First-day Mortality Research Articles

Effect of the Helping Babies Breathe Program on Newborn Outcomes: Systematic Review and Meta-Analysis.

Background and objectives: In low- and middle-income countries, the leading cause of neonatal mortality is perinatal asphyxia. Training in neonatal resuscitation has been shown to decrease this cause of mortality. The program "Helping Babies Breathe" (HBB) is a program to teach basic neonatal resuscitation focused on countries and areas with limited economic resources. The aim of the study was to determine the effect of the implementation of the HBB program on newborn outcomes: mortality and morbidity. Material and Methods: A systematic review was carried out on observational studies and clinical trials that reported the effect of the implementation in low- and middle-income countries of the HBB program on neonatal mortality and morbidity. We carried out a meta-analysis of the extracted data. Random-effect models were used to evaluate heterogeneity, using the Cochrane Q and I2 tests, and stratified analyses were performed by age and type of outcome to determine the sources of heterogeneity. Results: Eleven studies were identified. The implementation of the program includes educational strategies focused on the training of doctors, nurses, midwives, and students of health professions. The poled results showed a decrease in overall mortality (OR 0.67; 95% CI 0.57, 0.80), intrapartum stillbirth mortality (OR 0.62; 95% CI 0.51, 0.75), and first-day mortality (OR 0.70; 95% IC 0.64, 0.77). High heterogeneity was found, which was partly explained by differences in the gestational age of the participants. Conclusions: The implementation of the program HBB in low- and medium-income countries has a significant impact on reducing early neonatal mortality.

Comparative assessment of acceptability of the prognostic scales in predicting the risk of interhospital evacuation of newborns

BACKGROUND: The safety of interhospital transfer of newborns remains one of the most important issues of emergency neonatology. Assessment of risks associated with transfer is the basic concern of pre-transport preparation.
 AIM: This study aimed to assess and compare the predictive value of the KSCHONN, National Therapeutic Intervention Scoring System (NTISS), and TRIPS scales in predicting the risks associated with the interhospital transfer of newborns.
 MATERIALS AND METHODS: The cohort study included data from 604 visits of the transport team. The KSHONN, NTISS, and TRIPS scales were used in the assessments, the therapeutic actions of the transport team during transfer were evaluated, and mortality during the first day after assessments was analyzed. The area under the receiver operating characteristic curve (AUC ROC) was calculated for the KSCHONN, NTISS, and TRIPS scales in relation to the therapeutic actions of the transport team and first-day mortality.
 RESULTS: The predictive values of the KSHONN and TRIPS scales for additional infusion reflected AUC ROC values of 0.877 (0.4361.317) and AUC ROC 0.889 (0.4681.311), respectively. The AUC ROC value for predicting catecholamine dose adjustment or appointment and correction of ventilation for all three scales was less than 0.8. The predictive value of all three scales in the prediction of death on the day after the assessment of the transport team is high, and the TRIPS scale had the highest AUC ROC [0.988 (0.9770.999)], which was significantly higher than that for the NTISS scale 0.875 (0.7900.959) (p = 0.004). The KSHONN scale demonstrated a better predictive value for daily mortality [0.984 (0.8611.003)] in comparison with NTISS (p = 0.001). The risk ratio of the daily mortality in the group of patients with an assessment of 94 points according to KSHONN in comparison with patients with an assessment of 68 points was 17.73 (0.88355.8).
 CONCLUSIONS: The evaluated scales predict patient death within a day after the assessment of the transport team with good accuracy, and the KSHONN and TRIPS scales predict the need for additional infusion during transfer. However, none of the scales predict other actions of the team associated with the deterioration of the patients condition during transfer with the required accuracy.

The Value of Prehospital Early Warning Scores to Predict in - Hospital Clinical Deterioration: A Multicenter, Observational Base-Ambulance Study

Objectives Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54–81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services.

Augmentation of labor with oxytocin and its association with delivery outcomes: A large-scale cohort study in 12 public hospitals in Nepal.

The use of oxytocin to augment labor is increasing in many low-resource settings; however, little is known about the effects of such use in contexts where resources for intrapartum monitoring are scarce. In this study, we sought to assess the association between augmentation of labor with oxytocin and delivery outcomes. We conducted a cohort study in 12 public hospitals in Nepal, including all deliveries with and without augmentation of labor with oxytocin, but excluding elective cesarean sections, women with missing information on augmentation of labor, and women without fetal heart rate on admission. Bivariate and multivariate logistic regression calculating the crude and adjusted risk ratio (aRR) with corresponding 95% CI were performed, comparing (a) intrapartum stillbirth and first-day mortality (primary outcome); and (b) intrapartum monitoring, mode of delivery, postpartum hemorrhage, bag-and-mask ventilation of the newborn, Apgar score, and neonatal death before discharge (secondary outcomes) among women with and without oxytocin-augmented labor. The total cohort consisted of 78931 women, of whom 28915 (37%) had labor augmented with oxytocin and 50016 (63%) did not have labor augmented with oxytocin. Women with augmentation of labor had no increased risk of intrapartum stillbirth and first-day mortality (aRR 1.24, 95% CI 0.65-2.4), but decreased risks of suboptimal partograph use (aRR 0.71, 95% CI 0.68-0.74), suboptimal fetal heart rate monitoring (aRR 0.50, 95% CI 0.48-0.53), and emergency cesarean section (aRR 0.62, 95% CI 0.59-0.66), and increased risks of bag-and-mask ventilation (aRR 2.1, 95% CI 1.8-2.5), Apgar score <7 at 5minutes (aRR 1.65, 95% CI 1.49-1.86), and neonatal death (aRR 1.93, 95% CI 1.46-2.56). Although augmentation of labor with oxytocin might be associated with beneficial effects, such as improved monitoring and a decreased risk of cesarean section, its use may lead to an increased risk of adverse perinatal outcomes. We urge for a cautious use of oxytocin to augment labor in low-resource contexts, and call for evidence-based guidelines on augmentation of labor in low-resource settings.

The impact of the Helping Babies Survive program on neonatal outcomes and health provider skills: a systematic review.

The objective of this review was to evaluate the impact of the Helping Babies Survive program on neonatal outcomes and healthcare provider knowledge and skills. The Helping Babies Survive program consists of three modules: Helping Babies Breathe, Essential Care for Every Baby, and Essential Care for Small Babies. It was developed to reduce preventable newborn deaths through skill-based learning using simulation, learning exercises, and peer-to-peer training of healthcare providers in low-resource areas. Despite the widespread increase in healthcare provider training through Helping Babies Survive and the growing number of studies that have been conducted, there has been no systematic review of the Helping Babies Survive program to date. The review included studies on healthcare providers and/or birth attendants providing essential neonatal care during and post birth. Types of interventions were any Helping Babies Survive module (Helping Babies Breathe, Essential Care for Every Baby, Essential Care for Small Babies). Studies including experimental study designs with the following outcomes were considered: neonatal outcomes and/or healthcare provider knowledge and skills obtained, maintained, and used over time. PubMed, Embase, Web of Science, ProQuest Databases, Scopus and CINAHL were searched for published studies in English between January 2010 to December 2016. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). Conflicts were solved through consensus with a third reviewer. Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI. Conflicts were solved through consensus with a third reviewer. Quantitative data was, where possible, pooled in statistical meta-analysis using RevMan (Copenhagen: The Nordic Cochrane Centre, Cochrane). Where statistical pooling was not possible the findings have been reported narratively. A total of 17 studies were identified - 15 on Helping Babies Breathe (n = 172,685 infants and n = 2,261 healthcare providers) and two on Essential Care for Every Baby (n = 206 healthcare providers). No studies reported on Essential Care for Small Babies. Helping Babies Survive was found to significantly reduce fresh stillbirth rates and first day mortality rates, but was not found to influence stillbirth rates or mortality rates, measured at seven or 28 days post birth. Short-term improvements were significant in knowledge and skills scores but not significant in sustainability over time. Additionally, implementation of resuscitations skills in clinical practice related to the Helping Babies Breathe module including drying/stimulation, suction, and bag and mask ventilation did not show a significant increase after training even though the number of fresh stillbirth and first-day mortality rate decreased. Helping Babies Survive has a significant positive impact on early neonatal outcomes, including fresh stillbirth and first-day mortality primarily through Helping Babies Breathe, but limited conclusions can be drawn about its impact on other neonatal outcomes. While Helping Babies Survive was found to improve immediate knowledge and skill acquisition, there is some evidence that one-time training may not be sufficient for sustained knowledge or the incorporation of key skills related to resuscitation into clinical practice. Continued research on the sustained knowledge and skills is needed to evaluate the long-term impact of the Helping Babies Survive program.

Predictors of 30-day mortality in patients admitted to ED for acute heart failure

ObjectivesAcute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality. MethodsWe conducted a single site, retrospective review of adult patients (≥18years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period. ResultsThere were a total of 322 patients. Mean age was 83.9±9.1years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30days of admission to the ED. The following three characteristics were associated with increased mortality: age>85years (OR=1.5[95%CI:0.8–2.7], p=0.01), creatinine clearance <30mL/min (OR=2.6[95%CI:1.4–5], p<0.001) and Nt-proBNP >5000pg/mL (OR=2.2[95%CI:1.2–4], p<0.001). The best Nt-proBNP cut-off value to predict first-day mortality was 9000pg/mL (area under the curve (AUC) [95%CI] of 0.790 [0.634–0.935], p<0.001). For 7-day mortality, it was 7900pg/mL (0.698 [0.578–0.819], p<0.001) and for 30-day mortality, 5000pg/mL (0.667 [0.576–0.758], p<0.001). ConclusionsNt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF.

Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe.

Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related complications. Our study's objective was to improve adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol and reduce perinatal mortality by using a quality improvement cycle (QIC) in a tertiary hospital in Nepal. The HBB QIC was implemented through a multifaceted approach, including the formation of quality improvement teams; development of quality improvement goals, objectives, and standards; HBB protocol training; weekly review meetings; daily skill checks; use of self-evaluation checklists; and refresher training. A cohort design, including a nested case-control study was used to measure changes in clinical outcomes and adherence to the resuscitation protocol through video recording, before and after implementation of the QIC. The intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries, and first-day mortality from 5.2 to 1.9 per thousand live births after intervention, demonstrating a reduction of approximately half in the odds of intrapartum stillbirth (adjusted odds ratio [OR] 0.46, 95% confidence interval [CI] 0.32-0.66) and first-day mortality (adjusted OR 0.51, 95% CI 0.31-0.83). After intervention, the odds of inappropriate use of suction and stimulation decreased by 87% (OR 0.13, 95% CI 0.09-0.17) and 62% (OR 0.38, 95% CI 0.29-0.49), respectively. Before intervention, none of the infants received bag-and-mask ventilation within 1 minute of birth, compared with 83.9% of infants after. The HBB QIC reduced intrapartum stillbirth and first-day neonatal mortality and led to use of suctioning and stimulation more frequently. The HBB QIC requires further testing in primary settings across Nepal.

Exploratory analysis of preventable first day mortality in Colombia

ObjectiveThe goal of this study was to inform public health policy which can reduce Colombia's estimated infant mortality rate (IMR), 17.78 deaths for 1000 live births (2011), by lowering preventable first day mortality (PFDM). Study designThis study combined a time series analysis, using a linear regression method, for the period 2001–2012 with a cross-sectional analysis, using odds ratios and bi-variate methods, for the year 2012 to study first day mortality (FDM) and PFDM classified by biological, socio-economic, and medical correlates. MethodsThe study examined the trends for 2001–2012 in Colombia's infant mortality rate per 1000, and in the relative significance of PFDM by cause. It established the relative odds of PFDM for 2012 by major risk categories, defined by birthweight and gestational age, and within those by biological, sociodemographic risk factors or groups and by potential access to and use of care. Then, the study established the major causes of PFDM within major risk categories and groups. ResultsBetween 2001 and 2012, the average annual rate of FDM declined by 6.30%, while overall infant mortality only declined by 4.20%. Yet, in 2012, 37.04% of FDM was preventable by using proper pregnancy control (7.00% of total preventable), proper care during childbirth (37.20%), and handling causes associated with late diagnosis and treatment (55.80%). PFDM is primarily a socio-economic phenomenon, even among normal weight and gestational age newborns, who account for 32.73% of PFDM due to improper management of pregnancy and delivery among lower socio-economic and outlying populations, specifically in rural areas and among members of the inferior subsidised social insurance regime. ConclusionFrom efficacy and probable cost effectiveness perspectives, intervention priority should be given to handling babies with normal gestation age and birthweight, and then to babies with very low gestation age and birthweight. At the same time, more prenatal visits could lead to fewer very high-risk situations at the outset. In view of the Colombian regulation to the contrary, the use of foetal monitoring and echography methods by all general practitioners should be considered. They should be trained accordingly. Policies should focus on members of the underprovided subsidised health insurance regime, rural areas, young, low-educated and single mothers during pregnancy, mainly delivery.

Surviving the First Day in Nigeria: Risk Factors and Protectors

Background: Deaths occurring within the first twenty-four hours of life constitutes a large proportion of child mortality; about 36% of all neonatal deaths took place within the first twenty-fours of delivery globally. Nigeria contributes around 9% of the global first-day mortality. Objectives: To determine the levels and determinants of first-day mortality using the 2013 Nigeria DHS data. Methods: This study utilized the 2013 Nigeria DHS which is a cross-sectional involving a nationally representative sample of 38, 948 women aged 15-49 years. First-day mortality rates were estimated for all births within the past five year prior to the survey and disaggregated by background characteristics and Cox proportional hazard models were generated to assess the relationship between some background characteristics and first-day mortality. Analysis was conducted using Stata v13. Results: The first-day mortality rate was found to be 19 per 1000 live births which was found to be higher among younger aged women, overweight women, babies in Southern part of Nigeria, rural residents, male babies and those babies delivered in health facilities among others. Factors that significantly predict first-day mortality are maternal age of more than 35 years (HR=1.12, 95%CI: 1.01-1.24), residing in Northern Nigeria (HR=1.18, 95%CI: 1.10-1.26), living in rural areas (HR=1.30, 95%CI: 1.22-1.40) and increasing maternal education (HR=1.20, 95%CI: 1.10-1.32). Utilization of at least four ANC visits (HR=0.87, 95%CI: 0.80-0.93) and having postnatal care within 24hours (HR=094, 95%CI: 0.89-0.99) are all associated with decreased hazard of first-day mortality. Conclusion: First-day mortality rate in Nigeria is high; provision and expansion of both antenatal and postnatal care services particularly in rural areas and northern part of Nigeria will potential contribute in the reduction of first-day mortality.

Did professional attendance at home births improve early neonatal survival in Indonesia?

BACKGROUND Early neonatal mortality has been persistently high in developing countries. Indonesia, with its national policy of home-based, midwife-assisted birth, is an apt context for assessing the effect of home-based professional birth attendance on early neonatal survival. METHODS We pooled four Indonesian Demographic and Health Surveys and used multivariate logistic regression to analyse trends in first-day and early neonatal mortality. We measured the effect of the context of delivery, including place and type of provider, and tested for changes in trend when the 'Midwife in the Village' programme was initiated. RESULTS Reported first-day mortality did not decrease significantly between 1986 and 2002, whereas early neonatal mortality decreased by an average of 3.2% annually. The rate of the decline did not change over the time period, either in 1989 when the Midwife in the Village programme was initiated, or in any year following when uptake of professional care increased. In simple and multivariate analyses, there were no significant differences in first-day or early neonatal death rates comparing home-based births with or without a professional midwife. Early neonatal mortality was higher in public facilities, likely due to selection. Biological determinants (twin births, male sex, short birth interval, previous early neonatal loss) were important for both outcomes. CONCLUSIONS Decreasing newborn death rates in Indonesia are encouraging, but it is not clear that these decreases are associated with greater uptake of professional delivery care at home or in health facilities. This may suggest a need for improved training in immediate newborn care, strengthened emergency referral, and continued support for family planning policies.

The poor at birth: Birth weights and infant mortality at Philadelphia's almshouse hospital, 1848–1873

Birth weights and infant mortality in Philadelphia from 1848 to 1873 are analyzed using almshouse hospital case records. The mean birth weight was 7.48 pounds for live infants and compares favorably with mid-20th century standards; only 10% were below the critical level of 2500 grams. The absolute risk of fetal and first-day mortality, holding birth weight constant, is considerably higher than in modern data. There is no evidence of a time trend in birth weight, with the important exception of a sharp drop from 1866 to 1870. A mother's length of stay in the almshouse increased the weight of her infant. The poorhouse, despite much criticism, had some ameliorative impact.

Core-periphery differences in infant mortality

The study aims to describe the development of core-periphery differences in infant mortality trends in Finland from 1950 to 1984. The infant mortality trends in core and in periphery are described at three levels of spatial hierarchy: (1) nation, (2) province and (3) local hospital region. The main findings are: (1) at the national level: (a) the differences between core and periphery in infant mortality trends disappear by the mid 1960s, mainly due to the equalization of postneonatal mortality and (b) the diminishing of postneonatal mortality stops and the diminishing of especially the first-day mortality begins about the middle of 1960s, both in core and periphery; (2) in the province of Uundenmaan lääni there are no differences in infant mortality trends between the metropolitan area of Helsinki (core) and the rest of this province (periphery); (3) in the two local hospital regions the diminishing of infant mortality is significantly slower in periphery than in core. At present there is scarely any core-periphery variation in the trends of different components of infant mortality. This is a very remarkable fact when the achievements of the health and social policy of Finland are assessed. Several possible methodological, socio-economic, demographic and health care factors that may explain the differences in infant mortality trends between core and periphery at different levels of spatial hierarchy are discussed.

Mode of Action and Insecticidal Value of a Diatomaceous Earth as a Grain Protectant1

An inert diatomaceous earth of Arizona origin trade named Perma Guard was evaluated as a grain protectant, insecticidal and pathological properties being studied. Dosage-mortality curves are presented for eight test species confined in wheat dusted with Perma Guard at the rate of 2 to 7 pounds per ton, Ranking in order of decreasing susceptibility these species were: flat grain beetle, Cryptolestes pusillus (Schanherr); rice weevil, Sitophilus oryzae (L.); granary weevil, Sitophilus granarius (L.); lesser grain borer, Rhyzopertha dominica (F.); saw-toothed grain beetle, Oryzaephilus surinamensis (L.); dermestid larva, Trogoderma parabile Beal; red flour beetle, Tribolium castaneum (Herbst); and confused flour beetle, T. confusum Jacquelin du Val. Only the flat grain beetle mortality attained standards of commercial kill during the two weeks' exposure period at the commercially recommended dosage (4 pounds per ton) or below. Mortality exceeded 95% at 5 and 6 pounds per ton for this species. At the peak dosages used, the mortality of the remaining species did not approach the criterion for commercial kill, The results indicate that of the two moisture levels (12% and 14%) of wheat used in this study, the lower level contributed to mortality in both weevil species, the lesser grain borer and the saw-toothed grain beetle. The dust was directly applied to five test species. Significant differences in losses in weight were observed between test and control groups for the lesser grain borer, the confused flour beetle and the red flour beetle. Overall differences in losses in weight between test and control lots of rice and granary weevils were not significant. A drastic difference between test and control first-day mortality in the rice weevil may be indicative of an unknown lethal factor in the dust. The significant differences in loss in weight were ascribed to the dust's abrasive action on the water barrier portion of the epicuticle. The toxicology of this diatomaceous dust was studied. Dissections, epicuticular staining. and histological sectioning showed little that could be construed ns epicuticular damage.