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.     

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

This study was conducted at a rural medical college and aimed at analysis of the perinatal mortality and its determinants in a rural environment. 58 stillbirths and 62 early neonatal deaths among 1107 consecutive deliveries effected a perinatal mortality rate of 108.4/1000 deliveries. 50% of the total deliveries were unbooked. The perinatal mortality was higher in unbooked cases (16.3%), twins (33.2%), and preterm deliveries (33.9%) as compared to that in booked cases (5.3%), singletons (9.6%), and term deliveries (6.7%). 69% of the stillbirths were the result of obstructed labor, toxemia, 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 due largely to birth anoxia, intraventricular hemorrhage, aspiration, and infections.     

Newcastle survey of deaths in early childhood 1974/76, with special reference to sudden unexpected deaths. Working party for early childhood deaths in Newcastle.

All early childhood deaths within a total population of 297 000 were studied by prospective methods. 70 deaths of children aged 1 week to 5 years occurred during a 27-month period; 36 died at home, 29 suddenly and unexpectedly. An extensive standardized necropsy showed a disease process clearly or probably related to death in half the sudden unexpected deaths; in the remainder no recognized disease process was identified. The events preceding sudden unexpected death, and the child''s environment, were investigated by a controlled parental interview. Symptoms of serious illness within 24 hours of death were identified in 9 of the 29 children, but in the majority symptoms were thought to have been absent or no more severe than those of the control children. Most children with major symptoms had been seen by a doctor within a few days of death. The two most striking social findings were that 16 of the 29 sudden unexpected deaths occurred at a weekend or bank holiday, and that 45% occurred in three adjacent city wards which contain only 13% of the under-five study population. The additional support and explanation provided during the home visits was greatly appreciated by the bereaved families.     

Effect of birth order on neonatal morbidity and mortality among very low birthweight twins: a population based study

OBJECTIVE: To study the effect of birth order on the risk for respiratory distress syndrome (RDS), chronic lung disease (CLD), adverse neurological findings, and death in very low birthweight (VLBW; < 1500 g) twins. METHODS: A population based study of VLBW infants from the Israel National VLBW Infant Database. The sample included all complete sets of VLBW twin pairs admitted to all 28 neonatal intensive care units between 1995 and 1999. Outcome variables were compared by birth order and stratified by mode of delivery and gestational age, using General Estimating Equation models, with results expressed as odds ratio (OR) with 95% confidence interval (CI). RESULTS: Second twins were at increased risk for RDS (OR 1.51, 95% CI 1.29 to 1.76), CLD (OR 1.36, 95% CI 1.11 to 1.66), and death (OR 1.24, 95% CI 1.02 to 1.51) but not for adverse neurological findings (OR 1.20, 95% CI 0.91 to 1.60). Mode of delivery did not significantly influence outcome. The odds ratio for RDS in the second twin was inversely related to gestational age, and the increased risk for RDS and CLD was found in both vaginal and caesarean deliveries. CONCLUSIONS: VLBW second twins are at increased risk for acute and chronic lung disease and neonatal mortality, irrespective of mode of delivery.     

On the unpredictable development of congenital cytomegalovirus infection. A study in twins

Two cases of congenital cytomegalovirus (CMV) infection in twins are reported. In addition, congenital CMV infection in twin pairs described in the literature is reviewed. The relationship of monochorionic vs. dichorionic placentas and monozygosity vs. dizygosity in the development of congenital infection in either one or both members in a pair of twins is discussed.     

The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy. A Norwegian register based study

Aims

To examine the effects of multiple risk factors on cerebral palsy (CP).

Materials/methods

For 176,591 Norwegian infants born 1996-98 and surviving the early neonatal period, data on a number of potential pre- and perinatal risk factors (RFs) for CP were available in the Medical Birth Registry of Norway. For 241 children with CP detailed clinical data were available in the Norwegian CP registry.

Results

In children born at term, 31% had no RF, and none had five or more, while in children born preterm, 9% had no RF in addition to prematurity (p < 0.001 vs. term), and 5% had five or more (p < 0.02 vs. term). In both groups, few children shared the same combination of RFs. Interdependent sequences were more often observed among children born preterm than at term (p < 0.001 vs. term). The most detrimental effect was observed for the combination of maternal disease and low 5-min Apgar score, registered in 11.2% of children with CP. The combination of maternal disease and premature birth had an interaction contrast ratio of 9.25 (CI: 3.56; 14.94), which may be consistent with biological interaction.

Conclusions

The majority of children with CP born at term most likely had an antenatal or single cause, suggesting individual susceptibility to an injury. The majority of children born preterm, had combinations or sequences of antenatal and perinatal risk factors as the most likely cause of CP.     

Circumstances surrounding the deaths of children due to asthma. A case-control study

Features of the courses in 12 children who died of an acute attack of asthma were compared with those in 12 children of comparable age and sex who had a life-threatening attack of asthma but survived. Information obtained by structured interviews with the families and physicians and from the medical records was used to characterize (1) the patient, family, severity, and treatment of asthma primarily in the 6 months before the attack and (2) medical circumstances and patient characteristics present on the day of and/or during the acute episode. Patients in the study (mean age, 14.1 years) and controls (mean age, 13.8 years) were in early to late adolescence, had similar long-term medication use histories and an overall rating of the severity of asthma. For the analysis of the information concerning the 6 months before the attacks, the study patients had a greater frequency of respiratory failure requiring intubation, a decrease in steroid use in the month before the attack, history of family disturbance, abnormal reaction to separation or loss, and expressed hopelessness and despair. For the period more immediately surrounding the acute attack, study patients more often had attacks starting during sleep, but less frequently experienced vomiting during the course of the attacks. Treatment of the attack by the parents was poor (primarily because of delays) in 7 of the 12 children who died, but was also a factor in 6 of the 12 controls. Our data suggest that certain characteristics of asthmatic children may place them at greater risk for death due to their asthma. In addition, we postulate that there may be inherent differences in the mechanisms of the acute attacks between the children who died and those who survived.     

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

Objective  

To identify the determinants of neonatal mortality.     

A prospective study of urinary proteins in early infancy.

Urinary concentrations of protein, albumin, beta 2-microglobulin, alpha-amino nitrogen, and creatinine were determined in forty-one full-term infants on seven occasions up to six months of age. Except for beta 2-microglobulin the concentrations were highest on the first day, followed by a rapid decrease to a constant level within two weeks. Protein diminished approximately seven-fold, albumin twenty-fold, alpha-amino nitrogen three-fold and creatinine five-fold. By contrast, beta 2-microglobulin, a low molecular weight protein, first increased three-fold between day 1 and day 5, thereafter decreasing slowly 17-fold during the first three months of age. The data indicate that different kidney functions mature asynchronously.     

Two-year study of the causes of postperinatal deaths classified in terms of preventability.

A detailed pathological and psychosocial study was made of all postperinatal (8 days-2 years) deaths in Sheffield during a 2-year period. The cause of death was classified from the point of view of possible prevention. Of the total of 65 deaths, 35 were unpreventable after the perinatal period, but 9 might have been preventable before birth. Of the 30 other deaths, 20 had evidence of possible treatable disease, and for the majority of these adverse social factors could be identified. Proved non-accidental injury occurred in 2 children and in 3 others there was a high degree of suspicion of ''gentle battering''. Only in 4 children was death unexplained and this apparently represents the local true unexplained cot death rate of 0.16/1000 births.     

Infant mortality in southern Brazil: a population based study of causes of death.

The causes of 215 infant deaths occurring in a population based cohort of 5914 infants from southern Brazil were determined. Perinatal problems were responsible for 43% of these deaths and infectious diseases for 32%. In the group who died of infectious diseases, respiratory infections and diarrhoea were equally important, each accounting for 12% of all deaths. A total of 87% of the deaths occurred in the first six months of life, and this proportion remained high (77%) even after perinatal causes had been excluded. On the other hand, 53% of the infants who died were of low birth weight, as opposed to 7.9% of the survivors. This suggests that low birthweight infants need to be carefully followed by health workers at primary level, especially during the first six months. It was estimated that if the incidence of low birth weight was reduced from the present 8.8% to 5% the likely reduction in infant mortality would be 20%. This reduction would be 33% for deaths due to perinatal causes, 14% for respiratory infections, and only 5% for diarrhoea. Efforts for the prevention of infant deaths in southern Brazil are more likely to be effective if they concentrate on improving perinatal health care and environmental conditions.     

A follow-up study of the effects of early malnutrition on subsequent development. II. Fine motor skills in adolescence

One hundred nine children, aged 8 through 15 yr, who suffered from malnutrition in the 1st yr of life and 107 well-nourished comparison children were tested for fine motor skills by the Purdue Pegboard test. The performance of index children was impaired on three of the four test measures. IQ measured concurrently showed a reduction in the index group; when the effects of IQ were eliminated, there was no longer any significant difference between index and comparison groups. The data suggest that the effects of early malnutrition on Pegboard performance are largely mediated by deficits in IQ. The presence of soft neurologic signs measured 4 yr earlier in the same children was highly correlated with reduced Pegboard performance, implying that early malnutrition has effects on nervous system function that are evident at least through 15 yr of age.     

The applicability of immunohistochemistry in the diagnosis and differential diagnosis of malignant soft tissue tumors. A reevaluation based on the material of the Kiel Pediatric Tumor Registry

The diagnosis and differential diagnosis of malignant soft tissue tumors not infrequently poses great difficulties, especially in those cases which lack any feature of differentiation by conventional light microscopy. These difficulties have been partially resolved through the application of ultrastructural investigations. Recently considerable progress has been achieved using immunohistochemistry. At the Kiel Pediatric Tumor Registry we were able to reduce the percentage of unclassified soft tissue sarcomas from 17.6% in 1982 to 4.5% in 1989. Particularly useful were antibodies against the different types of intermediate filaments, muscle-specific actin, myoglobin, and the neural markers neuron-specific enolase and protein S-100. In contrast to the expected immunophenotype rhabdomyosarcomas, malignant peripheral neuroectodermal tumors and malignant schwannomas showed expression of cytokeratins. Moreover, in many cases rhabdomyosarcomas and synovial sarcomas expressed neural markers. Ewing's sarcoma and malignant peripheral neuroectodermal tumor are histogenetically related, but differ in grade of neural differentiation. In all soft tissue sarcomas immunohistochemistry is very useful to obtain information on the cellular heterogeneity. Despite the great achievements not every soft tissue sarcoma can be diagnosed with certainty. There will always be a baseline of unclassified cases due to problems which are not caused by the tumor itself but rather by diagnostic circumstances.