High Neonatal Mortality Research Articles

Experience of Providing Kangaroo Mother Care at a Tertiary Hospital

Introduction: Hypothermia is a major problem in newborns particularly among low birth weight (LBW) babies and it is one of the major cause of mortality and morbidity among LBW babies. Kangaroo Mother Care (KMC) is a simple method of maintaining temperature by keeping the LBW babies normothermic and indicated especially for LBW babies without using costly equipment. Dr Edgar Rey Sanabria introduced Kangaroo Mother Care (KMC) in Bogotá, Colombia in 1978 as an alternative to incubators for LBW infants to keep small babies warm. WHO defines KMC with its four components: early, continuous, and prolonged skin-to-skin contact between the newborns and mother; exclusive breastfeeding; early discharge from the health facility and close follow-up at home. Objective: To share the experience of Kangaroo Mother Care (KMC) at Kathmandu Medical College Teaching Hospital (KMCTH)
 Materials and Methods: At neonatal unit, 5 bedded an air-conditioned room were allocated as the KMC room and the temperature of this room was maintained at 28 0C. Before starting KMC, orientation on KMC, its procedures and benefits were explained to the mother or caregivers. Premature /LBW babies were kept over the mother’s chest with the help of cotton-made slings (Nyano Angalo wrap). The study period was of a one-year duration (Nov 2018- October 2019) .
 Results: 35 babies born in KMCTH received KMC during 12 months period (Nov 2018- October 2019) using Nyano Angalo wrap. The mean birth weight of babies kept on KMC was 1340 gms and mean gestational age was 33.6 wks. Each baby received KMC for 14.5 hrs average duration.
 Conclusion: Kangaroo mother care is a simple, feasible and non expensive intervention. It enhances breast feeding and bonding between the mother and the newborn babies. Its extensive use will help in the reduction of present high neonatal mortality, particularly among LBWs due to hypothermia.

Current findings and gaps in early initiation of breastfeeding practices in sub-Saharan African countries: A scoping review.

Early initiation of breastfeeding (EIBF) plays an important role in reducing neonatal and infant mortality. Sub-Saharan African countries have high rates of neonatal and infant mortality, as well as a low prevalence of EIBF. By conducting a scoping review, we aimed to determine the gaps and current understandings of EIBF in Sub-Saharan Africa. We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, focusing on primary studies published from 2008 to 2021. We reviewed their titles and abstracts against the eligibility criteria, selecting the relevant ones to this study's criteria for a further full-text review. The identified determinants can be categorized into household, maternal, and health service characteristics. Regarding health service characteristics, many studies reported that cesarean section was strongly associated with the delayed initiation of breastfeeding. Institutional delivery and delivery by skilled birth attendants were also reported to be associated with the early initiation of breastfeeding. Others pointed out that place of residence and wealth index as two household characteristics that were strongly associated with EIBF, as well as maternal characteristics such as older maternal age and higher education status. We found that only eleven studies on the early initiation of breastfeeding have been conducted in Central and West Africa. Household, maternal, and health service factors have been reported to be associated with the early initiation of breastfeeding across many countries. More studies are needed to fill the current geographic gaps and investigate determinants that have not been examined. Future research should also cover interventions that have been effective in improving EIBF for women after caesarean sections in sub-Saharan Africa. Interventions that promote institutional delivery and deliveries by skilled attendants have the potential to improve the practice.

Perspectives of stakeholders regarding the value of maternal and newborn health interventions and practices supported by UNICEF and other partners in the West Nile region of Uganda: a qualitative study

IntroductionUganda has high maternal, neonatal, and under-five mortality rates. This study documents stakeholder perspectives on best practices in a maternal and newborn health (MNH) quality-improvement programme implemented in the West Nile region of Uganda to improve delivery and utilisation of MNH services.MethodsThis exploratory cross-sectional qualitative study, conducted at the end of 2021, captured the perspectives of stakeholders representing the different levels of the healthcare system. Data were collected in four districts through: interviews with key informants working at all levels of the health system; focus group discussions with parents and caretakers and with community health workers; and interviews with individual community members whose lives had been impacted by the MNH programme. The initial content analysis was followed by a deductive synthesis pitched according to the different levels of the health system and the health-systems building blocks.ResultsThe findings are summarised according to the health-systems building blocks and an account is given of three of the interventions most valued by participants: (1) data use for evidence-based decision making (with regard to human resources, essential reproductive health commodities, and financing); (2) establishment of special newborn care units and high-dependency maternity units at district hospitals and training of the health workforce (also with reference to other infrastructural improvements such as the provision of water, sanitation and hygiene facilities at health facilities); and (3) community referral of pregnant women through a commercial motorcycle voucher referral system.ConclusionThe MNH programme in the West Nile region adopted a holistic and system-wide approach to addressing the key bottlenecks in the planning, delivery, and monitoring of quality MNH services. There was general stakeholder appreciation across the board that the interventions had the potential to improve quality of care and newborn and maternal health outcomes. However, as the funding was largely donor-driven, questions about government ownership and sustainability in the context of limited resources remain.

Common Causes of Neonatal Death in Calabar, South-South Nigeria: An Autopsy Study

Background: Neonatal deaths are deaths of live born babies occurring before 28 completed days. The vast majority occur in low-income countries like Nigeria with a high neonatal mortality rate. There is paucity of autopsy studies due to refusal of family to give consent for such procedures.
 Aim: To identify the commonest causes of neonatal death in 53 neonatal autopsies in Calabar, Nigeria.
 Materials and Methods: Detailed postmortem was carried out using lettules techniques and bits taken for histological analysis to ascertain the cause of death. Other relevant contributory factors such as the gestational age, mode of delivery, place of birth, antemortem cause of deaths and maternal obstetric history were obtained from the medical records and autopsy request forms.
 Results: In the one-year retrospective study of 53 neonatal autopsies, male: female ratio was 1: 0.83 and mean age at death was 6.5 + 7.3 days, ranging from 1 to 28 days. The commonest cause of neonatal death was severe birth asphyxia seen in 10 cases (18.9%), followed by kernicterus in 6 cases (11.3%), birth trauma seen in 6 cases (11.3%), congenital heart disease seen in 5 cases (9.4%), and prematurity seen in 5 cases (9.4%).
 Conclusion: The study confirms the usefulness of neonatal autopsy in ascertaining the definitive cause of death. Severe birth Asphyxia was identified as the commonest cause of death in the neonatal period followed by birth trauma, kernicterus and congenital heart diseases.

Male infants are at higher risk of neonatal mortality and severe morbidity.

While a male infant is usually born with a higher birthweight than his female counterpart, he is more at risk of variety of adverse perinatal outcomes. Indeed, throughout life, females exhibit a marked survival advantage compared to males. The aetiology for such pertinent sex disparity remains unclear and is likely multifactorial. The aim of this study was to investigate obstetric and perinatal outcomes by infant sex from 28 weeks in a contemporary, large Australian birth cohort. A 14-year retrospective cohort study of 130 133 births over 28 weeks gestation from a single tertiary centre. Male infants had overall higher rates of neonatal mortality (0.12% vs 0.06%, P < 0.001) and severe neonatal morbidity (12% vs 9.1%, P < 0.001) (adjusted odds ratio (aOR) 1.41, 95% CI 1.35-1.47). The odds of overall perinatal mortality (stillbirth and neonatal death) were higher for male infants (aOR 1.30, 95% CI 1.08-1.56). The difference in severe neonatal morbidity when stratified by gestational age at birth only remained significant from >35 weeks gestation. Regardless of infant sex, rates of neonatal mortality and morbidity were lowest at 39 weeks gestation. Rates of preterm birth and operative birth were also higher for male infants. Our study demonstrates significant disparities in clinical outcomes by infant sex with males at a disadvantage to female infants.

Economics of point-of-care infant HIV tests

Economics of point-of-care infant HIV tests

Liver Rupture in Preeclampsia Complicated by HELLP Syndrome, A Case Report

Pre-eclampsia remains a common pregnancy disorder with a high maternal and neonatal mortality and morbidity. It affects 2–5% of pregnancies, and occurs most commonly at term

Characterisation of the koala (Phascolarctos cinereus) pouch microbiota in a captive population reveals a dysbiotic compositional profile associated with neonatal mortality

BackgroundCaptive koala breeding programmes are essential for long-term species management. However, breeding efficacy is frequently impacted by high neonatal mortality rates in otherwise healthy females. Loss of pouch young typically occurs during early lactation without prior complications during parturition and is often attributed to bacterial infection. While these infections are thought to originate from the maternal pouch, little is known about the microbial composition of koala pouches. As such, we characterised the koala pouch microbiome across the reproductive cycle and identified bacteria associated with mortality in a cohort of 39 captive animals housed at two facilities.ResultsUsing 16S rRNA gene amplicon sequencing, we observed significant changes in pouch bacterial composition and diversity between reproductive time points, with the lowest diversity observed following parturition (Shannon entropy — 2.46). Of the 39 koalas initially sampled, 17 were successfully bred, after which seven animals lost pouch young (overall mortality rate — 41.18%). Compared to successful breeder pouches, which were largely dominated by Muribaculaceae (phylum — Bacteroidetes), unsuccessful breeder pouches exhibited persistent Enterobacteriaceae (phylum — Proteobacteria) dominance from early lactation until mortality occurred. We identified two species, Pluralibacter gergoviae and Klebsiella pneumoniae, which were associated with poor reproductive outcomes. In vitro antibiotic susceptibility testing identified resistance in both isolates to several antibiotics commonly used in koalas, with the former being multidrug resistant.ConclusionsThis study represents the first cultivation-independent characterisation of the koala pouch microbiota, and the first such investigation in marsupials associated with reproductive outcomes. Overall, our findings provide evidence that overgrowth of pathogenic organisms in the pouch during early development is associated with neonatal mortality in captive koalas. Our identification of previously unreported, multidrug resistant P. gergoviae strains linked to mortality also underscores the need for improved screening and monitoring procedures aimed at minimising neonatal mortality in future.2x5HUzrydQWXd3d2iYrm8oVideo

Synergy between Skilled and Traditional Birth Attendants on Quality of Maternal and Newborn Care in Nigeria

Maternal and newborn health remains a critical challenge in Nigeria, with high maternal and neonatal mortality rates persisting in many regions. The coexistence of formal healthcare systems with traditional birth practices provides a unique opportunity for synergy between Skilled Birth Attendants (SBAs) and Traditional Birth Attendants (TBAs) to improve the quality of maternal and newborn care. This study explores the potential benefits of collaboration between SBAs and TBAs in Nigeria and investigates the barriers and facilitators to such cooperation. The findings highlight the complementary strengths of SBAs and TBAs. SBAs bring formal medical training, evidence-based practices, and access to medical resources, while TBAs possess cultural knowledge, community trust, and local birthing expertise. Through joint training and capacity building initiatives, TBAs can be equipped with updated medical knowledge, improving their ability to identify high-risk pregnancies and refer cases to skilled healthcare providers effectively. Effective referral systems play a pivotal role in ensuring timely access to emergency obstetric care. Challenges to collaboration include cultural and traditional beliefs, language barriers, limited access to resources, and legal and regulatory obstacles. Addressing these barriers requires a comprehensive approach that promotes cultural sensitivity, mutual respect, and inclusiveness within the healthcare system. The study concludes that harnessing the synergy between SBAs and TBAs can lead to a more integrated and effective maternal and newborn healthcare system in Nigeria. By leveraging the strengths of both groups and creating an enabling environment for collaboration, Nigeria can make significant strides towards reducing maternal and neonatal mortality, improving the quality of care, and achieving better health outcomes for mothers and newborns. Continued research and collaborative efforts are essential to capitalize on this synergy and drive positive change in maternal and newborn healthcare across the country.

Predictors of Neonatal Mortality: A Retrospective Cross-Sectional Study From the Special Newborn Care Unit of a Tertiary Care Hospital.

Background In India, a significant number of newborns die each year, with Madhya Pradesh having the highest neonatal mortality rate. However, there is a lack of information on factors that can predict neonatal mortality. Objective This study aimed to examine the factors influencing neonatal mortality among neonates admitted to a tertiary care centre's special newborn care unit (SNCU). Methods This retrospective record-based observational study was done at a tertiary care centre, where data from the special newborn care unit (SNCU) from 1st January 2021 to 31st December 2021 was used. We included data of all newborns who were treated in SNCU during the said period and excluded those who got referred or left against medical advice. We abstracted data on age at admission, gender, category, maturity status, birth weight, place of delivery, mode of transport, type of admission, indication of admission, duration of stay and outcome. Qualitative variables were described using frequency and percentage. The chi-square test was used to find out the association of different variables with the outcome, while multivariate logistic regression was conducted to identify risk factors of neonatal mortality. A p-value of <0.05 was considered significant. Results We finalized data of 1052 neonates for analysis. Among them, 846 neonates were successfully discharged while 206 neonates were deceased. The major cause of admission was perinatal asphyxia followed by prematurity. The major cause of mortality in this study was sepsis followed by respiratory distress syndrome, birth asphyxia, and prematurity. Mortality of neonates was significantly associated with maturity status, birth weight, place of delivery, age during admission and duration of stay. Prematurity (OR=3.762, 95% CI:1.93-7.33), birth weight 1000-1499g (OR=4.78, 95% CI:2.21-10.32), birth weight <1000g (OR=25.11, 95% CI:5.71-110.24), age at admission <1-day (OR=2.312, 95% CI:1.03-5.19), duration of stay 1-3-days (OR=12.98, 95% CI:7.48-22.52) and <1-day (OR=1271.88, 95% CI:121.39-13325.69) were significant predictors of mortality in our study. Conclusion Our study emphasizes monitoring and addressing risk factors like maturity status, birth weight, and age at admission to reduce neonatal mortality, with a focus on early management of preterm births and low birth weight.

Cerebral palsy as a public health indicator.

Cerebral palsy as a public health indicator.

Neonatal and perinatal mortality in the urban continuum: a geospatial analysis of the household survey, satellite imagery and travel time data in Tanzania

IntroductionRecent studies suggest that the urban advantage of lower neonatal mortality in urban compared with rural areas may be reversing, but methodological challenges include misclassification of neonatal deaths and stillbirths,...

Growth failure among children of adolescent mothers at ages 0-5 and 6-12 years in India.

Adolescent motherhood has been linked with poor health outcomes at birth for children, including high neonatal mortality, low birthweight, and small-for-gestational-age rates. However, longer-term growth outcomes in the children of adolescent mothers in low-resource settings remain inadequately studied. We used longitudinal data from the India Human Development Surveys, 2004-2005 and 2011-2012 (n = 12,182) and employed regression and propensity score matching analysis to compare the following growth indicators of children born to adolescent mothers (ages 19 years or below) with those born to older mothers. Growth indicators included height and weight during ages 0-5 years and 6-12 years and change in height and weight between the two periods. In regression-based estimates, children born to adolescent mothers were 0.01 m shorter and weighed 0.2kg less than children of older mothers at ages 0-5 years. At ages 6-12 years, those born to adolescent mothers were 0.02 m shorter and weighed 0.97kg less. The height difference between the two groups increased by 0.01 m and the weight difference grew by 0.77kg over time. Height and weight difference between the two groups worsened among boys over time, while for girls, only the weight gap worsened. The results were similar when using propensity score matching methods. Public policies for reducing child marriage, combined with targeted health, nutrition, and well-being programs for adolescent mothers, are essential for both preventing adolescent childbearing and reducing its impact on growth failure among children in India.

Ten-year survival of children with trisomy 13 or trisomy 18: a multi-registry European cohort study

ObjectiveTo investigate the survival to 10 years of age of children with trisomy 13 (T13) and children with trisomy 18 (T18), born 1995–2014.DesignPopulation-based cohort study that linked mortality data to...

Placentaire chorioangiomen: casusbespreking met massieve foetomaternale bloeding en neonatale sterfte

Placental chorioangiomas associated with massive fetomaternal hemorrhage and neonatal death: a case report Placental chorioangiomas are morphologically aberrant blood vessels similar to hemangiomas, but histologically identical to placental blood vessels of fetal origin. They are usually small and clinically irrelevant. However, when they cover a large part of the placenta, the consequences can be important. Severe fetal complications such as hydrops, high-output failure, anemia, thrombocytopenia and placental abruption are described, all associated with a high fetal and neonatal mortality. The authors present a case of a fetus with pronounced anemia and signs of massive fetomaternal hemorrhage. Histopathological examination of the placenta revealed multiple placental chorioangiomas.

Perinatal Outcomes and Neurodevelopment 1 Year after Birth in Discordant Twins According to Chorionicity.

Background and Objectives: This study aimed to compare maternal complications, perinatal outcomes, and neurodevelopment 1 year after the birth between concordant and discordant twins in monochorionic and dichorionic twins. Materials and Methods: This retrospective study included twin pregnancies delivered between 24 + 1 and 38 + 2 weeks of gestation between January 2011 and September 2019. Chorionicity was confirmed by ultrasonography and was categorized into monochorionic and dichorionic. Each was then divided into two groups (concordant and discordant) according to birth weight discordancy. Maternal complications and neonatal outcomes, including neurodevelopmental delays, were compared between the two groups. Results: A total of 298 pairs of twin pregnancies were enrolled, of which 58 (19.26%) women were pregnant with monochorionic diamniotic twins and 240 (80.54%) with dichorionic diamniotic twins. In both monochorionic and dichorionic twins, the discordant twins had a greater incidence of emergency deliveries because of iatrogenic causes than the concordant twins. Among dichorionic twins, discordant twins had lower birth weight rates and higher hospitalization rates and morbidities than concordant twins. Among monochorionic twins, discordant twins had a lower birth weight and higher neonatal mortality than concordant twins. The neonatal size was not a predictor of neurodevelopment in this group. Based on the logistic regression analysis, male sex, respiratory distress syndrome, and bronchopulmonary dysplasia were risk factors for the neurodevelopmental delay; birth weight discordancy was significant only in dichorionic twins. Conclusions: Perinatal outcomes in discordant twins may be poor, and neurodevelopment 1 year after birth was worse in discordant twins than in concordant twins. Discordancy in twins can be a risk factor for neurodevelopmental delay.

Perinatal Infection with Listeria monocytogenes: A 10-Year Hospital-Based Study in Western China.

Listeriosis is a rare but severe foodborne disease that is contracted by the consumption of food contaminated with Listeria, and perinatal listeriosis can cause major adverse pregnancy outcomes. In the current study, we sought to retrospectively analyze 10 years of perinatal outcomes due to listeriosis in western China. Based on the isolation of Listeria monocytogenes (L. monocytogenes), we retrospectively reviewed the pregnancy-associated cases of listeriosis from June 2010 to February 2022 at our hospital. We investigated the crude incidence, clinical manifestations, perinatal management, and outcomes of perinatal listeriosis cases. We diagnosed a total of 28 cases of perinatal listeriosis during the study period at our hospital, including four cases of twin pregnancies. Of the 28 cases, 32.14% (9/28) were infected in the second trimester and 67.86% (19/28) in the third trimester. The fetal or neonatal mortality rate for perinatal listeriosis was high, with a crude fetal mortality rate of 46.88% (15/32) in the 32 offspring and a neonatal mortality rate of 47.06% (8/17) in the 17 live births. Perinatal listeriosis exhibits high fetal or neonatal mortality. We recommend that appropriate antibiotics be administered in cases of perinatal listeriosis.

The Effectiveness Of The Combination Of Acupressure Therapy With Oxytocin Massage Against The Length Of Time Of Milk Production In Puerperal Mothers

According to the UNICEF report, there were 54 neonatal infant deaths per 1,000 live births worldwide in 2020. The highest neonatal mortality rate in 2020 was found in the Sub-Saharan Africa region, namely 27 deaths per 1,000 live births. In Indonesia, only 1 out of 2 babies under 6 months is exclusively breastfed, and only a little more than 5% of children are still getting breast milk at 23 months of age. Nationally, the coverage of babies receiving exclusive breastfeeding in 2019 is 67.74%. The inhibiting factor in breastfeeding is the production of breast milk which is less and slow to come out which can cause the mother not to give her baby enough. A method that is rarely used to speed up milk release and stimulate milk productivity is a combination of acupressure therapy and oxytocin massage. Knowing the effectiveness of the combination of acupressure therapy with oxytocin massage on the length of time to express breast milk in postpartum mothers. Quasi experimental with posttest only control group design. The sample in this study were all postpartum mothers at BPM. Indah Susilowati in August-October 2022 as many as 30 people, the sampling technique is total sampling. The average time for breastfeeding in the intervention group was 2.16 hours and in the control group 2.79 hours. There is the effectiveness of the combination of acupressure therapy with oxytocin massage on the length of time for expressing milk in postpartum women with a p value of 0.000. There is an effective combination of acupressure therapy with oxytocin massage on the length of time to express breast milk in postpartum mothers. The combination of acupressure therapy and oxytocin massage can be considered as an alternative effort to accelerate breastfeeding in postpartum mothers.

Placental Metabolomics of Fetal Growth Restriction.

Fetal growth restriction is an obstetrical pathological condition that causes high neonatal mortality and morbidity. The mechanisms of its onset are not completely understood. Metabolites were extracted from 493 placentas from non-complicated pregnancies in Hamilton Country, TN (USA), and analyzed by gas chromatography-mass spectrometry (GC-MS). Newborns were classified according to raw fetal weight (low birth weight (LBW; <2500 g) and non-low birth weight (Non-LBW; >2500 g)), and according to the calculated birth weight centile as it relates to gestational age (small for gestational age (SGA), large for gestational age (LGA), and adequate for gestational age (AGA)). Mothers of LBW infants had a lower pre-pregnancy weight (66.2 ± 17.9 kg vs. 73.4 ± 21.3 kg, p < 0.0001), a lower body mass index (BMI) (25.27 ± 6.58 vs. 27.73 ± 7.83, p < 0.001), and a shorter gestation age (246.4 ± 24.0 days vs. 267.2 ± 19.4 days p < 0.001) compared with non-LBW. Marital status, tobacco use, and fetus sex affected birth weight centile classification according to gestational age. Multivariate statistical comparisons of the extracted metabolomes revealed that asparagine, aspartic acid, deoxyribose, erythritol, glycerophosphocholine, tyrosine, isoleucine, serine, and lactic acid were higher in both SGA and LBW placentas, while taurine, ethanolamine, β-hydroxybutyrate, and glycine were lower in both SGA and LBW. Several metabolic pathways are implicated in fetal growth restriction, including those related to the hypoxia response and amino-acid uptake and metabolism. Inflammatory pathways are also involved, suggesting that fetal growth restriction might share some mechanisms with preeclampsia.

Mother's Experiences Regarding Early Breastfeeding Initiation (Imd): Scoping Review

The Early Breastfeeding Initiation Program (IMD) was promoted as an effort to encourage the provision of colostrum to newborns, while preventing high infant and neonatal mortality. After the baby is born, immediately do skin-to-skin contact. This review is intended to find out the experience of mothers doing Early Initiation of Breastfeeding (IMD) based on existing articles. This scoping review method uses the Arkey H &amp; O'Malley framework in 2005. The five stages of the review process are (a) identification of review questions, (b) identification of relevant studies, (c) study selection, (d) data mapping (data charting), (e) compiling, summarizing, and reporting results. From the articles reviewed, 7 articles received grade A with a quantitative design of one article and a qualitative design of six articles. Based on the results of the scoping review that has been carried out, it was found that the mother's experience of IMD is influenced by husband's support, family support, and support from health workers. Factors that influence the implementation of IMD include mother's knowledge, mother's attitude, parity, and education. Barriers to the implementation of the IMD were delivery by cesarean section and non-adherence in the ANC examination. The reasons mothers do not want IMD are breast milk does not come out, feel tired, the baby is immediately separated from the mother, and pre-lacta feeding. Conclusion: ANC non-compliance is one of the obstacles in the implementation of IMD