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PubMed1985

The risk of low birth weight. Alternative models of neonatal mortality.

The authors examine the use of the infant's weight at birth to estimate its risk of mortality by the 28th day of life. The performance of several commonly employed statistical models is compared for the population of single births to resident South Carolina mothers in 1975-1980. A log-linear function, fitting the natural logarithm of the probability of neonatal mortality to birth weight, performs far better in this analysis than a quadratic or a logistic model or a model using the logarithm of the probability of survival. The parsimonious log-linear model also appears preferable to more complex models with additional parameters. The authors use the model in an analysis of data in two-year periods to demonstrate its value as an indicator of underlying changes in neonatal prospects and its easily interpreted parameters. The results highlight the importance of changes in neonatal mortality affecting low birth weight infants, which produce a noticeable shift in the range in which low birth weight is associated with the risk of mortality. These have proven more important in accounting for the decline in mortality rates than have changes affecting only neonates with more typical birth weights in South Carolina in 1975-1980.

Birth Certificates↗

PubMedDate not supplied

Reducing neonatal mortality rate with nurse-midwives.

Newborn health indices were measured before, during, and after a demonstration nurse-midwife program introduced to relieve a health manpower shortage at a county hospital in rural California. During the program, prenatal care increased, and prematurity and neonatal mortality rate decreased at the county hospital. After the 3 year program, prenatal care decreased while prematurity rose from 6.6 to 9.8 per cent (p<0.02) and neonatal mortality rate rose from 10.3 to 32.1 per 1,000 live births (p<0.005). No significant changes occurred in the same indices for births elsewhere in the county throughout the period of the study. It is concluded that the discontinuation of the nurse-midwives' services was the major factor in these changes, and it is suggested that nurse-midwives be used more extensively.

California↗

PubMed1986

Assessment of peri-neonatal mortality and morbidity risk in twin pregnancy.

A case control study on peri-neonatal mortality and morbidity rates in 154 twin pregnancies has been performed. The mortality rates along with main neonatal morbidity factors were evaluated in relation to the birth weight and gestational age. The risk of death in peri-neonatal period was 17 times greater (relative risk 17.30) (p less than .00005) in newborns weighing less than 2000 g and about 15 times (r.r. 14.53) (p less than .00005) in twins born before 34th week of gestational age with respect to the controls. The Apgar score of the 2nd twin was lower than that of the 1st, both at 1' (p less than .05) and 5' (p less than .025). The development of HMD was strongly influenced by the gestational age when less than 34th week (r.r. 15.89) (p less than .00005). No difference in incidence was found between the newborns with gestational age between 34-37 weeks and those at term. The potential implications of these findings on obstetric and neonatologic treatment of LBW and VLBW twins was discussed.

Delivery, Obstetric↗

PubMed1986

Neonatal mortality risk in relation to gestational age and birthweight. Results of a national survey of preterm and very-low-birthweight infants in the Netherlands.

In a cohort of 1338 very preterm and/or very-low-birthweight infants, representing 94% of all infants born alive after less than 32 weeks' gestation or weighing less than 1500 g in the Netherlands in 1983, the neonatal mortality rate was 233 per 1000. In these infants, the best obstetric estimate of gestational age was a better predictor of neonatal mortality than birthweight. In such pregnancies, careful obstetric assessment of gestational age seems to be a more accurate basis for clinical decisions and management than the expected birthweight.

Birth Weight↗

PubMedDate not supplied

Determinants of neonatal mortality at Wesley Guild Hospital, Ilesa, Nigeria.

BACKGROUND: More than 10 million under five children die each year of preventable and easily treatable conditions in developing countries. Of these, eight million are infants, half of whom are newborns in their first month of life. A high proportion of babies die in their first month of life, many of them during their first week. The objective of this study is to assess sociodemographic and other determinants of neonatal mortality in Wesley Guild Hospital (WGH), Ilesa, Nigeria. METHODS: This is a record review of 235 neonatal deaths reported at WGH from January 01 2001 to December 31 2003. Similarly, records of equal number of neonates (235) admitted to the same hospital during the same period but who were discharged alive was also reviewed for comparison. Four hundred and seventy records were reviewed. The two groups were matched for age, sex and within a 7-day period of admission. Information was collected with the aid of predesigned schedule from the patients' case notes, death registers and discharge summaries in the Records Department of the hospital. Information collected included the bio-data of the mothers, birth weight of neonates, estimated gestational age at delivery, age at death or discharge, date of admission, duration of the illness and date of discharge. Others included mode and place of delivery, maternal booking status and complications of pregnancy and birth. Data were analyzed using descriptive and inferential statistics by computer software, Epi-Info 2002. RESULTS: Teenage pregnancy, low birth weights (LBW), prematurity and neonatal tetanus were positively associated with neonatal death. Unbooked mothers, deliveries at missions and homes and low socioeconomic status were also positively associated with neonatal death (P < 0.05 in all cases). There was no statistically significant association between the sex of neonate, parity of mother and complications in pregnancy with neonatal death (P > 0.05 in all cases). CONCLUSION: The major determinants of neonatal deaths were teenage pregnancy, prematurity, LBW, poverty and lack of skilled attendance at delivery. Addressing the basic determinants of neonatal mortality will improve newborn survival and health and this will significantly reduce mortality among under five children in developing countries.

Adolescent↗

PubMedDate not supplied

Respiratory distress and neonatal mortality in infants of diabetic and prediabetic mothers.

The 149 live births of 19 insulin-dependent diabetic mothers and 62 prediabetic mothers between 1940 and 1970 were reviewed. The frequency of respiratory distress was 31% in infants of diabetic mothers, 2.6% in infants of prediabetic mothers, and 0.46% in all infants born at the same hospital during the same period. Neonatal mortality during the first month of life was 14% in the infants of diabetic mothers and 3.5% in the infants of prediabetic mothers. Both these rates for neonatal mortality are higher than those reported for live births in the United States and Minnesota between 1950 and 1965. Of the deaths in both groups combined, 77% occurred in the first 3 days of life in infants diagnosed as having respiratory distress. Birth weight and prematurity, gestational age, and toxemia were associated with an increased frequency of respiratory distress in the infants of prediabetic mothers, whereas gestational age, mode of delivery, and weight gain during pregnancy were so associated in infants of insulin-dependent diabetic mothers.

Body Weight↗

PubMed1998

[Neonatal mortality in the Tantigou pediatric hospital, Dapaong (north Togo) in 1984-1985 and 1994-1995].

370 deaths out of 1141 hospitalized cases of newborns aged 0-28 days were retrospectively analyzed in the Tantigou pediatric hospital of Dapaong, situated 645 km from Lome in northern Togo, in 1984-1985 and 1994-1995. A decreasing trend in neonatal mortality was noted: 42.5% and 27.6% respectively. Major causes of death were prematurity or low birth weight, sepsis, hypoxia conditions. The attendance of pregnant women at health information centres seems to be improving, but the neonatal mortality rate remaining high, the implementation of primary health care/Bamako Initiative resulting especially aiming at better prenatal care for pregnant women must be sustained.

Asphyxia Neonatorum↗

PubMed2006

Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial.

BACKGROUND: Omphalitis contributes to neonatal morbidity and mortality in developing countries. Umbilical cord cleansing with antiseptics might reduce infection and mortality risk, but has not been rigorously investigated. METHODS: In our community-based, cluster-randomised trial, 413 communities in Sarlahi, Nepal, were randomly assigned to one of three cord-care regimens. 4934 infants were assigned to 4.0% chlorhexidine, 5107 to cleansing with soap and water, and 5082 to dry cord care. In intervention clusters, the newborn cord was cleansed in the home on days 1-4, 6, 8, and 10. In all clusters, the cord was examined for signs of infection (pus, redness, or swelling) on these visits and in follow-up visits on days 12, 14, 21, and 28. Incidence of omphalitis was defined under three sign-based algorithms, with increasing severity. Infant vital status was recorded for 28 completed days. The primary outcomes were incidence of neonatal omphalitis and neonatal mortality. Analysis was by intention-to-treat. This trial is registered with , number NCT00109616. FINDINGS: Frequency of omphalitis by all three definitions was reduced significantly in the chlorhexidine group. Severe omphalitis in chlorhexidine clusters was reduced by 75% (incidence rate ratio 0.25, 95% CI 0.12-0.53; 13 infections/4839 neonatal periods) compared with dry cord-care clusters (52/4930). Neonatal mortality was 24% lower in the chlorhexidine group (relative risk 0.76 [95% CI 0.55-1.04]) than in the dry cord care group. In infants enrolled within the first 24 h, mortality was significantly reduced by 34% in the chlorhexidine group (0.66 [0.46-0.95]). Soap and water did not reduce infection or mortality risk. INTERPRETATION: Recommendations for dry cord care should be reconsidered on the basis of these findings that early antisepsis with chlorhexidine of the umbilical cord reduces local cord infections and overall neonatal mortality.

Administration, Topical↗

PubMed1996

[The use of the "linkage" technique of information systems in cohort studies on neonatal mortality].

The utilization of record linkage of the mortality and birth information systems in studies of neonatal mortality is presented. The record linkage was used to obtain a cohort of live births and neonatal deaths in Santo André county, located within greater S. Paulo, in 1992. The procedures applied in order to avoid selection and effect biases, are discussed. The use of linked data allows the probabilities of neonatal deaths according to the exposure status of the variables which are registered on the birth certificate, and the identification of the live born at risk, to be calculated. Another advantage of the record linkage is the low financial cost of this type of study, because it uses information already registered.

Birth Certificates↗

PubMed1997

The effect of mode of delivery on neonatal mortality in very low birthweight infants born in Victoria, Australia: Caesarean section is associated with increased survival in breech-presenting, but not vertex-presenting, infants.

To determine whether the improved survival of very low birthweight (VLBW) infants (< 1500 g) born in Australia can be attributed to currently high rates of Caesarean section, we examined the associations between neonatal mortality and Caesarean section in singleton liveborn VLBW infants (500-1499 g) born during 1986-93 in Victoria, Australia, using data from the Victorian Perinatal Collection Unit. The infants included in this study had completed > 23 weeks of gestation, had no life-threatening malformations and had not been delivered by a repeat Caesarean without a trial of labour (n = 2763). For infants weighing 500-749 g, 750-999 g, 1000-1249 g and 1250-1499 g, the neonatal mortality rates were 56.1%, 25.7%, 13.0% and 4.3% respectively, and the Caesarean section rates were 33.1%, 42.3%, 54.8% and 55.8%. Nearly half of these births (n = 1269) were associated with one or more obstetric indications for Caesarean section (non-breech malpresentation, fetal distress, prolapsed cord, placenta praevia, pre-eclampsia and hypertension). Overall, the odds ratio (OR) for neonatal death associated with Caesarean section was 0.92 [95% confidence interval 0.60-1.41], after adjustment for gestational age, birthweight, year of birth, type of hospital, presence or absence of labour, presentation and obstetric indications for Caesarean section. However, when the vertex-presenting (n = 1702) and breech-presenting (n = 746) infants were considered separately, the adjusted ORs for neonatal death were 1.98 [0.96-4.10] and 0.52 [0.29-0.96] respectively. For those infants without obstetric indications for Caesarean section, the adjusted ORs for neonatal death in vertex-presenting (n = 950) and breech-presenting (n = 446) infants were 3.80 [1.11-13.0] and 0.47 [0.23-0.6]. These recent population-based data support the view that Caesarean section does not enhance the neonatal survival of VLBW babies when obstetric complications are absent.

Birth Weight↗

PubMed1995

Birthweight, preterm births and neonatal mortality in Belgium and the United States.

Belgium is known to have a lesser low birthweight rate and a lower infant mortality rate than the United States. We used previously unpublished data to show that beneath this comparison lies a more complicated picture. Singleton live birth certificates for 1986-87 were analysed. Despite a lower mean birthweight in Belgium (3360 g) than in the United States (3420 g), Belgium had fewer (4.9%) low birthweight infants than the US (5.9%) because of fewer preterm births (4.4 vs. 9.3%). Consistent with the excess of preterm births in the US, the residual distribution of birthweight was smaller in Belgium (2.2% vs. 3.1%). Whereas neonatal mortality was 4.8/1000 in Belgium and 5.6/1000 in the US, birthweight-specific neonatal mortality was higher in Belgium. The challenge for Belgium is to improve the survival of newborns regardless of their birthweight. In the US, the task is to eliminate the excess of small preterm infants.

Belgium↗

PubMed1991

[Neonatal mortality and morbidity of low birth weight premature infants (less than or equal to 1500 g)].

Neonatal mortality and morbidity were reported over a 4-yr period from 1986-1989 in premature infants weighing less than 1,500 g, 278 of whom were born in the same obstetrico-neonatal unit. Total mortality was 15%, and was higher in premature infants weighing less than 1,000 g (38%) and lower if the gestational age was greater than 27 wk. Mortality was lower in small for gestational age (SGA) infants than in appropriate for gestational age (AGA) infants (5% vs 19%, P less than 0.001), and lower in inborn babies than in outborn (12% vs 19%, P less than 0.02) but only in neonates weighing less than 1,000 g. Neonatal morbidity was mainly due to hyaline membrane disease and cerebral haemorrhage. The incidence of broncho-pulmonary dysplasia was low (4%). These results indicate that gestational age, birth weight and place of delivery play a role in mortality and morbidity in very low birth weight premature infants.

France↗

PubMedDate not supplied

[Perinatal and neonatal mortality at the Clinicas de Porto Alegre Hospital, Brazil].

OBJECTIVE: Epidemiological analysis of neonatal and perinatal mortality of 20,280 newborns alive with 500g or more and 374 stillbirths occurred at the Hospital de Clínicas de Porto Alegre from 1984 to 1990. PURPOSE: To compare two periods: A (1984-1987) with B (1988-1990), establishing a relationship between the changes occurred in the causes and the rate of mortality. METHODS: The retrospective study was done with the records of promptuaries of obstetrical and neonatal centers, and review of flow-sheets of the deaths and autopsies. RESULTS: Between 1984 to 1990, 20,280 newborns alive with 500g or more, 374 stillbirths at perinatal unit of Hospital de Clínicas de Porto Alegre were born. 258 deaths occurred, the neonatal mortality rate was 12.7 per thousand. The stillbirth rate was 18.4 per thousand. The perinatal mortality rate was 28.4 per thousand. The incidence of low birth weight (< 2,500g) was 11.2% and very low birth weight (< 1,500 g) was 1.8%, the former group had an increase incidence between 1984-1988 (A) from 1.5% to 2.2% (B). The causes of deaths were distributed as follow: a) intrauterine infections (22.4%); b) hyaline membrane disease (20.1%); c) congenital malformation (18.2%); d) asphyxia (15.5%); e) postnatal infections (9.7%). The causes of stillbirth were: a) perinatal asphyxia (38.7%); b) intrauterine infections (9%); toxemia (8.2%); d) malformation (7.4%). The period B showed changes with an increase of postnatal infections odds ration (OR) 7 (1.9-30.6) and congenital malformations OR 1.6 (0.8-3.2). It did not occurred a decrease in mortality rate for prematures below 1,500g OR 90 (61-118) in A to 54 (37-68) in B. CONCLUSIONS: The advantages in technology and human capacity were not sufficient to reduce significantly the rate of neonatal mortality.

Birth Weight↗

PubMed1990

The use of logit models to investigate social and biological factors in infant mortality. V: A multilogit analysis of stillbirths, neonatal and post-neonatal mortality.

Infant mortality data for England and Wales, cross classified by mother's age, parity and social class were published for 1949/50 and 1975. Previous analyses of these data have been based on graphical, tabular and logit models of stillbirths, neonatal and post-neonatal deaths separately. This paper summarizes the overall changes in infant mortality using a multilogit model. The model selected is illustrated by appropriate graphical presentations.

Adolescent↗

PubMed2006

Reduction in preterm delivery and neonatal mortality after the introduction of antenatal cotrimoxazole prophylaxis among HIV-infected women with low CD4 cell counts.

BACKGROUND: Cotrimoxazole prophylaxis is recommended for subgroups of human immunodeficiency virus (HIV)-infected adults and children to reduce all-cause morbidity and mortality. We investigated whether antenatal cotrimoxazole prophylaxis begun during pregnancy for HIV-infected pregnant women with low CD4 cell counts would affect birth outcomes. METHODS: Cotrimoxazole prophylaxis was introduced as a routine component of antenatal care for HIV-infected women with CD4 cell counts <200 cells/ micro L during the course of a trial of mother-to-child HIV transmission in Lusaka, Zambia. Rates of preterm delivery, low birth weight, and neonatal mortality were compared for women with low CD4 cell counts before and after its introduction. RESULTS: Among 255 women with CD4 cell counts <200 cells/ micro L, the percentage of preterm births (< or =34 weeks of gestation) was lower (odds ratio [OR], 0.49 [95% confidence interval {CI}, 0.24-0.98]) after cotrimoxazole prophylaxis was introduced than before; there was a significant decrease in neonatal mortality (9% to 0%; P=.01) and a trend toward increased birth weight ( beta =114 g [95% CI, -42 to 271 g]). In contrast, there were no significant changes in these parameters over the same time interval among women with CD4 cell counts > or =200 cells/ micro L.Conclusion. Antenatal provision of cotrimoxazole for HIV-infected pregnant women with low CD4 cell counts may have indirect benefits for neonatal health.

AIDS-Related Opportunistic Infections↗

PubMed2001

Role of score for neonatal acute physiology (SNAP) in predicting neonatal mortality.

OBJECTIVES: To assess the validity of SNAP in predicting the outcome in terms of mortality and duration of hospital stay. The study was also undertaken to evolve the best cut-off SNAP scores for predicting mortality in different individual neonatal conditions. METHODS: 295 consecutive newborn admitted to NICU during an eleven month period were evaluated with the investigations required as per the specifications of SNAP. Neonates who succumbed within 24 hours of admission and those who were shifted to the NICU for observation purposes were excluded. RESULTS: In general, SNAP correlated well with mortality; the sensitivity and specificity of SNAP score > 15 in predicting mortality were 63% and 95% respectively. The positive and negative predictive values were 72% and 92.5% respectively. Very low birth weight babies and ventilated preterm neonates had higher mortality and the best cut-off SNAP score for predicting mortality in these groups was 10. In all the other groups, SNAP score > 15 correlated well with higher mortality. By using multiple regression analysis on three variables including birth weight, gestational age and SNAP, SNAP was found to show the best correlation with mortality. On correlating SNAP with duration of hospital stay, 76.8% of the surviving neonates with SNAP < 16 stayed for < 15 days, whereas the rest stayed longer despite low SNAP. All the 9 babies with SNAP > 15 who survived stayed for > 15 days. CONCLUSIONS: SNAP is a measure of illness severity and correlates well with neonatal mortality. SNAP may assist the clinician in explaining the probable outcome and therapeutic intervention needed and the cost of treatment to the parents. SNAP scores > 10 in VLBW babies and > 15 in others are associated with higher mortality.

Female↗

PubMed1989

Predictors of foetal and neonatal mortality in Curaçao, Netherlands Antilles. A multivariate analysis.

In Curaçao a systematic and comprehensive investigation of numerous factors, potentially associated with an increased risk of foetal and neonatal mortality, was carried out in a 2-year period (1984-85). The inquiry was restricted to singleton births. Data on 205 women who experienced pregnancy loss were compared with those on 913 women who did not sustain foetal or neonatal loss. Data comprised information on maternal characteristics, clinical course of pregnancy and delivery, and neonatal characteristics. Of 130 factors measured, 14 were entered into a multivariate analysis. From the analysis 5 risk factors emerged as significant predictors of mortality: gestational age, birth weight, sex, foetal presentation and congenital anomalies. Factors such as social class, marital status, maternal age and parity were not associated with an increased risk of foetal and neonatal mortality in Curaçao.

Adult↗

PubMed1992

Differences in neonatal mortality by race, income, and prenatal care.

To determine the extent to which the social and physical environment affects the association between prenatal care and black pregnancy outcome in Chicago, we performed a stratified analysis of 1982-1983 Illinois vital records and 1980 United States census income data. Median family income of the mother's census tract was used as the ecologic variable. In very-low-income census tracts (less than $10,000 per year), 40% of blacks and 47% of whites received adequate prenatal care. There was no racial disparity in the percentage of low-birth-weight infants attributed to inadequate prenatal care among poor mothers. For mothers who resided in moderate-income areas ($20,001 to $30,000 per year), 50% of blacks and 67% of whites received adequate prenatal care. Although adequate (compared to inadequate) prenatal care was associated with improved birthweight distribution independent of community income, only in moderate-income areas was it related to black neonatal survival. For term black infants who received adequate prenatal care, residence in impoverished areas was associated with a nearly fourfold greater neonatal mortality rate (deaths per 1000 live births): 5/1000 vs 1/1000; RR = 3.8 (1.3-11.0). We conclude that place of residence is an important risk factor for black neonatal mortality.

Black or African American↗