Differences In Neonatal Mortality Research Articles

Perinatal health outcomes of international migrant women in Brazil: A nationwide data linkage study of the CIDACS birth cohort (2011–2018)

BackgroundWe investigated perinatal outcomes among live births from international migrant and local-born mothers in a cohort of low-income individuals in Brazil. MethodsWe linked nationwide birth registries to mortality records and socioeconomic data from the CIDACS Birth Cohort and studied singleton live births of women aged 10–49 years from 1st January 2011 to 31st December 2018. We used logistic regressions to investigate differences in antenatal care, adverse pregnancy outcomes, and neonatal (i.e., ≤28 days) mortality among international migrants compared to non-migrants in Brazil; and explored the interaction between migration, race/ethnicity and living in international border municipalities. ResultsWe studied 10,279,011 live births, of which 9469 (0.1 %) were born to international migrants. Migrant women were more likely than their Brazilian-born counterparts to have a previous foetal loss (ORadj: 1.16, 1.11–1.22), a delayed start of antenatal care (i.e., beyond 1st trimester) (1.22, 95%CI:1.16–1.28), a newborn who is large for gestational age (1.29, 1.22–1.36), or a newborn with congenital anomalies (1.37, 1.14–1.65). Conversely, migrant women were less likely to deliver prematurely (0.89, 0.82–0.95) or have a low birth weight infant (0.74, 0.68–0.81). There were no differences in neonatal mortality rates between migrants and non-migrants. Our analyses also showed that, when disparities in perinatal outcomes were present, disparities were mostly concentrated among indigenous mothers in international borders and among live births of Black mothers in non-borders. ConclusionAlthough live births of international migrants generally have lower rates of adverse birth outcomes, our results suggest that indigenous and Black migrant mothers may face disproportionate barriers to accessing antenatal care.

Understanding the Effect of Expectant Versus Expedited Delivery in the Periviable Period [ID: 1376738

INTRODUCTION: Periviable birth accounts for only 0.5% of births but contributes to a majority of neonatal deaths. There is no clear recommendation regarding expediting delivery in periviable patients with advanced cervical dilation (ACD). The objective of this study was to assess whether expectant management versus expedited delivery in patients with ACD affects perinatal outcomes. METHODS: This is a single-institution retrospective cohort study of singleton gestations at 20.0–25.6 weeks with ACD (4–6 cm) on admission from 2016 to 2018. Individuals were stratified into two groups: 1) those who progressed spontaneously to delivery (expectant management) and 2) those who underwent augmentation of labor or cesarean delivery at the time of ACD diagnosis (expedited delivery). The primary outcome was neonatal mortality. Secondary outcomes included differences in postpartum hemorrhage and infection rates. RESULTS: Forty-three of 199 preterm deliveries met eligibility criteria: 21 were expectantly managed and 22 underwent expedited delivery. There was no difference in demographic characteristics or gestational age between the expectant management and expedited delivery groups (23′1 [SD 1.65] versus 24′4 [SD 3.05] weeks, [P=.9]). There was no difference in neonatal mortality (n=13 [61.9%] versus n=10 [45.5%], P=.3), maternal infection (n=1 [4.76%] versus n=4 [18.2%], P=.3) or postpartum hemorrhage (n=2 [9.5%] versus n=1 [4.5%], P=1.0) between the expectant management and expedited delivery groups, respectively. CONCLUSION: In this cohort, there were no differences in neonatal mortality, maternal infection, or postpartum hemorrhage between expectant management and expedited delivery in singletons with ACD in the periviable period. Larger studies are needed to inform guidelines for management of these complex cases.

NcGRA7 and NcROP40 Play a Role in the Virulence of Neospora caninum in a Pregnant Mouse Model.

The intraspecific variability among Neospora caninum isolates in their in vitro behaviour and in vivo virulence has been widely studied. In particular, transcriptomic and proteomic analyses have shown a higher expression/abundance of specific genes/proteins in high-virulence isolates. Consequently, the dense granule protein NcGRA7 and the rhoptry protein NcROP40 were proposed as potential virulence factors. The objective of this study was to characterize the role of these proteins using CRISPR/Cas9 knockout (KO) parasites in a well-established pregnant BALB/c mouse model of N. caninum infection at midgestation. The deletion of NcGRA7 and NcROP40 was associated with a reduction of virulence, as infected dams displayed milder clinical signs, lower parasite burdens in the brain, and reduced mortality rates compared to those infected with the wild-type parasite (Nc-Spain7). Specifically, those infected with the NcGRA7 KO parasites displayed significantly milder clinical signs and a lower brain parasite burden. The median survival time of the pups from dams infected with the two KO parasites was significantly increased, but differences in neonatal mortality rates were not detected. Overall, the present study indicates that the disruption of NcGRA7 considerably impairs virulence in mice, while the impact of NcROP40 deletion was more modest. Further research is needed to understand the role of these virulence factors during N. caninum infection.

Effect of multiple micronutrient supplements vs iron and folic acid supplements on neonatal mortality: a reanalysis by iron dose.

Antenatal multiple micronutrient supplements (MMS) are a cost-effective intervention to reduce adverse pregnancy and birth outcomes. However, the current WHO recommendation on the use of antenatal MMS is conditional, partly due to concerns about the effect on neonatal mortality in a subgroup of studies comparing MMS with iron and folic acid supplements (IFA) containing 60 mg of iron. We aimed to assess the effect of MMS vs IFA on neonatal mortality stratified by iron dose in each supplement. We updated the neonatal mortality analysis of the 2020 WHO guidelines using the generic inverse variance method and applied the random effects model to calculate the effect estimates of MMS vs. IFA on neonatal mortality in subgroups of trials (n=13) providing the same or different amounts of iron, i.e. MMS with 60 mg of iron vs IFA with 60 mg of iron; MMS with 30 mg of iron vs IFA with 30 mg of iron; MMS with 30 mg of iron vs IFA with 60 mg of iron; and MMS with 20 mg of iron vs IFA with 60 mg of iron. There were no statistically significant differences in neonatal mortality between MMS and IFA within any of the subgroups of trials. Analysis of MMS with 30 mg vs IFA with 60 mg of iron (7 trials, 14,114 participants), yielded a nonsignificant Risk Ratio (RR) of 1.12 (95% CI 0.83 to 1.50). Neonatal mortality did not differ between MMS and IFA regardless of iron dose in either supplement.

Latency to delivery in physical examination-indicated cerclage in twins is similar to that in singleton pregnancies.

To compare latency to delivery and perinatal outcomes between twin and singleton pregnancies undergoing physical examination-indicated cerclage. Retrospective observational study (2007-2017) of women who underwent physical examination-indicated cerclage at the Hospital Clinic of Barcelona. Primary outcomes were latency from cerclage to delivery and gestational age at delivery. Secondary outcomes included: neonatal morbidity and mortality, preterm prelabor rupture of membranes, clinical chorioamnionitis and cerclage displacement. Wilcoxon-test and χ2 test were used to compare continuous and categorical variables. Sixty women were included (17 twins and 43singletons). There were no differences in gestational age at cerclage or presence of bulging membranes between groups. Median (25th;75th percentile) gestational age at delivery was 27.1 (24.5;32.3) weeks in the twin group and 27.6 (25.3;35.3) weeks in the singleton group (P=0.594). There were no statistically significant differences in latency from cervical cerclage to delivery between the two groups (43days [21;64] vs. 29days [16;76], respectively; P=0.938). There were no differences in neonatal mortality (2/26 [7.7%] vs. 1/33 [3.1%]; P=0.578) or in composite neonatal morbidity (14 [53.9%] vs. 14 [42.4%]; P=0.283) between groups, respectively. These results suggest that physical examination-indicated cerclage placement in twins could prolong latency to delivery similarly to singleton pregnancies.

Cross-State Differences in the Processes Generating Black-White Disparities in Neonatal Mortality.

The U.S. Black neonatal mortality rate is more than twice the White rate. This dramatic disparity can be decomposed into two components: (1) disparities due to differences in the distribution of birth weights, and (2) disparities due to differences in birth weight-specific mortality. I utilize this distinction to explore how the social context into which infants are born contributes to gaps in mortality between Black and White neonates. I analyze variation in Black-White differences in neonatal mortality across 33 states using 1995-2010 data. For each state, I calculate the contribution of differences in birth weight distribution versus differences in birth weight-specific mortality to the total disparity in mortality between White and Black neonates. Disparities are largely a product of different birth weight distributions between Black and White newborns (mirroring the pattern for the United States as a whole). However, in at least nine states, differences in birth weight-specific mortality make a notable contribution. This pattern is observed even among those from advantaged sociodemographic backgrounds and is driven by differences in mortality among very low birth weight neonates. This calls attention to inequality in medical care at birth as an importantcontributor to racial disparities in neonatal mortality.

Community-level impacts of sanitation coverage on maternal and neonatal health: a retrospective cohort of survey data

IntroductionAccess to sanitation facilities (toilets or latrines) greatly improves human health. Low community sanitation coverage may lead to increased exposure to pathogens for households both with and without a sanitation...

Inequality in early life: Social class differences in childhood mortality in southern Sweden, 1815–1967

AbstractThis article analyses the long‐term development of social class differences in infant and child mortality in an area of southern Sweden, spanning from the early stages of the mortality transition at the beginning of the nineteenth century, to the late 1960s when both infant and child mortality had reached very low levels. Our findings show that infant and child mortality was fairly equal at the beginning of the study period. We find no clear pattern of class differentials in childhood mortality in the first half of the nineteenth century when both infant and child mortality declined. Later in the nineteenth century, class differences started to emerge. This is clear for both post‐neonatal mortality and child mortality, while we do not find any class differences in neonatal mortality. Over time, a more or less full gradient emerged for post‐neonatal mortality, and a weak gradient also emerged for child mortality. Strikingly, the disadvantaged position for unskilled and lower‐skilled workers remained throughout the 1960s, also at a time when mortality levels were very low, and living standards had increased dramatically for all classes in the population.

Gender variations in neonatal and early infant mortality in India and Pakistan: a secondary analysis from the Global Network Maternal Newborn Health Registry

BackgroundTo determine the gender differences in neonatal mortality, stillbirths, and perinatal mortality in south Asia using the Global Network data from the Maternal Newborn Health Registry.MethodsThis study is a secondary analysis of prospectively collected data from the three south Asian sites of the Global Network. The maternal and neonatal demographic, clinical characteristics, rates of stillbirths, early neonatal mortality (1–7 days), late neonatal mortality (8–28 days), mortality between 29–42 days and the number of infants hospitalized after birth were compared between the male and female infants.ResultsBetween 2010 and 2018, 297,509 births [154,790 males (52.03%) and 142,719 females (47.97%)] from two Indian sites and one Pakistani site were included in the analysis [288,859 live births (97.1%) and 8,648 stillbirths (2.9%)]. The neonatal mortality rate was significantly higher in male infants (33.2/1,000 live births) compared to their female counterparts (27.4/1,000, p < 0.001). The rates of stillbirths (31.0 vs. 26.9/1000 births) and early neonatal mortality (27.1 vs 21.6/1000 live births) were also higher in males. However, there were no significant differences in late neonatal mortality (6.3 vs. 5.9/1000 live births) and mortality between 29–42 days (2.1 vs. 1.9/1000 live births) between the two groups. More male infants were hospitalized within 42 days after birth (1.8/1000 vs. 1.3/1000 live births, p < 0.001) than females.ConclusionThe risks of stillbirths, and early neonatal mortality were higher among male infants than their female counterparts. However, there was no gender difference in mortality after 7 days of age. Our results highlight the importance of stratifying neonatal mortality into early and late neonatal period to better understand the impact of gender on neonatal mortality. The information from this study will help in developing strategies and identifying measures that can reduce differences in sex-specific mortality.

Morbimortalidad asociada al parto prematuro y su relación con el uso de corticoides y sulfato de magnesio

IntroductionPreterm labour is associated with multiple complications, with an increased risk of perinatal morbidity and mortality. Nevertheless, many studies support the use of corticosteroids and magnesium sulphate to improve outcomes in preterm birth. The objective of this study is to describe the morbidity and mortality incidence in preterm birth in a Spanish hospital and how the use of corticosteroids and magnesium sulphate has improved the short-term prognosis in these newborns. Material and methodsObservational retrospective study of 564 preterm births between the years 2018 to 2019, in the hospital area Juan Ramón Jiménez (Huelva). The treatment with corticosteroids and magnesium sulphate was performed based on current protocols of the Spanish Society of Gynaecology and Obstetrics. ResultsThe incidence of prematurity in this study was 7.9%. Twin pregnancies and hypertensive pregnancy disease were the most common obstetric disorders. The most common type of delivery was caesarean section in all prematurity groups, except late prematurity. Respiratory distress syndrome was the most frequent pathology (more than 33%) in all groups. Overall neonatal mortality was 1.8‰. As regards the use of corticosteroids, the main outcome was a decrease in neonatal morbidity and mortality, which was statistically significant in respiratory distress syndrome and preterm retinopathy. The use of magnesium sulphate caused a decrease in the incidence of intraventricular haemorrhage, periventricular leukomalacia, and bronchopulmonary dysplasia. There were no significant differences in neonatal mortality. ConclusionsMorbidity and mortality registered in this study were similar to that described in the literature. Although the use of corticosteroids reduced neonatal morbidity and mortality in this study, it was only statistically significant in premature retinopathy and respiratory distress syndrome. The use of magnesium sulphate also showed an improvement in some pathologies and in mortality, but were not statistically significant.

Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan

ABSTRACT Background In 2018, Pakistan had the world’s highest neonatal mortality rate. Within Pakistan, most neonatal deaths occur in rural areas where access to health facilities is limited, and robust vital registration systems are lacking. To improve newborn survival, there is a need to better understand the causes of neonatal death in high burden settings and engage caregivers in the promotion of newborn health. Objective To describe the causes of neonatal death in a rural area in Pakistan and to estimate the effect of an integrated neonatal care kit (iNCK) on cause-specific neonatal mortality. Methods We analyzed data from a community-based, cluster-randomized controlled trial of 5286 neonates in Rahim Yar Khan (RYK), Punjab, Pakistan between April 2014 and August 2015. In intervention clusters, Lady Health Workers (LHW) delivered the iNCK and education on its use to pregnant women while control clusters received the local standard of care. The iNCK included interventions to prevent and identify signs of infection, identify low birthweight (LBW), and identify and manage hypothermia. Verbal autopsies were attempted for all deaths. The primary outcome was cause-specific neonatal mortality. Results Verbal autopsies were conducted for 84 (57%) of the 147 reported neonatal deaths. The leading causes of death were infection (44%), intrapartum-related complications (26%) and prematurity/LBW (20%). There were no significant differences in neonatal mortality due to prematurity/LBW (RR 0.43; 95% CI 0.15–1.24), infection (RR 1.10; 95% CI 0.58–2.10) or intrapartum-related complications (RR 1.04; 95% CI 0.0.45–2.41) among neonates who died in the intervention arm compared to those who died in the control arm. Conclusion The major causes of neonatal deaths in RYK, Pakistan mirror the global landscape of neonatal deaths. The iNCK did not significantly reduce any cause-specific neonatal mortality.

Apgar Score and Risk of Neonatal Death among Preterm Infants

BackgroundGestational age is the major determinant of neonatal death (death within the first 28 days of life) in preterm infants. The joint effect of gestational age and Apgar score on the risk of neonatal death is unknown.MethodsUsing data from the Swedish Medical Birth Register, we identified 113,300 preterm infants (22 weeks 0 days to 36 weeks 6 days of gestation) born from 1992 through 2016. In analyses stratified according to gestational age (22 to 24 weeks, 25 to 27 weeks, 28 to 31 weeks, 32 to 34 weeks, and 35 or 36 weeks), we estimated adjusted relative risks of neonatal death and absolute rate differences in neonatal mortality (i.e., the excess number of neonatal deaths per 100 births) according to the Apgar scores at 5 and 10 minutes and according to the change in the Apgar score between 5 minutes and 10 minutes. Scores range from 0 to 10, with higher scores indicating a better physical condition of the newborn.ResultsThere were 1986 neonatal deaths (1.8%). The incidence of neonatal death ranged from 0.2% (at 36 weeks of gestation) to 76.5% (at 22 weeks of gestation). Lower Apgar scores were associated with higher relative risks of neonatal death and greater absolute rate differences in neonatal mortality in all gestational-age strata. For example, among infants born at 28 to 31 weeks, the adjusted absolute rate differences according to the 5-minute Apgar score, with those who had a score of 9 or 10 serving as the reference group, were 51.7 (95% confidence interval [CI], 38.1 to 65.4) for a score of 0 or 1, 25.5 (95% CI, 18.3 to 32.8) for a score of 2 or 3, 7.1 (95% CI, 5.1 to 9.1) for a score of 4 to 6, and 1.2 (95% CI, 0.5 to 1.9) for a score of 7 or 8. An increase in the Apgar score between 5 minutes and 10 minutes was associated with lower neonatal mortality than a stable Apgar score.ConclusionsIn this study, Apgar scores at 5 and 10 minutes provided prognostic information about neonatal survival among preterm infants across gestational-age strata. (Funded by the Swedish Research Council for Health, Working Life, and Welfare and Karolinska Institutet.)

Cerebral oxygenation reflects fetal development in preterm monochorionic and dichorionic twins

BackgroundCerebral oxygenation (crSO2) monitoring is increasingly used in high-risk infants. Monochorionic twins suffer from specific fetal pathologies that can affect cerebral hemodynamics. Limited data are available on crSO2 and blood flow patterns in this population after birth. ObjectiveTo evaluate crSO2 changes in preterm monochorionic and dichorionic twins during the first 72 h of life. MethodsNear-infrared spectroscopy was used to measure crSO2 in 62 infants from 31 twin pregnancies <32 weeks of gestation. The study group was divided into 4 subgroups: donor (1) and recipient (2) monochorionic twins (with twin-twin transfusion syndrome), fetal growth restriction (FGR) infants (3) and twins without fetal compromise (4). ResultsThere was significant difference in birth weight (p < 0.001) among 4 subgroups. We observed significant variation in crSO2 among the subgroups using mixed model analysis (p < 0.001). The recipient twins exhibited the lowest crSO2 (mean ± SE) throughout the study period (76 ± 0.3%), whereas the FGR and donor twins presented with the highest values (86 ± 0.3% and 83 ± 0.4% respectively). We found no statistically significant differences in neonatal mortality and morbidity among subgroups. ConclusionOur study revealed significant correlation between crSO2 values postnatally and underlying fetal pathology in monochorionic and dichorionic preterm twins.

1079: Racial differences in neonatal mortality of extreme premature births for each gestational age of birth

1079: Racial differences in neonatal mortality of extreme premature births for each gestational age of birth

Analysis of neonatal deaths in critical neonatal treatment centers at different levels in Henan province

Objective To investigate the death status and cause of death of newborns in critical care centers at different levels in Henan province. Methods Retrospective analysis was performed on the death cases at 85 critical neonatal treatment centers in 18 cities of Henan province from January to December 2018, and the similarities and differences in neonatal mortality, age of death and causes of death among cities and county-level critical neonatal care centers were compared. Results (1) A total of 99 832 neonates were admitted to 85 hospitals, and 318 neonates died, with a mortality rate of 3.19‰.A total of 42 066 neonates were admitted to 21 municipal hospitals, and 194 neonates died, with a mortality rate of 4.6‰.Among them, 109 cases (56.2%) were premature infants (14 cases were of 28 weeks, 70 cases were of 28-34 weeks, 25 cases were of >34-37 weeks), and 85 cases (43.8%) were full-term infants.A total of 57 766 neonates were admitted to 64 county-level hospitals, with 124 deaths and a mortality rate of 2.1‰.Among them, 67 cases (54.0%) were full-term infants, 57 cases (46.0%) were premature infants (9 cases were of 28 weeks, 34 cases were of 28-34 weeks and 14 cases were of >34-37 weeks). The mortality rates at muni-cipal hospital were higher than those at the county-level hospitals, and the difference was statistically significant (χ2=46.589, P<0.05). (2) Neonatal death mainly occurred within 1 week after birth, especially within 1 day after birth.There were 81 deaths (41.8%) in 21 municipal hospitals within 1 day, including 50 premature infants (61.7%) and 31 full-term infants (38.3%). There were 75 deaths (60.5%) in 64 county-level hospitals within 1 day, including 34 premature infants (45.3%) and 41 full-term infants (54.7%). The mortality rate in county-level hospitals was higher than that in the municipal hospital within 1 day, and the difference was statistically significant(χ2=10.621, P< 0.05). (3)The top 5 causes of neonatal death in the municipal and the county-level hospitals were pulmonary diseases (130 cases, 40.8%), birth asphyxia (74 cases, 23.3%), infection (50 cases, 15.7%), congenital malformation (24 cases, 7.5%), and very-early premature/very-low birth weight infants (12 cases, 4.1%). (4)For early (within 1 week after birth) death of full-term infants, the main causes of death in municipal hospitals were lung diseases (mainly neonatal respiratory distress syndrome/acute respiratory distress syndrome), birth asphyxia, infection, congenital malformation.The leading causes of death at county-level hospitals were birth asphyxia, pulmonary diseases and infection.For premature infants who died within 1 week, the main causes of death at the municipal and the county-level hospitals were pulmonary diseases and birth asphyxia.For late-stage (2-4 weeks after birth) death of neonates, whether full-term infants or premature infants, the main cause of death in municipal and county-level hospitals was infection. Conclusions There are differences in neonatal mortality, mortality within 1 day after birth and the first cause of death at critical neonatal treatment centers at municipal and county-level hospitals.For the early-stage(within 1 week) neonates, the main causes of death in municipal and county-level hospitals are lung diseases (mainly neonatal respiratory distress syndrome/acute respiratory distress syndrome), birth asphyxia and infection.For the late-stage neonates, infection is the main cause of death in the municipal and the county-level hospitals.It is necessary to improve the neonatal care ability of critical neonatal treatment centers at different levels separately in order to reduce neonatal mortality. Key words: Infant, newborn; Mortality; Cause of death

Newborn gender as a predictor of neonatal outcome in mixed gender twins born with very low birth weight

BackgroundMost studies have revealed that the incidence of morbidity and mortality of preterm male infants is greater than that of preterm female infants. Recently, conflicting outcomes have been reported regarding mixed-gender twins. The aim of this study was to estimate the association between gender and outcome in newborn twins of different gender.MethodsWe conducted a retrospective review of mixed-gender twins weighing < 1500 g that were born at Shamir Medical Center (Assaf Harofeh) between the years 1995 and 2016 (158 newborns). The incidence of morbidity and mortality until discharge from the hospital were evaluated while looking at gender differences.ResultsNo significant differences were found in neonatal mortality or morbidity between females and males from different-gender twins. Even after considering confounding variables (gestational age, birth weight & birth order) in linear and logistic regression models, no significant differences were found between the genders.ConclusionsOur study suggests that there are no significant differences in neonatal mortality or morbidity among different-gender twins. Our results support the need for further studies.

Neonatal mortality, cold weather, and socioeconomic status in two northern Italian rural parishes, 1820–1900

Background: Cold-related conditions represent one of the most common causes of neonatal death in many developing countries. The effects of cold external temperatures on neonatal mortality at the onset of demographic transition recently have attracted scholarly interest. Objective: First, we aim to study the effects of cold temperatures on neonatal mortality at the onset of demographic transition, focusing on two Italian rural parishes between 1820 and 1900. Second, we aim to assess whether the effects vary according to socioeconomic status (SES), especially among the most vulnerable social groups. Methods: We apply logistic regression and discrete-time event history analysis using micro-data from parish registers and daily records of external temperature. Results: The risk of death during the first month of life varied according to external temperature’s variation and to socioeconomic status, demonstrating that neonates born to landless rural labourers generally suffered a higher neonatal mortality risk during winter and, more specifically; in case of low temperature at the childbirth during coldest months. Conclusions: The risk of neonatal death increased as external temperatures decreased. The clear influence of temperature on the day of birth suggests that low temperatures on the day of birth exerted a fundamental scarring effect on children’s survival. We also find significant differences in neonatal mortality by SES, resulting in more pronounced effects from season and temperature in rural proletarian families. The results show that during the second half of the 19th century characterised by intense socioeconomic transformations, rural proletarians experienced a clear worsening of living conditions. Contribution: The results show that during the second half of the nineteenth century characterised by intense socio-economic transformations, rural proletarians experienced a clear worsening of living conditions.

The unfinished health agenda: Neonatal mortality in Cambodia.

BackgroundReduction of neonatal and under-five mortality rates remains a primary target in the achievement of universal health goals, as evident in renewed investments of Sustainable Development Goals. Various studies attribute declines in mortality to the combined effects of improvements in health care practices and changes in socio-economic factors. Since the early nineties, Cambodia has managed to evolve from a country devastated by war to a nation soon to enter the group of middle income countries. Cambodia's development efforts are reflected in some remarkable health outcomes such as a significant decline in child mortality rates and the early achievement of related Millennium Development Goals. An achievement acknowledged through the inclusion of Cambodia as one of the ten fast-track countries in the Partnership for Maternal, Newborn and Child Health. This study aims to highlight findings from the field so to provide evidence for future programming and policy efforts. It will be argued that to foster further advances in health, Cambodia will need to keep neonatal survival and health high on the agenda and tackle exacerbating inequities that arise from a pluralistic health system with considerable regional differences and socio-economic disparities.Methods/FindingsData was drawn from Demographic Health Surveys (2000, 2005, 2010, 2014). Information on a series of demographic and socio-economic household characteristics and on child anthropometry, feeding practices and child health were collected from nationally representative samples. To reach the required sample size, live-births that occurred over the past 10 years before the date of the interview were included. Demographic variables included: gender of the child, living area (urban or rural; four ecological regions (constructed by merging provinces and the capital), mother’s age at birth (<20, 20–35, 35+), birth interval (long, short) and birth order (1st, 2–3, 4–6, 7+). Socio-economic variables included: mother education level (none, primary, secondary+) and household wealth (asset-based index). Data on antenatal care, tetanus injection and skilled assistance at birth were used for the mother's last child.Between 2000 and 2014, Cambodia achieved a considerable reduction in neonatal mortality (46% reduction rate). By 2014, gender inequities became almost non-existent (for all measures of equality); inequity related to mother’s education decreased for all time periods; improvements were observed for differences in neonatal mortality by preceding birth interval; and a reduction in neonatal mortality rates could be noted among all the regional subgroups. Inequities increased between mothers who had limited antenatal care and those who received more than four antenatal care visits. In most scale indicators, the Slope Index of Inequality and Relative Index of Inequality estimates for all four rounds of the survey suggest inequity exacerbated in deprived communities. Also, wealth and residence (urban/rural divide) continued to be major determinants in neonatal mortality rates and related inequity trends.ConclusionAnalysis highlighted some of the complex patterns and determinants of neonatal mortality, in Cambodia. There has been a considerable decline in neonatal mortality which echoes global trends. Our analysis reveals that despite these advances, additional socio-economic and demographic characteristics considerably affected neonatal mortality rates and its inequities. There continue to be pockets of vulnerable groups that are lagging behind. This analysis highlights the determinants along the urban-rural and rich-poor divides in neonatal mortality inequities and how these affect access to and utilization of quality basic health services. This calls for future policy and programming efforts to be deliberate in their equity approach. Quality improvements in health services and targeted interventions for specific socio-economic groups will be required to further accelerate progress in reducing neonatal mortality and address Cambodia’s pressing unfinished agenda in health.

Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes.

Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes.

Perinatal Mortality and Advanced Maternal Age

Objective: To investigate the impact of advanced maternal age on the rate of perinatal mortality. Design: Retrospective cohort study including all 56,517 singleton hospital deliveries between 1999 and 2008. Methods: Data were analyzed according to maternal age at delivery in 3 groups of women, 25-34 years, 35-39 years and ≥40 years, using the youngest as the reference group. Results: Odds ratios (ORs) for antenatal deaths were 0.98 (CI: 0.67-1.43) and 2.57 (CI: 1.57-4.22) for age groups 35-39 years and ≥40 years, respectively. Significant differences in neonatal mortality rates between the age groups were not found. Significant amendable risk factors were attendance of <4 health care visits (OR = 15.55, CI: 9.47-25.51 in age group 35-39 years; OR = 16.38, CI: 9.78-27.43 in the age group ≥40 years) and obesity (OR = 1.85, CI: 1.27-2.70 in age group 35-39 years; OR = 1.83, CI: 1.22-2.74 in the age group ≥40 years). In the multivariate regression analysis, the adjusted ORs for perinatal mortality were 1.03 (95% CI: 0.77-1.39) and 1.66 (95% CI: 1.03-2.66) for age groups 35-39 and ≥40, respectively. Conclusions: Women older than 40 years carry an increased risk for stillbirth. Important amendable risk factors are obesity and poor antenatal care.