Cause Of Early Neonatal Death Research Articles

FAKTOR YANG BERPENGARUH TERHADAP KEJADIAN ASFIKSIA NEONATORUM DI RSUD BATARA GURU BELOPA

Asphyxia is an emergency event in the form of spontaneous breathing failure immediately after birth. It is very risky for death when the fetus does not breathe spontaneously and regularly so that it can reduce oxygen and increase carbon dioxide, which has bad consequences for continuing life. The cause of early neonatal death at Batara Guru Belopa Hospital is Asphyxia. Factors related to the incidence of asphyxia neonatorum at Batara Guru Belopa Hospital in 2021 This study uses a descriptive correlational method with a cross-sectional time approach. Sampling using the Slovin formula amounted to 62 respondents. Data collection tools using medical records Bivariate data analysis using the Chi-Square test shows that the incidence of asphyxia neonatorum is 52 infants, and infants who do not experience asphyxia neonatorum are 10 infants. There is a relationship between maternal age and neonatal asphyxia (p = 0.008), there is a relationship between parity and neonatal asphyxia (p = 0.000), there is a relationship between low birth weight (LBW) and neonatal asphyxia (p = 0.013), and there is a relationship between premature rupture (PROM) of membranes and neonatal asphyxia (p = 0.021). For institutions, it is hoped that the results of this study can be useful input for students, especially in preventing Neonatal Asphyxia so that it does not cause antenatal and neonatal deaths.
 Keywords: Asphyxia, maternal age, parity, LBW, PROM

Newborn asphyxia: features of the course of pregnancy and delivery and the structure of the placenta

BACKGROUND: The main cause of early neonatal death is neonatal asphyxia. Asphyxia transferred during childbirth can lead to damage of the brain, respiratory disorders, hemodynamic disorders, and impaired renal function.
 AIM: The aim of the study is to determine the factors predisposing to the birth of a child in a state of asphyxia.
 MATERIALS AND METHODS: A retrospective study was conducted, which included the analysis of medical records of 11,662 women who gave birth at the Perinatal Center of the Saint Petersburg State Pediatric Medical University (level IIIB obstetric institution), whose pregnancy ended in urgent delivery. The main group included patients who gave birth to full-term babies in a state of moderate and severe asphyxia (n = 70), the control group included patients who gave birth to children without asphyxia (n = 11,592).
 RESULTS: Factors predisposing to the birth of a full-term baby in a state of moderate and severe asphyxia were identified, which can be used to develop a system for predicting the birth of a child in a state of asphyxia and a set of preventive measures.
 CONCLUSIONS: More frequent ascending infection of stage II and III makes it necessary to timely identify and treat a bacterial infection in all full-term pregnant women. A prognostic model for the birth of a full-term baby in a state of asphyxia has been constructed. Women at risk should undergo an additional examination at 37 weeks of pregnancy: sowing from the cervical canal for flora and sensitivity to antibacterial drugs to identify pathogenic and opportunistic microflora, childbirth should be carried out under mandatory constant monitoring control.

Time to death and its predictors among early neonatal patients in neonatal intensive care unit of Dessie referral hospital, South Wollo Zone, Northeast Ethiopia

Background: Early neonatal death is a serious concern, both in the developing and developed worlds. Early neonatal death remains a health problem and is the biggest component of the neonatal mortality rate. Therefore, substantial reduction in early neonatal mortality is a crucial pre-requisite for achieving further gains in child survival in the country. However, the distribution of deaths in the community within the first week is poorly understood. Therefore, this study was conducted to assess time to death and its predictors among early neonates in the neonatal intensive care unit of Dessie Referral Hospital. Method: A retrospective cohort study was conducted in the early neonatal patient in Dessie referral hospital on the total sample size of 416 selected patients by using a simple random sampling technique. Data were collected by document review. Life table used to estimate the probability of survival, log-rank test to compare survival in two or more groups and the Cox proportional hazard model was used to determine factors associated with time to death of early neonate. The hazard ratio with 95% confidence level was used to declare statistical significant association. Result: A total of 416 early neonates were included in the study. There were 224(53.8%) male neonates. The overall early neonatal mortalities were 47(11.3%), of which 23.41% of them died on the first day of age. early neonatal mortality was associated with neonatal sepsis (AHR=3.349,95% CI,1.842-6.089), low birth weight of neonates (AHR=3.563%,95% CI,1.925-6.595), unable to breastfeeding during delivery (AHR=4.094,95% CI,1.603-10.452), neonatal respiratory distress (AHR=4.018,95% CI,1.733-9.371), perinatal asphyxia (AHR =2.540,95% CI,1.186-5.847). Conclusion: The causes of early neonatal death described in this study were preventable. Managing low birth weight, initiating exclusive breastfeeding, refining quality of service, and confirming the continuity of care are recommended to increase the survival of neonates.

Factors associated with neonatal near miss among neonates admitted to public hospitals in dire Dawa administration, Eastern Ethiopia: A case-control study.

The neonatal near-miss cases are subject to factors that are major causes of early neonatal deaths. For every death, more newborns suffer a life-threatening complication. Nearly 98% of neonatal death unduly existed in developing countries. Though there were few prior studies in other regions, they failed in identifying the factors of NNM. Besides, there has been no prior study in the study area. Therefore, this study aimed to assess factors associated with neonatal near-miss. A case-control study was employed on a total of 252 cases and 756 controls using a systematic random sampling technique. Data were collected using pre-tested and interview administered questionnaires adapted from similar studies and medical records from December 2020 -March 2021. Pragmatic and management criteria definition of neonatal near miss were utilized. Epi-Data version 3.1 and SPSS version 23 were used for data entry and analysis respectively. Bivariable and multivariable analyses were done to identify factors associated with a neonatal near-miss by using COR and AOR with a 95% confidence interval. Finally, the statistical significance was declared at a p-value < 0.05. There were a response rate of 100% for both cases, and controls. Factors that affects neonatal near miss were non-governmental/private employee (AOR, 1.72[95%CI: 1.037, 2.859]), referral in (AOR, 1.51[95%CI: 1.079, 2.108]), multiple birth (AOR, 2.50[95%CI: 1.387, 4.501]), instrumental assisted delivery (AOR, 4.11[95%CI: 1.681, 10.034]), hypertensive during pregnancy (AOR, 3.32[95%CI: 1.987, 5.530]), and male neonates (AOR, 1.71[95%CI: 1.230, 2.373]), paternal education of secondary school (AOR, 0.43[95%CI: 0.210, 0.868]) and college/above (AOR, 0.25[95%CI: 0.109, 0.578]), monthly income (1500-3500 birr) (AOR, 0.29[95%CI: 0.105, 0.809]) and >3500 birr (AOR, 0.34[95%CI: 0.124, 0.906]). Maternal occupation, paternal education, income, referral, multiple births, mode of delivery, hypertension during pregnancy, and sex of the neonate have identified factors with neonatal near-miss. Better to create job opportunities, improving education, and income generation. Counseling on multiple birth and hypertension, and minimizing instrumental delivery should be done at the health facility level.

Neonatal mortality rates at Al-Sadar city 2015 – 2019

Neonatal mortality is an index for newborn care and maternal health care. It is a useful indicator for obstetrical and neonatal healthcare services quality and availability. It is influenced by environmental, economic and social factors. Therefore, it is a measure of socio-economic status and health system. The study was a cross sectional one. It was conducted at Al Resafa side in Baghdad city. The requested data were reviewed from medical records (sex, cause of death, etc.). Chi-square was used to show the impact of dependent variables (death causes) on the independent variables (sex, and type of neonatal death). P value &lt; 0.05 was considered statistically significant. The results showed number of neonatal deaths per 1000 livebirths ranged from 19.30-19.08 per 1000 livebirths between 2015 - 2019 respectively. Males had the highest neonatal deaths through studied years (54.8%, 54.5%, 56.4%, 57.2%, and 59 respectively). Prematurity (487, 32.1%), and respiratory distress syndrome (387, 25.5%) were significantly the common causes of early neonatal deaths. Sepsis (216, 30.1%), and respiratory distress syndrome (149, 20.8%) were significantly the main late neonatal deaths causes (kh 2= 429.582, p value = 0.001). Both males and females mainly died from prematurity (340, 285; 27%, 29.2% respectively). The distribution of causes of neonatal death were significantly varied between sexes (kh2= 20.782, p value= 0.001). In conclusions, neonatal mortality rate is high in the studied period. Two thirds of neonatal death occurred early.

Causes of perinatal mortality and associated maternal factors in a tertiary referral hospital of Gandaki province of Nepal: a cross-sectional study from a hospital-based surveillance

BackgroundPerinatal and neonatal death rates have decreased recently but it still poses a major challenge to the health system of Nepal. The study was conducted to explore the pattern and causes of perinatal deaths.MethodsThis was a descriptive cross-sectional study conducted from September 2020 to June 2021 using the data of perinatal mortality of three years from June 15, 2017, to June 14, 2020. The demographic parameters of the mother consisted of maternal age, place of residence, ethnicity, antenatal care, the number of antenatal visits, gravida, gestational weeks, and the mode of delivery. The causes of death were categorized into fetal and early neonatal deaths. Fetal deaths were further classified as macerated stillbirth and fresh stillbirth. The attribution of the causes of deaths to fetal/neonatal and maternal conditions was done as per the guidelines of the WHO application of ICD-10 to deaths during the perinatal period.ResultsThere were a total of 145 perinatal deaths from 144 mothers among which 92 (63.5%) were males. Ten mothers (6.9%) had not sought even single antenatal care, whereas 32 (22.9%) had visited for antenatal care one to three times. At least one cause of death was identified in 114 (78.6%) and remained unknown in 31(21.4%) cases. Among the 28 cases of macerated stillbirths, the cause of death was not identified in 14 (50%), whereas preterm labor was attributed to the cause of death in four (14.3%). In 53 of the fresh stillbirths, intrapartum hypoxia was identified as the cause of death in 20 (37.7%) cases, preterm labor in nine (17%), and was left unknown in 15 (28.3%) cases. Among the 64 early neonatal deaths, prematurity was attributed as the cause of death in 32 (50%) cases, birth asphyxia, and infections each in 11 (17.2%).ConclusionsThe perinatal mortality surveillance system identified the causes of death in most of the cases in our observation. Prematurity was identified as the commonest cause of early neonatal deaths and preterm labor was the commonest cause responsible for perinatal deaths overall. The perinatal deaths should be investigated to establish exact causes of deaths which can be useful to develop prevention strategies.

Patient Acceptability of Universal Transvaginal Cervical Length Screening Program Implementation at HRH Princess Maha Chakri Sirindhorn Medical Center, Thailand

Background: Preterm birth is a significant problem. It is a leading cause of early neonatal death. Transvaginal ultrasonography for cervical length measurement during second trimester could predict preterm labor. Vaginal progesterone reduced preterm birth incidence in pregnant women with short cervical length. Objective: To evaluate the acceptance rate of a universal transvaginal cervical length (TCL) screening program implementation. Materials and Methods: A retrospective cohort study of universal TCL before 24 weeks of gestation at the time of anatomical scan between 18 to 23+6 weeks from single center from July, 2017 through July, 2018. Pregnant woman with cervical length (CL) &lt;20 millimeters (mm) were diagnosed cervical shortening and were offered treatment as protocol. Incidence of cervical shortening was assessed. Acceptance rates and factors for declining TCL screening were analyzed. The incidence of preterm birth before 34 weeks and 37 weeks were reported. Results: Three hundred forty-one Thai pregnant women were enrolled. Of those, 294 (86.2%) accepted TCL screening. Three pregnant woman (1.1%) had a CL &lt;20 mm. Employed women and women who had income &gt;10,000 Baht per month were likely to accept TCL screening (OR, 2.13; 95% CI, 1.14 to 3.98 and OR, 2.85; 95% CI, 1.37 to 5.95, respectively). The incidence of preterm birth was accounted for 8.9 percent in the acceptance and 2.1 percent in denial group. Conclusion: The universal transvaginal cervical length screening program at HRH Princess Maha Chakri Sirindhorn Medical Center was successfully implemented at 86.2% of acceptance rate. Keywords: Cervical length; Universal screening; Acceptability; Preterm birth; Prevention

Early neonatal death review from two provinces in Papua New Guinea: A retrospective analysis.

To determine the causes of early neonatal death and the avoidable factors associated with these deaths among women participating in a cluster-randomised crossover trial in Papua New Guinea. Early neonatal deaths were identified by retrospective chart review of the Women and Newborn Trial of Antenatal Interventions and Management study participants between July 2017 and January 2020. Causes of death and avoidable factors were identified using the Perinatal Problem Identification Program system. There were 35 early neonatal deaths among 2499 livebirths (14 per 1000 births). Fifty-seven percent (20/35) of deaths occurred on the first day of life. Idiopathic preterm birth was the leading obstetric cause of perinatal death (29%; 10/35). Extreme multi-organ immaturity (23%; 8/35) and hypoxic ischaemic encephalopathy (17%; 6/35) were the most common final causes of neonatal death. Forty-six avoidable factors were identified among 26 deaths, including delays in care-seeking, insufficient resources at health facilities, poor intrapartum care and immediate care of the newborn, including neonatal resuscitation. In this study, potentially preventable causes and avoidable factors were identified in the majority of early neonatal deaths. Addressing these factors will require health system strengthening, particularly the upskilling of primary level health staff, as well as targeted health education of women and the community.

Clinico-Biochemical Correlation in Birth Asphyxia and Its Effects on Outcome.

BackgroundBirth asphyxia is a major cause of early neonatal death and leads to severe consequences such as epilepsy, cerebral palsy, and developmental delay. This study aims to determine the correlation between dyselectrolytemia and the degree of hypoxic-ischemic encephalopathy (HIE) and to find out major risk factors contributing to the severity of HIE and neonatal death.MethodsIn this prospective cohort study (n=150), term babies weighing ≥ 2.5 kg at birth, with the diagnosis of birth asphyxia, admitted in a medical college in Odisha state from September 2014 to August 2016 were included. Clinical findings, biochemical parameters, treatment, and outcome of HIE babies were recorded.ResultThe majority of the asphyxiated babies were having moderate HIE (HIE II) (57.33%), whereas mild and severe stages were seen in 15.33%, and 27.34% of babies, respectively. Factors like prolonged labor (87.8%) and meconium-stained liquor (63.4%) were mostly attributed to the severe degree of birth asphyxia (p < 0.001). Apnea, lethargy, and hypothermia were the most remarkable feature of HIE III. The degree of hyponatremia, hypocalcemia, and hyperkalemia (124.4±4.4 mmol/l, 0.83±0.08 mmol/l, and 6.17± 0.89 mmol/l, respectively) were more severely affected in HIE III as compared to HIE l (137.5±3.8 mmol/l, 1.06±0.17 mmol/l, and 5.0±0.79 mmol/l, respectively). Serum urea and creatinine increased proportionately with an increase in the severity of HIE grade. The mildly asphyxiated neonates recovered completely, whereas all the cases who died (n=29,19.3%) belonged to the moderate or severe degree of birth asphyxia.ConclusionThe asphyxiated neonates had hyponatremia, hypocalcemia, hyperkalemia, raised serum urea, and creatinine and correlated with the severity of birth asphyxia. Prolonged labor and meconium-stained liquor were the most attributable factor for the severe degree of birth asphyxia. Effective neonatal resuscitation and quick correction of electrolyte imbalances will help in the reduction of neonatal mortality and long-term neurological sequelae.

Trends, patterns and cause-specific neonatal mortality in Tanzania: a hospital-based retrospective survey

BackgroundGlobally, large numbers of children die shortly after birth and many of them within the first 4 wk of life. This study aimed to determine the trends, patterns and causes of neonatal mortality in hospitals in Tanzania during 2006–2015.MethodsThis retrospective study involved 35 hospitals. Mortality data were extracted from inpatient registers, death registers and International Classification of Diseases-10 report forms. Annual specific hospital-based neonatal mortality rates were calculated and discussed. Two periods of 2006–2010 and 2011–2015 were assessed separately to account for data availability and interventions.ResultsA total of 235 689 deaths were recorded and neonatal deaths accounted for 11.3% (n=26 630) of the deaths. The majority of neonatal deaths (87.5%) occurred in the first week of life. Overall hospital-based neonatal mortality rates increased from 2.6 in 2006 to 10.4 deaths per 1000 live births in 2015, with the early neonates contributing 90% to this rate constantly over time. The neonatal mortality rate was 3.7/1000 during 2006–2010 and 10.4/1000 during 2011–2015, both periods indicating a stagnant trend in the years between. The leading causes of early neonatal death were birth asphyxia (22.3%) and respiratory distress (20.8%), while those of late neonatal death were sepsis (29.1%) and respiratory distress (20.0%).ConclusionThe majority of neonatal deaths in Tanzania occur among the early newborns and the trend over time indicates a slow improvement. Most neonatal deaths are preventable, hence there are opportunities to reduce mortality rates with improvements in service delivery during the first 7 d and maternal care.

Knowledge of Basic Neonatal Resuscitation and Associated Factors Among Midwives and Nurses in Public Health Institutions in Eastern Ethiopia.

BackgroundNeonatal resuscitation is a means to restore life to a baby from the state of asphyxia. It is a single intervention of birth asphyxia. Over 1.2 million African babies are supposed to die in the first four weeks of their life and many of them in the first 24 hours of birth in Sub-Saharan Africa. The major cause of early neonatal death is neonatal asphyxia, which can be prevented by neonatal resuscitation. However, there is limited evidence on midwives’ and nurses’ knowledge of neonatal resuscitation in the study area. Therefore, this study aimed to assess the knowledge of midwives and nurses about neonatal resuscitation and its associated factors.MethodsThis facility-based cross-sectional study was done on 427 midwives and nurses, who were selected using simple random sampling technique. Data were collected on facility type, availability of essential equipment, socio-demographic characteristics, working unit, professional experience, in-service training, and knowledge of neonatal resuscitation. First-degree holder midwives collected the data using a pre-tested face-to-face interviewer-administered questionnaire. Bivariate and multivariate logistic regression was used to analyze the association between the dependent and independent variables.ResultsThe study showed that 9.8% of the study participants had good knowledge about neonatal resuscitation. Factors significantly associated with knowledge of neonatal resuscitation were being trained on newborn resuscitation (AOR = 3.79, 95% CI: 1.73, 8.32), being unmarried (AOR = 2.36, 95% CI: 1.11, 5.02), holding bachelor sciences degree or above (AOR = 2.67, 95% CI: 1.11, 6.47), and working under West Hararghe health institutions (AOR = 0.30, 95% CI: 0.10, 0.88).ConclusionThe study participants had low knowledge of neonatal resuscitation. Being unmarried, holding bachelor sciences degree or above, being trained on neonatal resuscitation, and working under West Hararghe health institutions were factors associated with the knowledge of the study participants on neonatal resuscitation.

The Etiology of Neonatal Intensive Care Unit Death in Extremely Low Birth Weight Infants: A Multicenter Survey in China.

The aim of this study is to identify causes of neonatal intensive care unit (NICU) death in extremely low birth weight (ELBW) infants less than 1,000 g admitted in Chinese tertiary NICUs. We retrospectively collected data on 607 ELBW infants from 39 level III NICUs from July 2016 to June 2019. The primary causes of death were compared among different gestation age, postnatal age groups, and areas with variable economic status. Among all 607 ELBW NICU deaths, 47.1% were multiple gestation with high rate of in vitro fertilization (IVF) (43.3%); 53.4 and 34.1% received any or full course of antenatal corticosteroid (ACS). The most common causes of ELBW NICU death were respiratory distress syndrome-related neonatal respiratory failure (RDS-NRF, 43.5%), severe infection (19.1%), necrotizing enterocolitis or bowel perforation (9.4%), severe central nervous system injury (8.4%), and bronchopulmonary dysplasia-related respiratory failure (BPD-NRF, 7.7%). Causes of ELBW NICU death varied across postnatal age groups. RDS-NRF was the leading cause of early neonatal death, while severe infection in late neonatal death and BPD in postneonatal EBLW NICU death. RDS-NRF, severe brain injury, and asphyxia were most likely to die at early neonatal age (median age [interquartile range], 2 [0-5], 6 [3-9], and 3 [1-6] days, respectively) while severe infection and necrotizing enterocolitis (NEC) at late neonatal age, BPD-NRF at postneonatal age. In Chinese tertiary NICUs, the major causes of death in extremely low birth weight infants were RDS, infection, NEC, brain injury and BPD, and they varied with postnatal age. Developing specific prevention strategies for identified causes of death in ELBW NICU may potentially improve ELBW survival.

Genetic aetiology of early infant deaths in a neonatal intensive care unit

BackgroundCongenital anomalies are the leading cause of early neonatal death in neonatal intensive care units (NICUs), but the genetic causes are unclear. This study aims to investigate the genetic causes...

Incidence and Causes of Perinatal Mortality in Georgia

Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in 2016 to provide data for preventive measures of maternal and child health. In this study, we aim to determine the incidence of perinatal mortality, assess the distribution of stillbirths and early neonatal deaths, and to determine the major causes of perinatal mortality in Georgia. Data sources were the Georgian Birth Registry and the vital registration system for the year 2017. Causes of early neonatal deaths were assigned into five categories, using the Wigglesworth classification with the Neonatal and Intrauterine deaths Classification according to Etiology modification. The study used descriptive statistics only, specifically counts, means, proportions, and rates, using the statistical software STATA version 15.0 (StataCorp, College Station, TX, USA). In 2017, 489 stillbirths and 238 early neonatal deaths were recorded, resulting in a perinatal mortality rate of 13.6 per 1000 births. About 80% of stillbirths had an unknown cause of death. The majority of stillbirths occurred before the start of labor (85%), and almost one-third were delivered by caesarean section (28%). Prematurity (58%) and congenital malformations (23%) were the main causes of early neonatal deaths, and 70% of early neonatal deaths occurred after the first day of life. The perinatal mortality rate in Georgia remained high in 2017. The major causes of early neonatal deaths were comparable to those of many high-income countries. Contrary to global data, most early neonatal deaths occurred after the first day of life.

Status of Perinatal Mortality in Karnali Academy of Health Sciences, Jumla Nepal

Introduction: Perinatal mortality rate is sensitive indicator of quality of obstetric and pediatric health services. It also helps us to evaluate efficiency of health care provided by a particular hospital. The aim of this study was to evaluate the cause of perinatal death in a tertiary care medical centre, which may help to reduce the incidence of perinatal death and improve the quality of care.&#x0D; Methods: The two-year retrospective study of perinatal deaths was done at Karnali Academy of Health Sciences (KAHS), Jumla from March 2017 to April 2019. Data was collected from monthly perinatal audit and annual mortality reviews. Registers in the maternity ward, sick Neonate Care Unit, and files of dead newborns kept in the record section of the hospital were studied and reviewed.&#x0D; Results: A total of 1354 deliveries were conducted in the 24 months period at KAHS with perinatal mortality rate of 36.08 per 1000 total birth and early neonatal death rate of 12.8 per 1000 live birth. The Perinatal mortality was higher in low birth weight and premature baby. The cause of stillbirth and early Neonatal death were identified. Most of the early neonatal death was due to Prematurity (41.17%) followed by Birth Asphyxia and Neonatal Sepsis.&#x0D; Conclusion: Prematurity and its related complication were the most common cause of early neonatal death followed by birth Asphyxia and Neonatal Sepsis. There is need to improve antenatal, early identification of high-risk pregnancy as well as Neonatal Intensive Care Unit (NICU) to further reduce deaths due to prematurity and birth asphyxia.

Assessment of neonatal mortality major factors

Background: Neonatal mortality accounts for nearly half of the deaths of children under the age of five, the main leading causes for which are respiratory distress, infection, and congenital anomalies. Action plans, which call for the elimination of preventable deaths of newborn babies, set specific targets to reduce neonatal mortality. This retrospective descriptive study was conducted in the Basra Teaching Hospital for maternity and childhood from January 2019 to February 2020, including all the neonates who were admitted in the first and second neonatal care units of the hospital. Aim: This study aims to study the main causes of neonatal deaths in newborn babies in the neonatal care units at the main maternity and pediatric hospital of the Basra government. Patients and methods: A total of 716 neonatal deaths were registered along with days of life before death and the cause of death; the cases were classified as early (1–6) days death and late (7–28) days death. Results: In this study, we found that the main causes of early neonatal death were respiratory distress syndrome (68.4%), congenital anomalies (11.4%), infection (10.9%), birth asphyxia (7.2%), and other neonatal conditions (inborn error of metabolism, hemorrhagic disease of newborn, severe anemia, and unspecified causes) (2.1%), while for late neonatal death, respiratory distress (27.2%), congenital problems (17.7%), infection (45.6%), birth asphyxia (6.1%), and other conditions (3.4%) were cited. Conclusions: It is important to direct the health resources towards preventable causes of neonatal deaths both before, during and after the delivery of a baby when the higher risk factors are preventable (prematurity, birth problems, and sepsis). Using all available resources to decrease preterm labors and mother education toward pregnancy and to improve the facilities and quality of neonatal care at the delivery room and neonatal care units. Keywords: neonate, prematurity, congenital problems, birth asphyxia

Tracking progress on the health status and service delivery outcomes for neonates and children in the Metro West geographic service area of the Cape Metropole, 2010 - 2015

Background. Monitoring the health status of populations of children is one of the building blocks of the health system. The provision of an indicator dashboard with disaggregated data that are collected over time can be used to gauge the performance of the health system, guide the allocation of resources and prioritise health interventions within districts. Objectives. To determine neonatal and child mortality, morbidity and health service outcomes over a 6-year period in the Metro West geographic service area (GSA) of the Cape Town metropole. Methods. A dashboard with key indicators was developed using existing data. Results. From 2010 to 2015, there was a decrease in the perinatal mortality rate from 31.7 to 24.8 per 1 000 deliveries, and the early neonatal and neonatal mortality rates from 7.8 and 8.6 to 7.0 and 8.2 per 1 000 live births, respectively. The main obstetric causes of early neonatal deaths were antepartum haemorrhage (22 - 24%) and unexplained intrauterine death (13 - 16%); the main neonatal causes were immaturity (17 - 34%), congenital abnormalities (23 - 29%) and hypoxia (23 - 26%). Under-five mortality decreased in 2013 from 25 to 22 per 1 000 live births, with the main causes being neonatal conditions (32%), pneumonia (25%), congenital abnormalities (9%), injuries (8%) and diarrhoea (8%). Fifty percent of child deaths were out of hospital, with pneumonia and diarrhoea accounting for more than half of these. There was an improvement in health service coverage rates in 2015: immunisation <1 year old (99%); measles second dose (85%), pneumococcal third dose (100%) and rotavirus second dose (100%); maternal antiretroviral coverage (90%); HIV testing in mothers (93%); HIV DNA polymerase chain reaction testing in babies (97%); and a decrease in HIV transmission (2%). Exclusive breastfeeding coverage rates at 14 weeks, and vitamin A supplementation at 12 - 59 months, were only 30% and 44%, respectively, across the GSA. Conclusion. There was a decrease in perinatal, early neonatal, infant and under-five mortality in Metro West over the 6 years. Further reductions in under-five mortality will require focusing on interventions to reduce neonatal and out-of-hospital deaths across the service delivery platform. Home visits to at-risk mothers and infants by community health workers could prevent out-of-hospital deaths and improve exclusive breastfeeding and vitamin A coverage. This will require increasing the number of community health workers and broadening their scope of practice.

Analysis of statistical indicators of congenital anomalies as causes of early neonatal death in the Russian Federation

The article contains the analysis of Rosstat data for 2012–2016 on early neonatal death due to congenital developmental anomalies. From 2012 to 2016 there was an annual progressive decrease in the number of early neonatal deaths (from 6969 to 4113) in the Russian Federation. The total number of newborns died in the first 168 hours of life due congenital anomalies decreased from 1126 (2012) to 759 (2016), while the values of early neonatal mortality decreased from 366.4 to 217.8. However, the proportion of such infants increased from 16.2% (2012) to 18.5% (2016) from the total number of deaths in the early neonatal period. The type of defects and the frequency of their registration as the initial cause of early neonatal death differ in the federal districts of the Russian Federation and there are certain gender differences.Conflict of interest: The authors of this article confirmed the lack of conflict of interest and financial support, which should be reported.

Risk Factors and Neonatal Outcome among Preterm Birth at Basrah Central Hospitals

Background: Preterm birth (PTB) is a major clinical problem associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with preterm birth and neonatal outcome in Basrah, Iraq. Material and Method: A prospective observational study was conducted over a period of one year from May 2014 to May 2015. About 1145 cases of preterm deliveries were studied in the three main central hospitals in Basra city (Basrah Maternity and Child Hospital, Al-Mwany Hospital and Al-Basrah Hospital). The probable risk factors and the neonatal outcome were recorded and analyzed. Results: Incidence of preterm birth was 2.42%. Presence of factors like multiparty 73.6%, prior miscarriage 41.3%, inter pregnancy interval of < 1 year 39.1%, urinary tract infection 28.4%, cervical incompetence 12.1%, prior preterm birth 12.1%, multiple pregnancies 11.6%, poor socio-economic state were the most frequent risk factor associated with preterm birth. Perinatal death among preterm birth in the study group was 34.7%, antepartum haemorrhage and congenital abnormalities were the common causes of stillbirth, whereas respiratory distress syndrome was the common cause of early neonatal deaths. Neonatal death rate was 84.3% in babies with birth weight less than 1000 grams. Conclusion: The commonest predisposing factors were multiparous, smoker and co smoker, previous miscarriage, inter-pregnancy interval less than one year, infection, and maternal age. .

Identification of SMAD3 as a Novel Mediator of Inflammation in Human Myometrium In Vitro.

Preterm birth remains the primary cause of early neonatal death and is a major determinant for long-term health consequences. Aberrant intrauterine inflammation and infection are known to augment the synthesis of proinflammatory cytokines and induce uterine contractions, which can subsequently lead to preterm birth. The transforming growth factor-β (TGF-β) superfamily members regulate numerous cellular processes through the activation of intracellular mediators known as mothers against decapentaplegic homolog (SMADs). Studies in nongestational tissues have shown that SMAD3 plays a role in immune regulation and inflammation; however, its role in human labour remains unknown. Thus, the present study aimed at (i) characterising the expression of SMAD3 in the human myometrium; (ii) determining the effect of bacterial and viral products and proinflammatory cytokines on SMAD3 transcriptional activity in primary human myometrial cells; and (iii) investigating the effect of SMAD3 siRNA knockdown on the production of prolabour mediators in primary human myometrial cells. Phosphorylated (i.e., active) SMAD3 protein expression was lower in the myometrium after spontaneous term labour compared to the myometrium from nonlabouring women. Using a luciferase assay, the proinflammatory cytokines IL-1β and TNF, and viral analogue polyinosinic : polycytidylic acid (poly(I : C)) significantly reduced SMAD3 transcriptional activity in human primary myometrial cells. Loss-of-function studies found that SMAD3 knockdown in myometrial cells significantly increased IL-1β- and poly(I : C)-induced proinflammatory cytokines (IL-1A, IL-6), chemokines (IL-8, MCP-1), the adhesion molecule ICAM-1, COX-2 mRNA expression, and subsequent PGF2α release. In conclusion, SMAD3 deficiency is associated with increased production of proinflammatory and prolabour mediators in the human myometrium.