Main Causes Of Neonatal Deaths Research Articles

Cortisol regulates neonatal lung development via Smoothened

BackgroundNeonatal respiratory distress syndrome (NRDS), one of the main causes of neonatal death, is clinically characterized by progressive dyspnea and cyanosis 1 to 2 h after birth. Corticosteroids are commonly used to prevent NRDS in clinical. However, the protective mechanism of the corticosteroids remains largely unclear.MethodsIn this study, the simulation of the molecular docking by Autodock, in vitro binding experiments, and Sonic Hedgehog (SHH) pathway examination in cells were performed to study the directly binding of cortisol to Smoothened (SMO). To explore the effect of cortisol action on the SHH pathway on neonatal lung development, we generated a genetic mouse, in which leucine 116 (L112 in human) of SMO was mutated to alanine 116 (L116A, Smoa/a) by the CRISPR-Cas9, based on sequence differences between human and mice. Then, we performed morphological analysis, single-cell RNA sequencing (scRNA-seq) on lung tissue and fluorescence in situ hybridization (FISH).ResultsIn this study, we reported that cortisol, the endogenous glucocorticoid, inhibited the sonic hedgehog (Shh)/SMO-mediated proliferation of lung fibroblasts to maintain the normal lung development. Specifically, cortisol competed with cholesterol for binding to the cysteine-rich domain (CRD) in SMO to inhibit the activation of Shh/SMO signaling, a critical signaling known for cell proliferation. Cortisol did not inhibit the activation of SMO when L112 in its CRD was mutated to A112. Moreover, Smoa/a (L116A) mice exhibited the immature lungs in which over-proliferation of interstitial fibroblasts and reduction in the surfactant protein were evident.ConclusionTogether, these results suggested that cortisol regulated cholesterol stimulation of SMO by competitively binding to the CRD to regulate neonatal lung maturation in mice.

Current status and controversies in the treatment of neonatal hypoxic-ischemic encephalopathy: A review.

Neonatal hypoxic-ischemic encephalopathy is a type of traumatic brain injury caused by insufficient cerebral perfusion and oxygen supply in the perinatal neonate, which can be accompanied by different types of long-term neurodevelopmental sequelae, such as cerebral palsy, learning disabilities, mental retardation and epilepsy It is one of the main causes of neonatal death and disability, and it has caused a great burden on families and society. Therefore, this article mainly reviews the latest developments in mild hypothermia therapy and related drugs for neonatal hypoxic-ischemic encephalopathy.

Gestational age, birth weight, and blood culture microbial patterns in late-onset neonatal sepsis

Background The three main causes of neonatal deaths in Indonesia according to the WHO are sepsis, prematurity, and asphyxia. A suboptimal hospital environment increases the risk of late-onset neonatal sepsis (LONS), which in turn can prolong hospital stays.
 Objective To assess for possible associations of bacterial patterns in neonates with LONS, prematurity, and/or low birth weight.
 Methods Medical record data of 1,706 hospitalized neonates who were treated for sepsis or other disease in the Neonatal Unit, Dr. Cipto Mangunkusumo Hospital (CMH), Jakarta in 2020 were analyzed retrospectively. A total of 262 neonates had proven LONS. We assessed for possible risk factors such as gestational age, birth weight, and cultured blood microbes.
 Results Out of a total of 1,706 neonates admitted to the neonatal unit, the incidence of proven LONS was 15.4%. LONS was more prevalent (58.4%) in preterm than in full-term (41.6%) neonates. The majority (67.6%) of subjects with proven LONS were neonates with low birth weight (LBW) (<2,500 grams), and the largest percentage of them (35.1%) was in the 1,500-2,500-gram group. Gram negative bacteria emerged as the predominant pathogens of LONS patients in our hospital; the most common were Klebsiella pneumonia, Acinetobacter spp., Escherichia coli, Enterobacter spp., and Pseudomonas aeruginosa.
 Conclusion The proportion of LONS among LBW and preterm neonates is significantly higher compared to normal birth weight and neonates. In our unit, LONS was mostly caused by Gram-negative bacteria. The antibiotic susceptibility of the various pathogens causing LONS in CMH should be tested and compared to the current empirical antibiotic guidelines used in CMH.

Causes of sudden neonatal mortality disclosed by autopsy and histopathological examination.

The neonatal period, or the first 28 days of life, is the most vulnerable time in a child's life. Neonatal mortality has decreased in recent years. However, this progress varies at the national level, which necessitates actual regional data from different countries to identify local handicaps for life-saving precautions. This study aimed to investigate the causes for neonatal deaths as revealed by autopsy and histopathological examinations. A retrospective cross-sectional study was designed to identify the main causes of neonatal deaths in children who were autopsied at our institution between January 1, 2014, and December 31, 2021. Children who died within the first 28 days after birth (1-28 days of age) were referred to as neonatal cases. The main causes of neonatal death in children were determined via autopsy and histopathological and toxicological examinations. Furthermore, the causes of death were classified according to their manner of death. During this period, 122 neonatal children were autopsied at our institution. This group comprised 57 girls and 65 boys. For the manner of the death, natural causes were the most common cause (n = 91, 74.5%). Among natural causes, pneumonia (n = 66) was the leading one, representing 54% of all neonatal deaths, followed by perinatal conditions (n = 16, 13.1%). One of the pioneering reasons for death was sudden, unexpected postnatal collapse (n = 24, 19.6%), which was categorized under the undetermined group considering the manner of death. Unintentional (accidental) deaths accounted for 0.8% (n = 1) of total deaths, and intentional deaths were responsible for 6 neonates (4.9%) losses. This study shows that newborn children still die from simple and treatable infectious causes, probably arising from various familial and/or public inadequacies. In addition, sudden and unexpected postnatal collapse remains an important cause of neonatal mortality that has yet to be fully resolved. This study points out valuable inferences for caregivers and competent authorities to take preventive measures to prevent avoidable neonatal deaths.

The determinants of neonatal asphyxia in the tropical province of China: A case-control study.

As the major public health problem among under-5 children in the world, neonatal asphyxia (NA) contributes to 24% of the main causes of neonatal death. The effects of NA is not only limited to death but also has a long-term brain injury with lifelong adverse effects. Therefore, the goal of this study was to identify determinants of NA among newborns in the tropical province of China to guide early interventions and improve the survival and quality of life of these infants. A case control study was conducted at Hainan Women and Children's Medical Center from January 1 to December 31, 2021. A total of 255 newborns (85 cases and 170 controls, 1:2 case to control ratio) were enrolled in the study. A systematic random sampling approach was adopted based on hospital delivery registration. Structured questionnaires were used to collected data. The data was entered into statistical software SPSS version 20.0 for analysis. In the bivariable analysis, variables with P values less than .1 were entered into multivariable logistic regression analysis. At a P value of .05, a statistically significant level was reported. Amniotic fluid stained by meconium/blood (AOR = 3.19, 95% confidence interval [CI]: 1.47-6.95), primiparity, fetal presentation of malpresentation (AOR = 3.89, 95% CI: 1.25-12.09), and low birth weight (AOR = 10.51, 95% CI: 3.02-36.55) were to be significantly associated with NA. This study identified that amniotic fluid stained by meconium/blood, primiparity, low birth weight were determinants of NA. Thus, preventive solutions such as close monitoring of fetus presentation, meliorating the obstetric care setup during antenatal care consultations should be stressed in China.

Mortality rate among Iraqi neonates in neonatal intensive care units: Retrospective study

BackgroundNeonatal mortality (NM) is defined as the death of babies within the first 28 days of their lives, and it's considered a key outcome indicator used to assess and evaluate the development of maternal and neonatal health services in the community. ObjectiveTo identify the neonatal mortality rate (NMR) and to find out the essential causes and related factors of mortality among neonates admitted to the neonatal intensive care units (NICU) at all hospitals of Babylon governorate/Iraq. MethodsA retrospective study was used to review the medical records of all the admitted neonates (No = 27379) to the NICU at hospitals of Babylon governorate, throughout 2020 and 2021 years, the study was done from mid-November 2022 to the end of March 2023. Data were obtained from the statistical department in the health directorate of Babylon governorate electronically from the program called (Microsoft Visual FoxPro). ResultsThe neonatal deaths rate was 42.9 for each 1000 live birth in 2020 and September 38, 1000 live birth in 2021 among all admitted neonates in Babylon hospitals, NMR was very high among neonates with respiratory distress syndrome (RDS) (48% in 2020 and 55.2% in 2021), and low-birth-weight preterm neonates (25.8% in 2020 and 10.3% in 2021). The obstetric history such as gestational age, mode and place of delivery, and type of pregnancy, as well as birth weight, age at the time of death, and residency, were significantly associated with high rates of neonates’ mortality. ConclusionThe neonatal mortality rate was high in Babylon governmental hospitals, especially the hospitals in rural areas. RDS and prematurity were the main cause of neonatal deaths. Furthermore, the maternal history and neonatal characteristics data were associated with increased NMR in prematurity, low birth weight, normal delivery, and delivery at home than a hospital, and in single birth than twins in both 2020 and 2021.

The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting.

Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births. This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs). The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors. The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.

A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system.

BackgroundPreterm birth is the main cause of neonatal deaths with increasing mortality and morbidity rates with decreasing GA at time of birth. Currently, premature infants are treated in neonatal intensive care units to support further development. However, the organs of, especially, extremely premature infants (born before 28 weeks of GA) are not mature enough to function optimally outside the womb. This is seen as the main cause of the high morbidity and mortality rates in this group. A liquid-filled incubator, a so-called PLS system, could potentially improve these numbers for extremely premature infants, since this system is designed to mimic the environment of the natural womb. To support the development and implementation of such a complex system and to interpret vital signals of the fetus during a PLS system operation, a digital twin is proposed. This mathematical model is connected with a manikin representing the digital and physical twin of the real-life PLS system. Before developing a digital twin of a fetus in a PLS system, its functional and technical requirements are defined and existing mathematical models are evaluated.Method and resultsThis review summarizes existing 0D and 1D fetal circulatory models that potentially could be (partly) adopted for integration in a digital twin of a fetus in a PLS system based on predefined requirements. The 0D models typically describe hemodynamics and/or oxygen transport during specific events, such as the transition from fetus to neonate. Furthermore, these models can be used to find hemodynamic differences between healthy and pathological physiological states. Rather than giving a global description of an entire cardiovascular system, some studies focus on specific organs or vessels. In order to analyze pressure and flow wave profiles in the cardiovascular system, transmission line or 1D models are used. As for now, these models do not include oxygen transport.ConclusionThis study shows that none of the models identified in literature meet all the requirements relevant for a digital twin of a fetus in a PLS system. Nevertheless, it does show the potential to develop this digital twin by integrating (parts) of models into a single model.

Mental health impact on Black, Asian and Minority Ethnic populations with preterm birth: A systematic review and meta-analysis.

BACKGROUNDPreterm birth (PTB) is one of the main causes of neonatal deaths globally, with approximately 15 million infants are born preterm. Women from the Black, Asian, and Minority Ethnic (BAME) populations maybe at higher risk of PTB, therefore, the mental health impact on mothers experiencing a PTB is particularly important, within the BAME populations.AIMTo determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODSA systematic methodology was developed and published as a protocol in PROSPERO (CRD42020210863). Multiple databases were used to extract relevant data. I2 and Egger’s tests were used to detect the heterogeneity and publication bias. A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTSThirty-nine studies met the eligibility criteria from a possible 3526. The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95% confidence interval (CI) 29%-74%. The subgroup analysis indicated depressive symptoms to be time sensitive. Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB. The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers (odds ratio of 88% and 60% with a CI of 42%-149% and 24%-106%, respectively).CONCLUSIONBAME women with PTB suffer with mental health conditions. Many studies did not report on specific mental health outcomes for BAME populations. Therefore, the impact of PTB is not accurately represented in this population, and thus could negatively influence the quality of maternity services they receive.

Mortality and cause of death of hospitalized neonates in Weifang, China: a multicenter study

To study the changes in the mortality rate and cause of death of hospitalized neonates in grade A tertiary hospitals in Weifang City of Shandong Province during a 10-year period. A retrospective analysis was performed on 461 neonates who died in three grade A tertiary hospitals in Weifang City of Shandong Province from January 1, 2012 to December 31, 2021. The related clinical data were collected to examine the changes of neonatal mortality with time, gestational age (GA) and birth weight (BW). The main causes of death of the neonates were compared between the first 5 years (2012-2016) and the last 5 years (2017-2021) in the period. A total of 43 037 neonates were admitted from 2012 to 2021, among whom 461 died, resulting in a mortality rate of 1.07%. The mortality rate in the last 5 years was significantly lower than that in the first 5 years [0.96% (211/22 059 vs 1.19% (250/20 978); P<0.05]. The mortality rate of neonates decreased with the increases in GA and BW (P<0.05). In the first 5 years, the top three main causes of neonatal death were respiratory distress syndrome (RDS), sepsis, and pneumorrhagia, while in the last 5 years, the top three causes were sepsis, pneumorrhagia, and RDS. The leading cause of death was severe asphyxia for the neonates with a GA of <26 weeks and a BW of <750 g in both the first and last 5 years. For the neonates with a GA of 26-<28 weeks, the leading cause of death changed from RDS in the first 5 years to pneumorrhagia in the last 5 years. For the neonates with a BW of 750-<1 000 g, the leading cause of death changed from pneumorrhagia in the first 5 years to RDS in the last 5 years. For the neonates with a GA of 28-<32 weeks and a BW of 1 000-<1 500 g, the leading cause of death was RDS in both the first and last 5 years. For the neonates with a GA of 32-<37 weeks and a BW of 1 500-<2 500 g, the leading cause of death changed from RDS in the first 5 years to sepsis in the last 5 years. The leading cause of death was sepsis for the neonates with a GA of 37-<42 weeks and a BW of 2 500-<4 000 g in both the first and last 5 years. The mortality rate of neonates in the grade A tertiary hospitals in Weifang City of Shandong Province has been decreasing in the past 10 years, and it decreases with the increases in GA and BW. Sepsis, RDS, and pneumorrhagia are the leading causes of neonatal death. The mortality rate caused by RDS decreases from the first 5 years to the last 5 years, while the mortality rate caused by sepsis or pneumorrhagia increases from the first 5 years to the last 5 years. Therefore, reducing the incidence rates of sepsis, RDS, and pneumorrhagia is the key to reducing neonatal mortality.

Relationship Between Premature Rupture Of Membranes And The Incidence Of Asphyxia In Newborns At RSUD Dr. Soegiri Lamongan

Neonatal mortality rate is one indicator to assess health in the community. According to WHO, the main causes of neonatal death include prematurity, neonatal asphyxia, and neonatal sepsis. The purpose of this study was to analyze the relationship between premature rupture of membranes and asphyxia in newborns at RSUD Dr. Soegiri Lamongan. This study used an analytical method with a cross sectional approach. The total sample was 240 newborns, consisting of babies with asphyxia and normal babies. Sampling with simple random sampling. Collecting data using a check list. Data taken from patient medical records (secondary data). Data analysis used the Chi Square test with a significance level of α &lt;0.05. The results of the analysis with the Chi square test showed that the value of Asympt.Sig. (2-sided) on the Pearson Chi square test is 0.000 less than 0.05. So it can be concluded that there is a significant relationship between PROM/KPD and the incidence of neonatal asphyxia in the delivery room of dr. Soegiri Lamongan. Asphyschia neonatorum is a complication of newborns which one of the contributing factors is PROM. Therefore, emergency obstetric and newborn care efforts should be strengthened to prevent neonatal asphyxia. It is hoped that health workers in the delivery room will carry out careful monitoring of labor, and identify and take appropriate measures to help reduce the occurrence of neonatal asphyxia

Evolution of neonatal mortality by preventable causes over the past ten years in Espírito Santo State

Abstract Objectives: analyze neonatal mortality causes, highlighting the pteventable ones from 2008 to 2017, in Espírito Santo State and health regions. Methods: ecological study of temporal series on neonatal mortality using data from Mortality Information System and from Live Birth Information System. The death causes were classified based on the List of Avoidable Causes of Deaths due to Interventions of the Brazilian Health System. The temporal tendency was analyzed using linear regression. Results: the neonatal mortality rate reduced, approximately 5%, with a reduction of almost 27% in the late neonatal component. Approximately, 70% of neonatal deaths were preventable, with a higher frequency of reducible causes by adequate care at pregnancy, childbirth and to the newborn. The reduction was significant for adequate care for pregnant women in Espírito Santo and in Metropolitan Region and due to adequate care to the newborn in the South Region. Conclusions: the main causes of neonatal deaths were due inadequate care for women during pregnancy, at childbirth and to the newborn, despite the reduction in neonatal mortality over the past 10 years. This study may contribute to the planning of health policies to improve care for pregnant women, parturient and to the newborn.

Faktor yang Berhubungan dengan Praktik Manajemen Terpadu Bayi Muda oleh Gasurkes KIA di Kota Semarang

Background: The main causes of neonatal deaths in Semarang city were low birth weight (LBW) approximately 38%, birth asphyxia (23%), congenital defect (8%), infections such as sepsis (3%), jaundice (3%), and others (25%). The most common causes of mortality were considered preventable and treatable at an affordable, easily-to-implement, and efficient through integrated management of young infants (IMYI) performed during neonatal visits. It has previously been observed that IMYI has contributed to reducing the neonatal mortality rate by 30-60%. This study aims to investigate the factors that determine the integrated management of young infants carried by maternal and perinatal death surveillance and response (MPDSR) workers in Semarang city.Methods: Quantitative research designs were adopted to provide the correlation between independent variables and dependent variables using statistical hypothesis testing. A cross-sectional approach was utilized to collect the data, both independent dan dependent variables simultaneously. The data were analyzed using chi-square, Fisher exact test, and logistic regression.Results: The result suggests that knowledge, work period, attitude, workload, recording system, supervision had an association toward the practice of IMYI conducted by MPDSR workers in Semarang City. No significant correlation was found on the availability of tools and appraisal toward the practice of IMYI. Work periods was the most dominant factor affecting IMYI practice.Conclusion: these results indicate that knowledge, work period, attitude, workload, recording system, supervision has an important role to increase the practice of IMYI performed by maternal and perinatal death surveillance and response (MPDSR) workers in Semarang city.

Etiologies of Neonatal Mortality in a Tertiary Care Hospital in a Resource-Limited Setting

Background: Neonatal mortality remains a major public health problem in low income countries. The survival within the first 28 days of life remains a challenge in such countries. Many strategies have been implemented to reduce deaths in children under five especially in sub-Saharan Africa. Laquintinie Douala Hospital benefits from some of these measures including a perinatal network and an emergency voucher. We aimed to describe the main causes of neonatal deaths at Laquintinie Douala Hospital. Methods: We carried out a cross-sectional study including files of all deceased neonates in the neonatal unit during a 24 months period from January 1st, 2017 to December 31st, 2018. Data collection included socio-demographic characteristics of the mothers and the newborns, clinical and therapeutic data and the evolution of the newborn. We used SPSS 20 software for data analysis with a p-value less than 0.05. Results: We included 270 files with an overall mortality rate of 13.1% and a sex ratio of 1.2. The main causes of death included prematurity (37.8%), neonatal infection (34.1%) and neonatal asphyxia (24.4%). The main factors associated with deaths included informal sector (OR = 5.49; 95% CI 0.86 - 34.77; p = 0.07) and a primary level of education for mothers, malaria during pregnancy (OR 2.28; 95% CI, 1.44 - 3.12; p = 0.0001), very preterm babies (OR 6.45; 95% CI 4.68 - 8.89; p 0.001) and resuscitation (OR 1.63; 95% CI 1.25 - 2.13; p = 0.0001). Conclusion: Neonatal mortality was lower than data in previous studies but remains high. This highlights the need for caregiver training and improvement of antenatal visits in our setting.

Mortalidade infantil em uma capital do norte do Brasil: estudo de série temporal

Objetivo: caracterizar e identificar causas de mortalidade infantil em Porto Velho, Rondônia de 2012 a 2017. Métodos: série temporal com dados do Sistema de Informação sobre Mortalidade e Sistema de Informações sobre Nascidos Vivos. As frequências e o coeficiente foram realizadas pelo software SPSS Statistics, versão 17. Resultados: Dos 53.321 nascidos vivos, 1,31% vieram a óbitos antes de completar um ano de vida. Destes, 48,93% ocorreram no período neonatal precoce e 56,78% foram por causas não claramente evitáveis. As maiores causas de óbitos foram associadas às ações com adequada atenção ao feto e recém-nascido (46,50%) e à mulher na gestação (32,87%). A principal causa de óbitos neonatais foi por septicemia bacteriana não especificada no recém-nascido (57,73%). O maior coeficiente de mortalidade Infantil foi em 2016 (14,82 óbitos/1.000 nascidos vivos). Conclusão: O óbito infantil no período neonatal precoce ocorreu por causas evitáveis ligadas à atenção ao feto/recém-nascido e à gestante. A mortalidade neonatal por septicemia bacteriana não especificada reflete falhas no pré-natal/parto/pós-nascimento. É imprescindível qualificar profissionais que atuam no ciclo gravídico-puerperal, sobretudo médicos responsáveis pelas notificações para melhorar a vigilância do óbito infantil. Sugere-se avaliar fatores que interferem na qualidade do pré-natal e na assistência realizada no momento do parto.

Rate, Risk Factors, and Causes of Neonatal Deaths in Jordan: Analysis of Data From Jordan Stillbirth and Neonatal Surveillance System (JSANDS).

Background: It has been estimated that 27.8 million neonates will die worldwide between 2018 and 2030 if no improvements in neonatal and maternal care take place. The aim of this study was to determine the rate, risk factors, and causes of neonatal mortality in Jordan.Methods: In August 2019, an electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in in three large cities through five hospitals. Data on all births, neonatal mortality and their causes, and other characteristics in the period between August 2019 and January 2020 were exported from the JSANDS and analyzed.Results: A total of 10,328 births [10,226 live births (LB) and 102 stillbirths] were registered in the study period, with a rate of 14.1 deaths per 1,000 LBs; 76% were early neonatal deaths and 24% were late deaths. The odds of deaths in the Ministry of Health hospitals were almost 21 times (OR = 20.8, 95% CI: 2.8, 153.1) higher than that in private hospitals. Low birthweight and pre-term babies were significantly more likely to die during the neonatal period compared to full-term babies. The odds of neonatal mortality were significantly higher among babies born to housewives compared to those who were born to employed women (OR = 2.7; 95% CI: 1.2, 6.0). Main causes of neonatal deaths that occurred pre-discharge were respiratory and cardiovascular disorders (43%) and low birthweight and pre-term (33%). The main maternal conditions that attributed to these deaths were complications of the placenta and cord, complications of pregnancy, and medical and surgical conditions. The main cause of neonatal deaths that occurred post-discharge were low birthweight and pre-term (42%).Conclusions: The rate of neonatal mortality have not decreased since 2012 and the majority of neonatal deaths occurred could have been prevented. Regular antenatal visits, in which any possible diseases or complications of pregnant women or fetal anomalies, need to be fully documented and monitored with appropriate and timely medical intervention to minimize such deaths.

Causes and determinants of neonatal deaths: Evidence from a secondary care hospital in Bangladesh

Background: Neonatal death is a major barrier to improve child survival in Bangladesh. This study assessed the patterns of neonatal admissions, causes of deaths and associated risk factors to prioritize and design interventions to improve quality of services.&#x0D; Materials &amp; Methods: This study was conducted at the Satkhira District Hospital, a secondary health care facility in Bangladesh. From January to December 2014 hospital records of neonatal admissions and outcomes were reviewed and analyzed. Risk factors were determined by logistic regression analysis.&#x0D; Results: A total of 2,632 neonates were admitted during the period. More than one-third had admission bodyweight below 2500 grams. The leading causes of admissions were perinatal asphyxia (39.6%), prematurity/low-birth weight (LBW) (16.3%), pneumonia (11.9%) and sepsis (10.0%). The overall neonatal case fatality rate (CFR) was 11.7%. The main causes of neonatal deaths were perinatal asphyxia (41.6%) and prematurity/ LBW (35.8%). Most of the deaths (74.3%) occurred on first day of life. Significant risk factors for death were body weight on admission &lt;1500 grams (OR: 17.08; 95% CI: 7.22 - 40.44; p&lt;0.001), first day of life (OR: 7.99; 95% CI: 2.86 -22.27; p&lt;0.001).&#x0D; Conclusions: The main causes of neonatal deaths were perinatal asphyxia and prematurity/LBW and most of the deaths occurred on first day of life.&#x0D; Bangladesh J Child Health 2019; VOL 43 (3) :138-144

Management and experience of postural placement in postoperative mechanical ventilation of newborns

Congenital diaphragmatic hernia (CDH) is a neonatal condition that mainly occurs when the abdominal organs herniate into the thorax, obstructing the development of the lungs. Postoperative neonatal breathing disorder is one of the main causes of neonatal death. This study summarizes the postoperative nursing status of 30 cases of neonatal CDH in our hospital, and explores the effect of body position in mechanical ventilation care following CDH surgery. A total of 30 CHD children admitted in our hospital between June, 2018 and October, 2019 were included. The neonates were divided into preterm infant group (n=15) and full-term infant group (n=15). Each child was immediately transferred to the newborn intensive care unit (NICU) ward after surgery and received the hospital's NCIU special care. Besides routine nursing, each child was placed in a randomly selected primary position (the prone position or supine position). After 30 min, their oxygenation indexes were measured, and then their position (prone position or supine position) was changed. After 30 min, the neonates' oxygenation indicators were measured again. A hospital-made satisfaction questionnaire was used to evaluate the parents' satisfaction with nursing care. Two children died of respiratory failure (one in the preterm group and one in the full-term group), and the rest were in a stable condition after surgery. There was no significant difference between the rates of parent satisfaction in the two groups (preterm infant group: 96.67% verse full-term group: 93.33%, P>0.05). In both groups, the partial pressure of oxygen in arterial blood (PaO2), partial pressure of oxygen in arterial blood/fraction of inspiration O2 (PaO2/FiO2), and partial pressure of oxygen in arterial blood/partial pressure of oxygen in the alveolar gas (PaO2/PAO2) in prone position were significantly higher than those in supine position (P<0.05); the alveolar-arterial oxygen difference (A-aDO2) was significantly lower than that in the supine position (0.05). The prone position can improve the oxygenation index of children after surgery, and improve their respiratory system function. This method is suitable for newborn postoperative NICU care.

Postnatal foot length of newborn: its correlation with gestational maturity

Background: Neonatal death is one of the major contributors (50%) of Under-five child mortality and 70% of the infant mortality. The main causes of neonatal deaths are prematurity and low birth weight (LBW). This study was undertaken to assess newborn foot length and determine its usefulness in identifying LBW/Preterm Babies.Methods: This is a cross sectional hospital based study of 173 newborn babies, done in KIMS Hospital, Bengaluru. All live newborn infants were included in the study. Newborn babies with lower limb congenital anomalies were excluded from the study.Results: Out of 173 newborn, 99 babies were male (57%) and 74 were female (43%). 122 (70.5%) were term and 51(29.5%) were preterm. 48 (38%) were SGA, 120 (69%) were AGA and 5 (3%) were LGA. Their gestational age ranged from 28 to 40 weeks. In this study positive Correlation between foot length and gestational age was found with the “r” value of 0.823. The study also showed a positive correlation between foot length and weight with the “r” value of 0.831.Conclusions: This study has a good correlation of Foot length with gestational maturity and birth weight. Foot length of 7.45cm can be used as a cut- off point for differentiating between term and preterm babies. Derived equation from this study can be used by ASHAs and Anganwadi workers for the estimation of gestational age in resource poor situations and refer the preterm newborns to higher centres for further management as early as possible to prevent long and short term complications of prematurity.

Treatment and new progress of neonatal hypoxic-ischemic brain damage.

Neonatal hypoxic ischemia (HI) results in different extents of brain damage, and immature brain tissue is particularly sensitive to the stimulation of HI. Hypoxic-ischemic brain damage (HIBD) is a common and serious nervous system disease in neonates, for both full-term infants and preterm infants, and is one of the main causes of neonatal death. The surviving infants are often associated with cerebral palsy, mental retardation, and other sequelae, which severely affect quality of life. For term infants, hypoxia and ischemia mainly affect gray matter, whereas in preterm infants, the white matter. However, up to now, inadequate standards and specific measures that can be used to treat hypoxic-ischemic brain injury are available. Recently, in addition to supportive therapy and symptomatic treatment, research on the treatment of hypoxic-ischemic brain injury has focused on the following aspects: hypothermia therapy, stem cell therapy, neuroprotective agents, ibuprofen, and combination therapy. In this review, we will summarize the treatment of HIBD and make suggestions for the future treatment direction.