENM) occurring among 12,283 consecutive live birthsover a period of 3 years were analysed. The early neonatal mortality rate (ENMR) was 26.6/1000 live births. Birth weight less than 2,000 gm, lack of antenatal care, male sex, operative vaginal delivery, prematurity and multiple pregnancy were significantly associated with early neonatal deaths. Birth asphyxia was found to be the most important cause of death, followed by hyaline membrane disease and congenital malformations. Majority of the asphyxia related deaths were due to late intrapartum referral of the mothers. Forty-two per cent of early neonatal deaths occurred in babies weighing less than 1,500 gm. Early identification and referral of high risk mothers and health education would significantly reduce the early neonatal deaths.     

Duration of inter-facility neonatal transport and neonatal mortality: Systematic review and cohort study

BACKGROUND: Regionalization of perinatal health services has been actively discussed, although important determinants such as effect of duration of neonatal transport on neonatal outcomes have not been investigated well as yet. Therefore the purpose of the present paper was to investigate the association between duration of inter-facility transport and perinatal mortality. METHODS: For the systematic review, six major databases were searched. Any comparative studies investigating associations between duration of inter-facility neonatal transport and their outcomes, published in the English language were selected. The studies were screened and reviewed by two independent researchers. For the cohort study, study subjects included every neonate transported to neonatal wards in Osaka, Japan between 1980 and 2000 in an existing surveillance called Neonatal Mutual Cooperative System. They are followed up until 28 days of age, or discharge if earlier. Other variables were also considered as effect modifiers or confounders, including calendar year, birthweight (BW), gestational age (GA), sex, maternal/paternal age, Apgar scores at 1 and 5 min, place of birth and personnel accompanying the neonate during transport (transport personnel), body temperature before transport and on admission, severity of illness, and intraventricular hemorrhage (IVH) grade. Cox regression analyses were performed to obtain principal results, and sensitivity analysis to support them. RESULTS: Systematic review: only one cross-sectional study conducted in an urban area in India was identified. That study showed that neonates with a long duration of transport had 79% higher odds of death than those transported for a short duration after adjusting for the confounding effects. For the cohort study, among 16 429 subjects, full data were available for 4966 neonates. There was strong evidence that those transported for >90 min had more than twice the rate of neonatal death (rate ratio [RR] 2.26, 95% confidence interval [CI]: 1.26-4.04), and some evidence that those transported for between 60 and 89 min had an 80% higher rate of neonatal death (RR 1.81, 95%CI: 1.07-3.06), both compared with those transported for between 30 and 59 min, after adjusting for the confounding effects. A sensitivity analysis on missing values also supported the results. CONCLUSION: There is evidence of an association between duration of transport and increased neonatal mortality, which can be applied to organization of perinatal health services. A prospective cohort study is needed for further investigation.     

Persistent neonatal mortality despite improved under-five survival: a retrospective cohort study in northern Vietnam

AIM: To examine trends in neonatal, infant and under-five mortality rates in a northern Vietnamese district during 1970-2000, and to analyze socioeconomic differences in child survival over time. METHODS: Retrospective interviews with all women aged 15-54 years in Bavi district in Northern Vietnam (n = 14 329) were conducted. Of these women, 13 943 had been pregnant, giving birth to 26 796 children during 1970-2000. RESULTS: There was a dramatic reduction in infant and under-five mortality rate (47%) over time. However, the neonatal mortality rate (NMR) showed a very small reduction, thus causing its proportion of the total child mortality to increase. Mortality trends followed the political and socioeconomic development of Vietnam over war, peace and periods of reforms. There were no differences in under-five and neonatal mortalities associated with family economy, while differentials related to mothers' education and ethnicity were increasing. CONCLUSION: Interventions to reduce child mortality should be focused on improving neonatal care. In settings with a rapid economic growth and consequent social change, like in Vietnam, it is important that such interventions are targeted at vulnerable groups, in this case, families with low level of education and belonging to ethnic minorities.     

Early growth and childhood obesity: a historical cohort study

Objective: To investigate to what extent prenatal, early postnatal, and late postnatal growth predicts risk of childhood obesity. Methods: This was a historical cohort study of 1335 full term singletons born in southwest England in 1989. The main outcome measure was body mass index (BMI) at age 7. Absolute weights at birth, 6 weeks, and 18 months, and change in weights during the intervening periods were measured. Measures were examined as z scores standardised to the 1990 UK reference population. Results: BMI at age 7 was positively associated with z scores for weight at all ages. Regression coefficients (95% confidence intervals) were: 0.16 (0.11 to 0.22), 0.19 (0.15 to 0.24), and 0.29 (0.26 to 0.33) for weights at birth, 6 weeks, and 18 months, respectively. Regression coefficients for birth weight, early weight gain (change in weight z score between birth and 6 weeks), and late weight gain (change in weight z score between 6 weeks and 18 months), adjusted for each other were: 0.32 (0.27 to 0.38), 0.31 (0.26 to 0.37), and 0.28 (0.23 to 0.32), respectively. There was no statistical evidence for interaction among weights, weight gains, or social deprivation. Social deprivation independently predicted BMI at age 7, the major influence being weight gain after 6 weeks of life. Conclusions: These data suggest that obesity risk is acquired gradually over the perinatal and postnatal periods, instead of during a prenatal or early postnatal critical window. The association of obesity risk with social circumstances and the timing of its origin offer pointers to some underlying determinants of obesity.     

Early growth and childhood obesity: a historical cohort study.

OBJECTIVE: To investigate to what extent prenatal, early postnatal, and late postnatal growth predicts risk of childhood obesity. METHODS: This was a historical cohort study of 1335 full term singletons born in southwest England in 1989. The main outcome measure was body mass index (BMI) at age 7. Absolute weights at birth, 6 weeks, and 18 months, and change in weights during the intervening periods were measured. Measures were examined as z scores standardised to the 1990 UK reference population. RESULTS: BMI at age 7 was positively associated with z scores for weight at all ages. Regression coefficients (95% confidence intervals) were: 0.16 (0.11 to 0.22), 0.19 (0.15 to 0.24), and 0.29 (0.26 to 0.33) for weights at birth, 6 weeks, and 18 months, respectively. Regression coefficients for birth weight, early weight gain (change in weight z score between birth and 6 weeks), and late weight gain (change in weight z score between 6 weeks and 18 months), adjusted for each other were: 0.32 (0.27 to 0.38), 0.31 (0.26 to 0.37), and 0.28 (0.23 to 0.32), respectively. There was no statistical evidence for interaction among weights, weight gains, or social deprivation. Social deprivation independently predicted BMI at age 7, the major influence being weight gain after 6 weeks of life. CONCLUSIONS: These data suggest that obesity risk is acquired gradually over the perinatal and postnatal periods, instead of during a prenatal or early postnatal critical window. The association of obesity risk with social circumstances and the timing of its origin offer pointers to some underlying determinants of obesity.     

Gestational and neonatal characteristics of children with cystic fibrosis: a cohort study

OBJECTIVE: To examine whether the birth weight (BW) and the risks of being pre-term, low birth weight (LBW), and small for gestational age (SGA) of children with cystic fibrosis (CF) are different from nonaffected children. STUDY DESIGN: Retrospective cohort study. We examined all the children with CF born in Tuscany, Italy, from 1991 to 2002 (n = 70) comparing them to the entire population of non-CF-affected children born in the same period (n = 290,059). RESULTS: The mean BW of newborns with CF was 246.2 g lower than the mean BW of the non-CF neonatal population (P = .0003). Children with CF had a higher risk of being born pre-term (RR 2.62, P = .001), LBW (RR 2.66, P = .0009), and SGA (RR = 1.74, P = .04) than the non-CF-affected children. The mean BW of term newborns with CF was 205.7 g lower than that of term non-CF-affected babies (P = .0002). CONCLUSIONS: Our data show an association between CF and reduced BW and show a greater risk of being pre-term for babies with CF.     

Association between gestational anemia in different trimesters and neonatal outcomes:a retrospective longitudinal cohort study

Background Previous studies investigated the association between gestational anemia and neonatal outcomes.However,few studies explored whether the effects of ge...     

Determinants of neonatal mortality in Rural Haryana: A retrospective population based study

Objective  

To identify the determinants of neonatal mortality.     

中国新生儿协作网2019年行胎儿宫内手术和/或产前侵入性操作的极早产儿病死率的队列研究

背景：近年来我国胎儿医学发展迅速,全国各地陆续开展了各种胎儿宫内手术,但目前胎儿医学干预效果评价多基于单中心、小样本数据并局限于围产期结局,缺乏胎儿生后近期和远期预后的多中心、大样本研究。 目的：描述2019年中国新生儿协作网（CHNN）57家NICU收治的极早产儿中接受胎儿宫内手术和/或产前侵入性操作者的现状及预后。 设计：队列研究。 方法：以CHNN收录的极早产儿为队列人群,以接受胎儿宫内手术和/或产前侵入性操作（胎儿镜激光凝固术、选择性减胎术、宫内输血、体腔内积液引流术、减羊水术、羊膜腔穿刺或绒毛膜取样术）者为暴露组,采用倾向性评分的方法1∶4匹配未接受产前干预的对照组,比较两组间病死率（NICU院内、生后28 d、生后7 d）和主要并发症［严重脑损伤、严重早产儿视网膜病、支气管肺发育不良（BPD）、坏死性小肠结肠炎和败血症］发生率。 主要结局指标：病死率。 结果：2019年CHNN数据库共收治极早产儿9 520例,接受胎儿宫内手术和/或产前侵入性操作患儿共187例（2.1%）,其中选择性减胎术69例,羊膜腔穿刺或绒毛膜取样术66例,减羊水术42例,胎儿镜激光凝固术20例,宫内输血10例,体腔内积液引流术2例。暴露组极早产儿NICU全因病死率为15.5%（29/187）,其中22例死亡发生在生后7 d内;最常见的并发症为BPD（41.7%）、败血症（11.8%）和严重脑损伤（9.4%）。匹配后与对照组患儿相比,接受产前干预的极早产儿NICU全因病死率及主要并发症发生率差异无统计学意义,暴露组生后7 d内全因死亡（RR=1.69,95%CI：1.06~2.71）,早发败血症（RR=3.20,95%CI：1.28~7.99）发生风险高于对照组。 结论：CHNN 2019年NICU入院极早产儿中接受宫内手术和/或产前侵入性操作的患儿占2.1%,接受宫内手术和/或产前侵入性操作并不显著增加极早产儿NICU死亡或并发症的发生率。     

Change in neonatal care pattern and neonatal mortality in a rural medical college

Due to the nonavailability of separate nursing staff for a special care neonatal unit in a rural medical college, the strategy for neonatal care of high risk babies was changed from January 1, 1985 onwards. These babies were managed mainly in postnatal wards with emphasis on maternal involvement reinforced by day-to-day orientation of mothers, nurses, and doctors to neonatal care. The incidence of fullterm (FT), preterm (PT), and low birthweight (LBW) babies were comparable in 1984 and 1985. The overall neonatal mortality (NM) was 8.3% in 1984 and 4.3% in 1985, NM in PT was 50.8% in 1984 and 30.0% in 1985, and NM in LBW was 17.0% in 1984 and 9.3% in 1985. These rates were reduced by approximately 40-50% of that recorded in 1984. The difference in all groups was statistically significant. However, the NM in the VLBW (1500 g) did not change substantially. Deaths due to severe asphyxia and intraventricular hemorrhage were reduced from 4.03% of all livebirths in 1984 to 2.2%, the difference being statistically significant. The most significant reeducation was seen in deaths due to infection which dropped from 2.45% of total livebirths in 1984 to 0.88% of the total in 1985. With this experience, the authors recommend the measures adopted by them to reduce the NM, especially in small centers and rural areas where nursing and other facilities are not optimal.     

Lactate dehydrogenase as an indicator of severe illness in neonatal intensive care patients: a longitudinal cohort study

Aim: Lactate dehydrogenase (LDH) increases in several critical conditions that cause cell damage and could potentially be used for early detection of serious illness in the newborn. Our aim was to investigate the relationship between the early clinical course of NICU infants and LDH in plasma at admission. Methods: LDH was measured in a cohort of patients consecutively admitted to a major NICU in Hanoi. The infants were classified as ‘obviously needing intensive care during the first week’ (n = 83) or ‘not receiving intensive care measures during the first week’ (n = 260) by a senior neonatologist blinded to the LDH and lactate activity. Results: LDH differed significantly between the groups in infants born after 32 gestational weeks. LDH differed with the vitality of the patient (F = 26.25, p < 0.0001) at admittance and correlated with lactate (R = 0.496, p < 0.0001). Also, the predictive value for obvious need of intensive care was higher for LDH than for lactate assessed by area under the curve calculated with ROC-curves [0.82 (0.77–0.88) vs. 0.67 (0.60–0.75)]. Conclusion: There is a strong relationship between bad clinical condition of infants during first week of life and elevated plasma LDH. The results suggest that LDH might be a valuable support in decision making in the neonatal period.