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Changes in infant morbidity associated with decreases in neonatal mortality.

Neonatal mortality and morbidity among infants surviving to 1 year of age in eight geographic areas have been compared to determine whether recent decreases in mortality have affected the risk of infants having congenital anomalies or developmental delay. Mortality was obtained from birth and death records in 1976 and either 1978 or 1979; morbidity through home interviews with mothers of random samples of infants and developmental observations on the children. It is concluded that the decrease in mortality was not offset by increases in children with defects. Neonatal mortality decreased by 18% in this 2- to 3-year period; risk of congenital anomalies or developmental delay (all types combined) declined by 16% among the surviving infants. The reduction in risk was concentrated in the minor congenital anomalies or developmental delay category; the proportion of children with severe or moderate congenital anomalies or developmental delay did not change. Decreases occurred at every birth weight including the very low birth weights of 1,500 g or less, a subgroup with especially high mortality and morbidity resulting from perinatal events.

Birth Weight

The use of logit models to investigate social and biological factors in infant mortality. III. Neonatal mortality.

Infant mortality data for England and Wales, cross-classified by mother's age, parity and social class have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular analysis. This paper develops the methodology from an earlier paper by Murrells et al. to the analysis of the neonatal data.

Adolescent

Neonatal mortality in infants born weighing 501 to 1000 grams. The influence of changes in birth weight distribution and birth weight-specific mortality rates on neonatal survival.

We analyzed changes over time in neonatal mortality rates for infants born weighing 501 to 1000 gm. The decline in total mortality in this weight group due to improved small-group, birth weight-specific mortality was contrasted to the increase in mortality caused by changes in the birth weight distribution resulting from the care of smaller infants. Had the birth weight distribution remained unchanged, the total improvement in neonatal mortality for the entire 501 to 1000 gm group would have been substantially greater.

Alabama

Infant mortality in Macaca mulatta: neonatal and post-neonatal mortality at the California Primate Research Center, 1968-1972. A retrospective study.

Seven hundred forty-two Macaca mulatta births were recorded at the California Primate Research Center, 1968-1972. The neonatal mortality rate (deaths smaller than or equal to 30 days of age) was 10.8%, and the post-neonatal mortality rate (deaths at 31-183 days) was 6.9%. The neonatal mortality rate was higher in outdoor group cages than in indoor individual cages (24.8 vs. 8.0%). The post-neonatal mortality rate was also higher outdoors than indoors (15.9 vs. 5.9%). Outdoor mortality showed apparent seasonal variation, while indoor mortality did not.

Age Factors

[Clinico-statistical features of perinatal and early neonatal mortality].

Perinatal and neonatal mortality rates are considered to be among the most sensitive measures available for monitoring the health of population and consequently have been assumed, too, to reflect primarily the capacity of the obstetricians and pediatricians. Perinatal mortality is here defined as stillbirths (or late fetal deaths) plus early neonatal deaths, that is, it includes fetuses born dead after 28 completed weeks of pregnancy and liveborn infants who died before the completion of the first week after birth. This report is concerned with the variation in neonatal mortality observed at the Istituto Clinico di Puericultura, Bologna University in a period from 1971 to 1981 and in perinatal mortality from 1976 to 1981 only. In this period reductions in stillbirths (from 12.5% to 7.8%) and early neonatal mortality (from 13.2% to 7.0%) are recorded. The decrease in the perinatal mortality rate, which occurred at the Obstretic-Neonatal Unit of Bologna University (dropping from 25.6% in 1976 to 14.8% in 1981) may be attributed to a comparable reduction in stillbirths and early neonatal mortality due to better health services and a more modern pattern of medical care. More attention must be given to that particular group of newborn babies weighing 1,500 gm or less (VLBW Infants) which accounted for about 40% of all the neonatal deaths.

Female

Importance of using standardized birth weight increments to report neonatal mortality data.

Neonatal mortality statistics are frequently reported in 100-g increments of birth weight. We tabulated our mortality statistics using two methods of incrementation: 500 to 599 g, 600 to 699 g, 700 to 799 g, etc. (method A) and 501 to 600 g, 601 to 700 g, 701 to 800 g, etc (method B). In each 100-g weight group, the mortality was less using method B. The average reduction in mortality using method B was 4.1%. Use of the two different methods creates difficulty in making meaningful comparisons of various published reports. We recommend that all future studies use method A, as that method is more consistent with previous recommendations of the World Health Organization.

Birth Weight

Influence of admission weight on neonatal mortality amongst hospitalised neonates in Calcutta.

The study was conducted on 785 neonates aged up to 28 days to evaluate the influence of admission weight on mortality. It was observed that there were 200 (25.5%) cases of septicaemia, 134(17.1%) of diarrhoea, 120(15.3%) each of prematurity related conditions and neonatal jaundice, 117(14.9%) of respiratory diseases and 94 (11.9%) cases of convulsion. There were total 182(23.18%) deaths comprising 70(38.5%) from prematurity related conditions, 40(22%) from diarrhoea, 35(19.2%) from respiratory diseases, 26(14.3%) from septicaemia, 8(4.4%) from neonatal jaundice and 3(1.6%) deaths from convulsion. The incidence of deaths among neonates weighing less than 2500 g on admission was 59.2% in diarrhoeal diseases, 53.4% in respiratory diseases and 44.6% in other conditions compared to those of 10%, 8.2% and 7.1% respectively in neonates having admission weight more than 2500 g. The findings are statistically significant. The results of the study indicate that low admission weight should be considered as a predictor of mortality among neonates.

Body Weight

Asian neonatal mortality in Blackburn.

Neonatal mortality among Asian and non-Asian babies in Blackburn was determined for 1982-84. Though Asian mothers have more low birthweight babies, proportionately fewer babies require intensive care. Preterm delivery and asphyxia were not major factors in neonatal mortality among Asian babies, most deaths being due to lethal congenital malformations.

Asia

Comparison of neonatal mortality rates between transports to tertiary and intermediate neonatal intensive care units.

The differential of neonatal mortality rates between infant transports to tertiary and to intermediate neonatal intensive care units (NICUs) was examined based on 8,391 one-time infant transports from community hospitals to tertiary or intermediate NICUs in Southern California in the three-year period 1981-1983. Among the demographic, birth and delivery, and diagnostic characteristics studied, nine were identified to be related significantly to the higher neonatal mortality rate among transports to tertiary NICUs: birthweight, gestational age, necessity of intubation, multiple clinical conditions, presence of cardiac, neurologic, and genitourinary problems, anomalies, and syndromes. Adjusting for differences in the number of cases with necessity of intubation and the presence of the five clinical problems reduced the neonatal mortality ratio of tertiary to intermediate NICUs from 1:56 to 1:01, while adjustment for birthweight and gestational age differences reduced the ratio from 1.56 to 1.54. This analysis indicates that the difference of neonatal mortality between the two levels of NICUs can be explained to a larger extent by the higher proportion of infants requiring intubation with serious clinical problems. Birthweight and gestational age played only a minor role in this respect.

Apgar Score

Neonatal deaths in Alabama. II. Policy and research implications derived from a comparison of birth weight-specific state and medical center neonatal mortality rates.

An analysis of Alabama's recent neonatal mortality rate was performed to answer questions pertaining to projected changes in the neonatal mortality rate in the next decade. With current technology these questions include: (1) Can the current decline in the neonatal mortality rate continue? (2) Which infants not now surviving are potentially able to be saved? (3) What types of new programs may further reduce the neonatal mortality rate? (4) For which infants may research provide technology leading to further reductions in the neonatal mortality rate? In this analysis, birth weight-specific neonatal mortality rates for Alabama were compared with the lowest birth rate-specific neonatal mortality rates achieved in perinatal centers. Specific causes of neonatal death for each birth weight group were determined. Data suggest that 20% of current neonatal deaths would be preventable with available technology through expanded regionalization of perinatal care for infants born weighing less than 2,500 gm. Since lethal congenital anomalies cause the majority of neonatal deaths in infants born weighing greater than 2,499 gm, there is apparently little room for an improved neonatal mortality rate in this group. Without successful research leading to a reduction in preterm delivery rates, a reduction in lethal congenital anomalies or better survival of low-birth weight infants. Alabama's neonatal mortality rate is likely to level off at five to six per 1,000.

Alabama

Neonatal mortality clusters: a new tool for classifying neonatal outcomes.

BACKGROUND: A method for assessing general hospital neonatal care performance is needed that is simple, is easy to use, and requires minimal data. METHODS: All neonatal deaths in Washington State obstetric hospitals from 1980 to 1983 were assigned to 10 mutually exclusive neonatal mortality clusters, a new classification method derived from information available on the death certificate. RESULTS: More than one-third (35.3 percent) of all neonatal deaths fell within one of the seven clusters considered to represent potentially preventable causes of death. The rate of possibly preventable deaths was much higher in level III hospitals than in level II or level I hospitals, a finding similar to that observed in other states using different analytic approaches. CONCLUSIONS: Neonatal mortality clusters offer a less complex method of classifying neonatal deaths and assessing hospital performance than other currently used techniques.

Birth Weight

Proportionality of small for gestational age babies as a predictor of neonatal mortality and morbidity.

Neonatal mortality and morbidity of 2609 babies who weighed less than the fifth centile for gestational age were studied in order to evaluate the relationship between the type of intrauterine growth retardation and the short-term prognosis after birth. Of these babies, 1175 had both a birthweight and head circumference below the fifth centile ('proportionately small'); the others, whose body weight was below but head circumference above the fifth centile, were defined as 'disproportionately small'. The former group showed a consistently higher risk of death during the neonatal period. Morbidity defined by birth asphyxia, respiratory distress and neonatal infections was higher in those proportionately small babies who were delivered at term. The picture reversed for hyperbilirubinaemia, which was more frequent among disproportionately small babies. Proportionality, defined on the basis of the correspondence between birthweight and head circumference centiles, appears to be a simple and non-invasive clinical method to identify babies who are at higher risk of adverse outcome.

Asphyxia Neonatorum

Lethal congenital anomalies as a cause of birth-weight-specific neonatal mortality.

The percentage of neonatal mortality caused by lethal congenital anomalies and the distribution of specific anomalies in various birth-weight groups are presented. State vital statistics data and autopsy-confirmed data from a single hospital are compared. Of neonates who died, less than 5% who were born weighing between 500 and 999 g died of a congenital anomaly, and nearly 45% who were born weighing more than 2,500 g died of a congenital anomaly. Most deaths associated with congenital anomalies in infants born weighing more than 2,500 g are cardiac in origin. Twenty-three percent of all neonatal deaths in Alabama are attributed to a lethal congenital anomaly. Use of these data to define limits to future improvements in neonatal mortality by standard medical care is discussed.

Abnormalities, Multiple

Determinants of the neonatal mortality.

A recent sharp decline in the neonatal mortality in our medical center prompted a critical analysis of viral statistics of the newborn service during the years 1966 through 1973. The mean neonatal mortality for the entire period was 15.4 per 1,000 live births, and 11.0 in the period 1972 through 1973. The annual neonatal mortalities bore a direct relationship to the annual incidences of infants with birth weights of 1,500 gm or less. The reduction in the proportion of infants in the latter weight group during 1972 through 1973 accounted for three quarters of the improvement in the neonatal mortality as compared to that of the previous years. One quarter of the improvement could be attributable to a decrease in mortality that occurred only in infants in the latter weight group during the same period.

Birth Weight

Perinatal mortality in rural India: intervention through primary health care. II Neonatal mortality.

Early neonatal mortality is unacceptably high in most developing countries. A large majority of births in rural areas of these countries occur at home, attended by relatives or traditional birth attendants and without easy access to skilled professional care. Under these circumstances cause of death has to be based on lay descriptions of terminal events. Analysis of cause of death shows that 74% of the early neonatal deaths are amenable to intervention. Admittance to hospital of the "at risk" neonates is not practicable. Intervention through primary health care can be effective if based on scientific principles and offered through female community health workers. Objectives of domiciliary care given by these workers should be to educate and guide the mother to protect the delicate newborn from the effects of adverse environmental conditions, to ensure adequate nutrition, and to prevent infections. Interventions supporting beneficial traditional cultural practices as well as simple techniques for care of the newborn are discussed.

Adult