Analysis of United States neonatal mortality statistics from 1968 to 1974, with specific reference to changing trends in major causalities.
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Black or African American↗
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Errors in neonatal mortality statistics.
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Epidemiologic Methods↗
[Neonatal respiratory distress syndrome in Switzerland--a comparison of a survey and official statistics].
A survey in all neonatal intensive care units in Switzerland showed that most children with a birth weight below 2000 g (identified in the birth statistics) are hospitalised in those units. Also comparison with the official neonatal mortality statistics shows that most neonatal deaths occur in these units. High agreement was found between diagnosis in hospitalised children and those recorded on death certificates. 40% of neonatal mortality in Switzerland are still due to neonatal respiratory distress syndrome.
Cross-Sectional Studies↗
Epidemiology of hyaline membrane disease in the United States: analysis of national mortality statistics.
National mortality statistics for hyaline membrane disease (HMD) and respiratory distress syndrome (RDS) were examined in this study for the years 1968 to 1973. Detailed data were obtained by computer analysis of magnetic tapes from the National Center for Health Statistics. During the six-year interval, HMD/RDS was determined to be the underlying cause of death in 54,064 infants or 9,010 +/- 560 (mean +/- SD) infants per year. Analysis of individual death certificates for 1968 revealed the disease to a major contributing factor in another 24%. Thus, it may be estimated that HMD was involved in the demise of nearly 12,000 neonates per year over this period. This amounts to approximately 20% of all neonatal deaths. On the basis of mortality rates, a trend toward an increased incidence of fatal HMD/RDS was established from 1968 to 1973. Deaths tend to cluster in the summer months and January-February represent the lowest months of recorded fatalities. Analysis of the age at death, reflecting time course of the disease, revealed idential patterns for 1968 to 1970. The number of deaths was found to decline exponentially between the first and fourth 24-hour periods so that 92% of all deaths occurred by 4 days of age. Boys contributed more prominently to the death totals than girls with ratios from 1.62 to 1.76. Examination of mortality rates by race suggested that black permatures have a lower incidence of fatal HMD/RDS. In addition to nationwide figures, those of individual states were compared for three years. Generally, HMD/RDS mortality rates correlated with overall neonatal mortality statistics. Exceptions were observed, however, such as Illinois where low rates for the former coexist with relatively high neonatal death rates. These data respresent the first national mortality statistics for HMD and may prove useful in planning and providing intensive neonatal care.
Black People↗
Postponed neonatal death in the premature infant.
Improved obstetrical and neonatal care has increased survival for many small premature infants. However, there remains a distinct group who die of complications later in infancy. The autopsy findings associated with these "postponed neonatal deaths" were the subject of our retrospective study of 18 premature infants (mean estimated gestational age, 28.6 +/- 0.6 weeks) who survived from 4 weeks to 4 months of age (mean, 70 +/- 11 days). All 18 infants required prolonged artificial ventilatory support and parenteral nutrition. The major findings at autopsy were similar in all cases and included bronchopulmonary dysplasia, hepatic cholestasis and fibrosis, abnormalities of endochondral ossification, and diffuse cerebral gliosis and infarction. Infection was the most common cause of death, and most of the infants died with acute bronchopneumonia. These postponed neonatal deaths, while they do not appear in standard neonatal mortality statistics, represent a problem of concern.
Bronchopulmonary Dysplasia↗
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↗
Breech births in twin pregnancy: an analysis of Apgar score and perinatal mortality from a Nigerian sample.
Perinatal mortality (PNM) rates are reported for 146 twin-1 and 192 twin-2 breech births among 622 consecutive twin pairs delivered at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Stillbirths and infants with severe asphyxia (Apgar score 1-3) were recorded in significant proportions of both first and second twin breech infants. PNM rates were 13.7% twin-1, 18.8% twin-2; corrected PNM for infants weighing 2.0 kg or more, were 9.3% and 12.4% for twin-1 and twin-2, respectively. Twin specific breech PNM decreased with increasing birthweight of first and second twin to a low optimum in the weight group 2.5-2.9 kg, and thereafter rose for both first and second twin with birthweight 3.0 kg and above. Factors such as low birthweight, breech/breech presentation, breech extraction and retained second twin breech contributed significantly to the high PNM rates. More favorable PNM rates were recorded among a limited number of breech infants delivered by primary cesarean section for breech/breech or first twin breech presentations. A liberal approach to cesarean section delivery for breech twin births, and particularly for paired breech/breech presentations is strongly advocated.
Apgar Score↗
Perinatal and neonatal mortality and morbidity in Lusaka, 1976.
A prospective study of perinatal and neonatal mortality and morbidity at the University Teaching Hospital (UTH), Lusaka for 1976 is presented. The early neonatal mortality of the babies born in hospital was 28.7 per 1000 live-births; it was 239.96 per 1000 admissions of those born outside the hospital. The still-birth rate in the hospital-born babies was 25.2 per 1000 deliveries; the perinatal mortality was 53.3 per 1000 deliveries; and the neonatal mortality in the hospital-born was 31.1 per 1000 live-births. The cause of death were asphyxia, infections could injury, respiratory distress syndrome, congenital malformation and intracranial haemmorrhage. If the perinatal and neonatal mortality and morbidity are to be reduced, much effort and co-operation of all concerned with the health of the expectant mother, and her child are required. Records of birth-weights, stillbirth, and causes of deaths in the University Teaching Hospital (UTH) for the year 1976 have been analysed. The aim is to provide a basis for future comparisons and improvement of the care given to newborns.
Female↗
Perinatal mortality statistics in Harare 1980-1989.
Perinatal and neonatal mortality rates, in the Greater Harare Maternity Unit, which showed a modest decline from 1980 to 1985, have rise dramatically since then. Half of the rise in neonatal mortality rate is due to increased numbers and an increased mortality rate in babies of birth weight less than 1001g. There is also an increase in the numbers of deaths of large babies. There is a strong case for a broad-based on-going enquiry into the reasons for such changes.
Birth Rate↗
Database use in neonatal intensive care units: success or failure.
The purpose of this national survey was to define the extent and features of database use by 445 tertiary level neonatal intensive care nurseries in the United States. Of the 305 centers responding to our survey, 78% had a database in use in 1989 and 15% planned to develop one in the future. Nurseries varied remarkably in the volume of data collected, the amount of time devoted to completing data collection forms, and the personnel involved in data collection. Although data were used primarily for statistical reports (93% of nurseries), quality assurance (73%) and research activities (61%) were also enhanced by database information. Neonatal databases were used to generate reports for the permanent medical record in 38% of centers. Satisfaction with the database was dependent on how useful the database information was to centers which collected and actually used a large volume of information. Overall, nurseries expressed a high degree of confidence in the data they collected, and 65% felt their neonatal database information could be used directly in publication of research. It was disturbing that accuracy of data was not monitored formally by the majority of nurseries. Only 27% of centers followed a routine schedule of data quality assurance, and only 53% had built in error messages for data entry. We caution all who receive database information in the form of morbidity and mortality statistics, clinical reports on patients cared for in neonatal units, and published manuscripts to be attentive to the quality of the data they consume. We feel that future database design efforts need to better address data quality control. Our findings stress the importance and need for immediate efforts to better address database quality control.
Data Collection↗
Birth weight-specific causes of infant mortality, United States, 1980.
To describe underlying causes of infant death by birth weight, we used data from the 1980 National Infant Mortality Surveillance project and aggregated International Classification of Diseases codes into seven categories: perinatal conditions, infections, congenital anomalies, injuries, sudden infant death syndrome (SIDS), other known causes, and nonspecific or unknown causes. Compared with heavier infants, infants with birth weights of 500-2,499 grams (g) are at increased risk of both neonatal and postneonatal death for virtually all causes. Sixty-two percent of neonatal deaths (under 28 days of life) were attributed to "conditions arising in the perinatal period," as defined using codes from the International Classification of Diseases. Prematurity-low birth weight and respiratory distress syndrome (RDS) were the leading causes of such deaths among infants with birth weights of 500-2,499 g, while birth trauma-hypoxia-asphyxia and other perinatal respiratory conditions were the leading causes among heavier infants. For all birth weight groups, congenital anomalies were the second leading cause, representing 27 percent of neonatal deaths. Although perinatal conditions caused nearly one-third of postneonatal deaths (28 days to under 1 year of life) among infants with birth weights of 500-1,499 g, for the other birth weight groups these conditions were much less important; predominant causes of postneonatal death were sudden infant death syndrome (SIDS), congenital anomalies, infections, and injuries. Black infants had a roughly twofold higher risk of neonatal and postneonatal death than did white infants for all causes except congenital anomalies, which occurred with almost equal frequency in blacks and whites. However, for infants with birth weights of 500-2,499 g, blacks had lower risks of neonatal death from RDS and congenital anomalies. Between 1960 (the latest year for which national birth weight-specific mortality statistics had been available) and 1980, SIDS emerged as a major diagnostic rubric. Otherwise, except for infections and congenital anomalies among infants with birth weights of 500-1,499 g, all causes of death declined in frequency among all birth weight groups.
Birth Weight↗
In utero exposure to steroid contraceptives and survival during infancy.
A cohort study was conducted in Chiang Mai, northern Thailand, in 1,431 children of women who had used the injectable contraceptive Depo-Provera (The Upjohn Company, Kalamazoo, Michigan), 565 children of women who had used oral contraceptives during pregnancy, and a group of 2,307 control infants with no hormonal contraceptive exposures. In follow-up interviews, information was obtained on stillbirths and deaths. Cause of death was ascertained by interview, death certificate, or medical record, and underlying causes of death were ascribed by a panel. The children exposed in utero to Depo-Provera had higher neonatal and infant mortality rates (44.3 and 62.9 per 1,000 live births, respectively) than did the controls (19.8 and 29.1 per 1,000 live births). Mortality in infants exposed in utero to oral contraceptives was intermediate between that in the other two groups. Adjustment by logistic regression showed no significantly increased risk of mortality among infants exposed to oral contraceptives, but the odds ratio for death was significantly increased with Depo-Provera exposures due to accidental pregnancy (odds ratio (OR) = 1.8 (95% confidence interval (Cl) 1.1-3.0) for neonatal deaths; OR = 2.0 (95% Cl 1.3-3.2) for infant deaths). Adjustment for low birth weight reduced the risks, suggesting that low birth weight may act as an intermediate determinant of Depo-Provera-associated mortality. Among the accidental pregnancies with Depo-Provera, there was a relation between shorter injection-to-conception intervals, when maternal blood levels of the drug are high, and an increased risk of mortality. The odds ratios for neonatal mortality were 2.5 (95% Cl 1.1-5.7), 2.1 (95% Cl 1.0-4.6), and 0.9 (95% Cl 0.4-2.4) for injection-to-conception intervals of less than or equal to 4, 5-8, and greater than 9 weeks, respectively. Adjustment for low birth weight reduced these risks. Chi-square tests for trend were highly significant. Similar associations were also observed between Depo-Provera accidental pregnancies and risks of low birth weight. Thus, infants from accidental pregnancies that occur 1-2 months after a 150-mg Depo-Provera injection may be at increased risk for low birth weight and death. However, the attributable risk is low, because such pregnancies are uncommon.
Cause of Death↗
The influence of in-utero transfer on perinatal mortality in a tertiary care centre.
From March 1, 1986 through February 28, 1989 inclusive there was a total of 8,319 births with a birth-weight of 500 g or more at Royal North Shore Hospital (RNS). Three hundred and sixty one births (4.3%) resulted from in-utero transfer of high risk pregnancies (IUT); the remainder were booked at RNS. There were 141 perinatal deaths of which 55 (39%) occurred in infants transferred in-utero. For the whole population delivered at RNS the perinatal mortality rate was 17.0/1,000 births (10.8/1,000 for booked patients versus 152.4/1,000 for IUT births), the stillbirth rate was 7.1/1,000 births (5.4/1,000 for booked patients versus 44.3/1,000 for IUT births) and the neonatal mortality rate was 9.9/1,000 livebirths (5.4/1,000 for booked patients versus 113.0/1,000 for IUT livebirths). These data show that crude perinatal mortality statistics from individual hospitals do not necessarily reflect their standard of care. Although the infants transferred in-utero comprised only 4.3% of the total population they constituted more than one third of the perinatal deaths at RNS. Their very high group specific mortality rates are related to their degree of prematurity and associated maternal and neonatal conditions.
Female↗
Childhood mortality, family size and birth order in pre-industrial Europe.
Based on parish registers, demographic histories of Crulai (France), Tourouvre-au-Perche (France), and Geneva (Swizertland) established the childhood mortality experienced by complete sibships during periods of at least half a century before the Fench revolution. These observations may be presented as frequenceis in incomplete five-dimensional contingency tables. The five dimensions are: survival (living or dead), completed sibship size, birth order, type of family (according to completeness of information about family), and epoch (period in which the family lived). This paper reanalyzes these published data, using hierarchical log-linear models to discern which interations among the five variables can justifiably be inferred from the data. The neonatal and infant mortality rates of firstborn are probably higher than those of later sibs (in Crulai and Tourouvre). But mortality by age 20 (in Geneva) is associated strongly with the epoch, type of family, and family size, and not significantly with birth order. The increase in mortality with completed family size is insufficient to select, in an evolutionary sense, for limited family size.
Adolescent↗
ICMR Task Force National Collaborative Study on Identification of High Risk Families, Mothers and Outcome of their Off-springs with particular reference to the problem of maternal nutrition, low birth weight, perinatal and infant morbidity and mortality in rural and urban slum communities. Summary, conclusions and recommendations.
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Adolescent↗
Childhood morbidity and mortality in a large hospital over last four decades.
Pediatric statistics in a 50-year-old large hospital were analysed to find out any change in pediatric admission rate, morbidity and mortality and outcome of common disorders during the last four decades. Information was collected from four block years from each of the last four decades and compared. An increase of almost 250% in the total pediatric admissions as compared to an increase of 150% in total hospital admissions over last four decades suggest an increased awareness of maternal and child health by the community. The pediatric mortality excluding neonates has not shown a significant fall over the last four decades, being 14.6, 12.7 and 13.0% in 1955-1958, 1974-1977 and 1984-1987, respectively. Diarrheal disorders, pneumonia, tetanus and infections of central nervous system continue to remain the common causes of hospital admissions in children. The morbidity and mortality in these disorders, in general, have shown a significant decline though less appreciable in pyogenic meningitis, encephalitis and tetanus cases.
Brain Diseases↗
Causes of death: an assessment of global patterns of mortality around 1985.
Cause-of-death statistics are available for virtually the entire population of the developed world (1.17 billion in 1985) and thus estimates of the mortality pattern in these countries can be made with some confidence, notwithstanding the artefacts which arise due to differences in diagnostic and certification practices between countries. In the developing countries, cause-of-death estimation is much more difficult due to the paucity of mortality statistics. Nonetheless, there are several sources of information on mortality, ranging from surveillance systems and small-scale community studies to complete vital registration, which can be exploited to estimate mortality patterns. Of the 50 million deaths which occur throughout the world each year, roughly 39 million (78%) occur in developing countries. For the developing countries as a whole, infectious and parasitic diseases are estimated to have accounted for almost one-half of all deaths in 1985. Diarrhoeal diseases, acute respiratory diseases (primarily pneumonia) and tuberculosis each claimed about 3-5 million deaths in the developing world in the mid-1980s, with a further 2.6 million due to measles and whooping cough. Perinatal conditions are estimated to have been responsible for a little over 3.2 million deaths in 1985 in developing countries, one-quarter of which were due to neonatal tetanus alone. Maternal causes claimed the lives of about 0.5 million women. At the same time, the chronic diseases are emerging as a leading cause of death in several regions of the developing world, particularly Latin America and East Asia. Circulatory and specific degenerative diseases are estimated to have caused about 6.5 million deaths in 1985. Chronic lung diseases and cancer are each thought to have claimed about 2.5 million lives in 1985. External causes also probably accounted for 2.0-2.5 million deaths.
Australia↗
New approaches for epidemiologic studies of mortality statistics.
Finding and analyzing multiple causes of death-rather than single causes-has major epidemiologic advantages. Besides helping to reveal the magnitude of the causes or morbid conditions leading to death, it also demonstrates that deaths are usually the result of several simultaneous or sequential causes. This article reviews ways that multiple cause of death data have been analyzed in order to improve our knowledge of these causes and other relevant health factors.
Cause of Death↗