Postneonatal Death Research Articles

The Effect of PM10 Pollutant Levels on the Postneonatal Mortality Rate: Application of the AirQ+ Model in Istanbul, Türkiye

Background: Air pollution is one of the major environmental risk factors for health. Children are vulnerable to the negative health consequences of air pollution. We aimed to determine the effect of PM10 levels on postneonatal mortality in Istanbul, the most populous city in Türkiye. Methods: In this cross-sectional study, the relationship between PM10 levels and postneonatal deaths occurring in Istanbul, Türkiye in 2015-2019 was examined. PM10 levels for Istanbul were calculated by taking the average of daily PM10 measurements between 01.01.2015 and 31.12.2019, made available from Istanbul Air Quality Monitoring Stations. Data were analyzed using Microsoft Office Excel 2016 and AIRQ+ 2.2.3 software. Results: If the PM10 value in Istanbul province had been reduced to 20 μg/m3, the limit value recommended by the WHO; in 2019; 36(19-61) postneonatal infant deaths could have been prevented; 7.73% (3.98-12.95) of postneonatal infant deaths were attributed to PM10. During this period, the PM10 value in Istanbul was above the limit value recommended by WHO, the European Union and Turkish legislation. Conclusion: Infant mortality due to air pollution is an important public health problem.

Timing of infant mortality in French Guiana: The persistence of high post neonatal mortality

BackgroundInfant mortality in French Guiana, a French overseas territory, is 2.7 times greater than in mainland France. Given the importance of better understanding infant mortality we aimed to describe the early & late neonatal, and postneonatal mortality in French Guiana between 2007 and 2022. MethodsWe used data from the Institut National de la Statistique et des Etudes Economiques to describe trends and performed survival analysis. ResultsOverall, there were 1 073 deaths before one year of age, of which 297 (27.7 %) occurred on the first day of life. The overall proportion of early neonatal deaths was 47.1 %, late neonatal deaths was 17.3 %, and post-neonatal deaths was 35.6 %. The overall incidences were 4.6 per 1,000 for early neonatal mortality, 1.4 per 1,000 for late neonatal mortality, and 3.1 per 1,000 for post neonatal mortality. The incidence for infant mortality for French Guiana residents was thus 9.1 per 1,000. ConclusionsWe show that post neonatal deaths in French Guiana are proportionally greater than in mainland France and they do not seem to decline, as they did in France. The relative proportions of post-neonatal mortality can thus help to identify important areas for action to correct excess infant mortality. Although poor pregnancy follow-up remains a problem we show that follow-up of infants is also a pressing problem that warrants increased efforts.

Associations Between Infant Formula Exposure, Housing Instability and Postneonatal Mortality Among Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

To quantify infant mortality rates (IMR) using expanded racial categories, and to examine associations between infant formula exposure, housing instability and postneonatal mortality among Minnesota WIC Participants. Births in Minnesota from 2014 through 2019 (n = 404,102) and associated infant death records (n = 2034) were used to calculate neonatal and postneonatal rates using expanded racial categories. Those births that participated in the WIC program (n = 170,011) and their linked death records (n = 853) were analyzed using logistic regression to examine associations between formula exposure, housing instability, and postneonatal death. Postneonatal IMR was more than twice as prevalent among Black (African American) as East African immigrant infants (IMR = 3.9 vs 1.5). After adjustment for confounding (term status and nativity of mother (U.S. vs foreign born), infants exposed to formula by 28days were four times as likely to die in the postneonatal period as those without formula exposure (aOR = 4.0; 95% CI 3.2-4.9). WIC participants who experienced housing instability at birth were 1.7 times as likely to lose an infant in the postneonatal period (28 to 364days of age) as those in stable housing (aOR = 1.7; 95% CI 1.2, 2.4). Disaggregating Black mortality rates revealed inequities in infant mortality among Black families of varied backgrounds. Formula exposure and housing instability are modifiable risk factors associated with postneonatal mortality. Appropriate interventions to reduce barriers to breastfeeding and provide housing stability for vulnerable families could reduce disparities in postneonatal mortality.

Adverse obstetric and neonatal outcomes associated with maternal schizophrenia-spectrum disorders and prenatal antipsychotic use: a meta-analysis of 37,214,330 pregnancy deliveries and propensity-score weighted population-based cohort study assessing confounder dependency of risk estimates.

Studies demonstrated increased obstetric and neonatal complications in women with schizophrenia-spectrum disorder (SSD), but most inadequately addressed confounders and rarely considered antipsychotic effects. We conducted a meta-analysis and a population-based cohort study evaluating associations of adverse obstetric/neonatal outcomes with SSD and prenatal antipsychotic use. In the meta-analysis, we searched four databases from inception to October-31-2023 and generated pooled risk estimates using random-effect models. In the cohort study, we identified women aged 15-50 years with SSD-diagnosis from electronic-heath-record database of public healthcare-services who delivered first/singleton children between 2003 and 2018 in Hong Kong. Propensity-score weighted regression-analyses incorporating important confounders including maternal pre-existing and gestational morbidities, substance/alcohol abuse, and psychotropic use, were performed to assess risk of adverse obstetric/neonatal outcomes in SSD-women versus non-SSD-women, and subsequently treated-SSD and untreated-SSD subgroups to disentangle effects of SSD from antipsychotic exposure. The meta-analysis (studies = 18, women = 37,214,330, including 42,926 SSD-women) found significant associations of SSD with 12 of 17 analyzed negative obstetric/neonatal outcomes (with pooled relative risk ranged:1.12-2.10), including placental complications, induced labor, Caesarean delivery, fetal distress, stillbirth, preterm birth, small-for-gestational-age, low birth weight, low APGAR scores, neonatal and post-neonatal deaths. However, the cohort study (466,358 women, including 804 SSD-women) revealed that elevated risk of most study outcomes in unadjusted-models were markedly-attenuated or became non-significant in propensity-score weighted adjusted-models, except index-delivery hospitalization ≥7 days (odds ratio [OR] = 1.76 [95% CI = 1.33-2.34]), preterm birth (OR = 1.48 [95% CI = 1.09-2.00]) and neonatal special-care admission (OR = 1.65 [95% CI = 1.35-2.01]). Apart from higher neonatal special-care admission in treated-SSD than untreated-SSD women (OR = 1.75 [95% CI = 1.23-2.52]), no significant between-group differences emerged in other outcomes. In sum, elevated risk of most obstetric/neonatal complications reported in SSD-women might largely be explained by maternal physical comorbidities, substance/alcohol use disorders and other confounders. Interventions targeting modifiable maternal risk factors should be incorporated in prenatal care for SSD-women to minimize avoidable adverse outcomes.

Managing the Historic Burden of Kernicterus Mortality in India.

Prevention of neonatal bilirubin injury exemplifies success of systems approach to avert adverse neonatal and childhood outcomes that rely on strategies including prenatal identification of Rhesus sensitization, universal maternal blood typing, risk assessment for neonatal extreme hyperbilirubinemia (EHB), unfettered access to safe, effective phototherapy, and application of patient safety principles. India's diverse landscape suggests varied real-time experiences of neonatal hyperbilirubinemia and consequent infant mortality rates (IMR). Utilizing Global Burden of Disease (GBD) database, the authors examined national and subnational trends, infant mortality timing, and the disease burden from hemolytic and perinatal jaundice over 30 y (1999 to 2019). They also assessed the correlation of EHB-IMR with socio-demographic index and health expenditure per capita, estimating economic losses from EHB-related infant mortality to guide policy decisions at national and state domains. From 1990 to 2019, India delivered 811,078,415 livebirths of which, 1,189,856 infant deaths were due to EHB. EHB-related deaths decreased from 57,773 in 1990 to 19,664 in 2019, a 60% reduction vs. 40% in overall IMR. Early (0-6 d), late (7-27 d), and post-neonatal (28-364 d) deaths accounted for 61%, 34%, and 5% of mortality, respectively. Uttar Pradesh and Bihar contributed to 38% of all EHB deaths. Economic analysis estimate losses between US $7.2 and 11.7 billion for the year 2019 secondary to EHB-related mortality. The present analysis reveals consistent declines across all states to reach current EHB-IMR of 0.8 per 1,000 live-births in India by 2019. Significant economic impact of lost human productivity highlight ongoing need for targeted life-saving public health strategies.

Air Pollution and Mortality in India: Investigating the Nexus of Ambient and Household Pollution Across Life Stages.

Air pollution in India is a foremost environmental risk factor that affects human health. This study first investigates the geographical distribution of ambient and household air pollution (HAP) and then examines the associated mortality risk. Data on fine particulate matter (PM2.5) concentration has been extracted from the Greenhouse Gas Air Pollution Interactions and Synergies (GAINS) model. HAP, mortality and socio-demographic data were extracted from the National Family and Health Survey-5, India, 2019-2021. Regression models were applied to see the difference in age-group mortality by different pollution parameters. The districts with PM2.5 concentration above the National Ambient Air Quality Standard (NAAQS) level of 40μg/m3 show a higher risk of neonatal (OR-1.86, CI 1.418-2.433), postneonatal (OR-2.04, CI 1.399-2.971), child (OR-2.19, CI 0.999-4.803) and adult death (OR-1.13, CI 1.060-1.208). The absence of a separate kitchen shows a higher probability of neonatal (OR: 1.18, CI 1.074-1.306) and adult death (OR-1.06, CI 1.027-1.088). The interaction between PM2.5 levels above NAAQS and HAP leads toa substantial rise in mortality observed for neonatal (OR 1.19 CI 1.051-1.337), child (OR 1.17 CI 1.054-1.289), and adult (OR 1.13 CI 1.096-1.168) age groups. This study advocates that there is a strong positive association between ambient and HAP and mortality risk. PM2.5 pollution significantly contributes to the mortality risk in all age groups. Children are more vulnerable to HAP than adults. In India, policymakers should focus on reducing the anthropogenic PM2.5 emission at least to reach the NAAQS, which can substantially reduce disease burden and, more precisely, mortality.

Long-Term Outcomes, Including Fetal and Neonatal Prognosis, of Renal Oligohydramnios: A Retrospective Study over 22 Years

To assess the long-term outcome of renal oligohydramnios and risk factors for fetal, neonatal, and postneonatal death. This retrospective cohort study included fetuses with prenatally detected renal oligohydramnios between 2002 and 2023. Patients who were lost to follow-up were excluded. Fetal, neonatal, and long-term outcomes were evaluated, and their risk factors were analyzed. Of 131 fetuses with renal oligohydramnios, 46 (35%) underwent a termination of pregnancy, 11 (8%) had an intrauterine fetal death, 26 (20%) had a neonatal death, nine (7%) had a postneonatal death, and 39 (30%) survived. Logistic regression analyses showed that an earlier gestational age at onset (odds ratio 1.16, 95% confidence interval (CI) 1.01-1.37) was significantly associated with intrauterine fetal death; anhydramnios (odds ratio 12.7, 95% CI 1.52-106.7) was significantly associated with neonatal death as a prenatal factor. Although neonatal survival rates for bilateral renal agenesis, bilateral multicystic dysplastic kidney (MCDK), and unilateral MCDK with contralateral renal agenesis were lower than for other kidney diseases, one case of bilateral renal agenesis and two of bilateral MCDK survived with fetal intervention. Kaplan-Meier overall survival rates were 57%, 55%, and 51% for 1, 3, and 5 years, respectively. In the Cox proportional hazards model, birth weight <2000 g (hazard ratio 7.33, 95% CI 1.48-36.1) and gastrointestinal comorbidity (hazard ratio 4.37, 95% CI 1.03-18.5) were significant risk factors for postneonatal death. Long-term survival following renal oligohydramnios is a feasible goal and its appropriate risk assessment is important.

IJCM_48A: Nutritional Challenges in Tribal Infants: The Tragic Link to Beriberi and Mortality

Background: Infant mortality is a critical public health indicator that reflects the well-being of a population. In India, infant mortality remains a poignant challenge, reflecting the nation’s diverse healthcare landscape. Despite commendable strides in recent years, infants continue to face a higher risk of mortality, influenced by a complex interplay of factors such as maternal health, socioeconomic disparities, and limited access to quality healthcare. Currently in India NNMR-24.9, IMR-35.2 (NFHS 5), As the SVYM tribal RCH program was implemented in 3 districts (Mysore, Chamarajanagar &amp; Kodagu Districts), recorded infant mortality in this area IMR- 62.93 (during Jan to Dec 2022), higher than the national average, most of infant deaths falls under are postneonatal deaths. This abstract will spotlight the impact of infant mortality in specific contexts, such as within tribal populations, considering unique socio-cultural aspects that influence health outcomes. Objectives: Identify factors responsible for infant deaths among tribal communities under intervention areas of SVYM Methodology: Identify factors responsible for infant deaths among tribal communities under intervention areas of SVYM Results: 73% of women who experienced infant deaths were aged &lt;25 years, 8% were illiterate and 96% depended on daily wages. 99 % of Pregnant mothers received ANC check-ups. 95 % were institutional deliveries and 5 % were home delivery. Out of 75 infant deaths, 51% were male, and 49% were female, 51(68%) were low birth weight, 22(29%) infant deaths in Hdkote &amp; 56(75%) were in Jenu kuruba, 2(3%) in Betta kuruba &amp; Paniya. Age of infants during death, 46(61%) infant deaths (29 days to 6 months) and 4 deaths (6 to 12 months) were postneonatal, 12(16%) were early neonatal deaths,13 (17%) were Late neonatal death. 68% of infant deaths were at Home, 32% in hospitals. 29% of babies were admitted to NICU due to various reasons like 10(48%) LBW, 4(19%) preterm &amp; Neonatal jaundice,1(3%) breathing difficulties, and 2(10%) not drinking milk and 88% started breastfeeding within 1 hour. As per verbal autopsy before the death Infants had the following symptoms, 55.47% breathing difficulty, 28.40 % fever, and excess crying, 24.30% cold, 18.9% vomiting, 14.90% cough, and change in voice 9.5%. Based on the FGD and personal interviews found that most of the tribes depend on the government rations in these high-risk regions, which results in Poor dietary diversity, food preparation, cooking practices, and traditional post-partum food restrictions. uncertainties surrounding the identification and assessment of thiamine deficiency, due to the broad non-specific clinical manifestations, that overlap with other conditions resulting in frequent misdiagnosis and missed treatment opportunities, and secondly the lack of readily available and agreed upon biomarker analysis. Conclusion: The prevalence of beriberi in tribal populations presents a pressing health concern that demands attention and targeted interventions. Remains an important public health problem where highly polished rice is the major staple food and other primary dietary sources of thiamine are in short supply. The impact of nutritional deficiency on infant mortality within these communities underscores the need for comprehensive strategies addressing both prevention and treatment. Education on nutrition, promotion of diverse and nutrient-rich diets, and accessibility to fortified foods or supplements can play pivotal roles in mitigating the risk of beriberi.

Population-based surveillance for birth defects potentially related to Zika virus infection including 3-year mortality and developmental outcomes, and Early Intervention Program service use-New York City, 2016 birth cohort.

In response to the 2015-2017 Zika virus outbreak, New York City (NYC) identified and monitored infants with birth defects potentially related to congenital Zika virus. Administrative data matches were used to describe the birth characteristics of children born in 2016 meeting screening criteria for birth defects potentially related to congenital Zika virus infection relative to other NYC births and to monitor mortality and Early Intervention Program use through age 2. Among 120,367 children born in NYC in 2016, 463 met screening criteria and 155 met the Centers for Disease Control and Prevention's case definition for birth defects potentially related to congenital Zika virus infection (1.3 per 1000; 95% confidence interval [CI], 1.1-1.5). Post-neonatal deaths occurred among 7.7% of cases (12) and 5.2% of non-cases (8). Odds of referral to the Early intervention Program among children who met screening criteria were lower among children of mothers who were married (OR, 0.60; 95% CI, 0.37-0.97) and among children not classified as cases whose mothers were born in Latin America and the Caribbean (OR, 0.59; 95% CI, 0.37-1.09). Prevalence of birth defects potentially related to congenital Zika virus infection was similar to that seen in other jurisdictions without local transmission. Birth defects attributable to congenital Zika virus infection may also have been present among screened children who did not meet the case definition.

Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network.

The number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3 million in 2019 (with 2.8 million deaths occurring in those aged 1-59 months [53% of all deaths in children aged <5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival. To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network conducts childhood mortality surveillance in sub-Saharan Africa and South Asia using innovative postmortem minimally invasive tissue sampling (MITS). In this cross-sectional study, MITS was conducted in deceased children aged 1 to 59 months at 7 sites in sub-Saharan Africa and South Asia from December 3, 2016, to December 3, 2020. Data analysis was conducted between October and November 2021. The expert panel attributed underlying, intermediate, and immediate conditions in the chain of events leading to death, based on histopathologic analysis, microbiological diagnostics, clinical data, and verbal autopsies. In this study, MITS was performed in 632 deceased children (mean [SD] age at death, 1.3 [0.3] years; 342 [54.1%] male). The 6 most common underlying causes of death were malnutrition (104 [16.5%]), HIV (75 [11.9%]), malaria (71 [11.2%]), congenital birth defects (64 [10.1%]), lower respiratory tract infections (LRTIs; 53 [8.4%]), and diarrheal diseases (46 [7.2%]). When considering immediate causes only, sepsis (191 [36.7%]) and LRTI (129 [24.8%]) were the 2 dominant causes. An infection was present in the causal chain in 549 of 632 deaths (86.9%); pathogens most frequently contributing to infectious deaths included Klebsiella pneumoniae (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), Plasmodium falciparum (122 of 549 [22.2%]), and Streptococcus pneumoniae (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and Acinetobacter baumannii (39 [7.1%]; 35 of 39 [89.7%] considered nosocomial), also played important roles. For the top underlying causes of death, the median number of conditions in the chain of events leading to death was 3 for malnutrition, 3 for HIV, 1 for malaria, 3 for congenital birth defects, and 1 for LRTI. Expert panels considered 494 of 632 deaths (78.2%) preventable and 26 of 632 deaths (4.1%) preventable under certain conditions. In this cross-sectional study investigating causes of child mortality in the CHAMPS Network, results indicate that, in these high-mortality settings, infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition. These results also highlight opportunities for action to prevent deaths and reveal common interaction of various causes in the path toward death.

Identification of bacterial pathogens in sudden unexpected death in infancy and childhood using 16S rRNA gene sequencing.

Sudden unexpected death in infancy (SUDI) is the most common cause of post-neonatal death in the developed world. Following an extensive investigation, the cause of ~40% of deaths remains unknown. It is hypothesized that a proportion of deaths are due to an infection that remains undetected due to limitations in routine techniques. This study aimed to apply 16S rRNA gene sequencing to post-mortem (PM) tissues collected from cases of SUDI, as well as those from the childhood equivalent (collectively known as sudden unexpected death in infancy and childhood or SUDIC), to investigate whether this molecular approach could help identify potential infection-causing bacteria to enhance the diagnosis of infection. In this study, 16S rRNA gene sequencing was applied to de-identified frozen post-mortem (PM) tissues from the diagnostic archive of Great Ormond Street Hospital. The cases were grouped depending on the cause of death: (i) explained non-infectious, (ii) infectious, and (iii) unknown. In the cases of known bacterial infection, the likely causative pathogen was identified in 3/5 cases using bacterial culture at PM compared to 5/5 cases using 16S rRNA gene sequencing. Where a bacterial infection was identified at routine investigation, the same organism was identified by 16S rRNA gene sequencing. Using these findings, we defined criteria based on sequencing reads and alpha diversity to identify PM tissues with likely infection. Using these criteria, 4/20 (20%) cases of unexplained SUDIC were identified which may be due to bacterial infection that was previously undetected. This study demonstrates the potential feasibility and effectiveness of 16S rRNA gene sequencing in PM tissue investigation to improve the diagnosis of infection, potentially reducing the number of unexplained deaths and improving the understanding of the mechanisms involved.

Improving outcomes for children with malaria, diarrhoea and pneumonia in Mozambique: A cluster randomised controlled trial of the inSCALE technology innovation.

The majority of post-neonatal deaths in children under 5 are due to malaria, diarrhoea and pneumonia (MDP). The WHO recommends integrated community case management (iCCM) of these conditions using community-based health workers (CHW). However iCCM programmes have suffered from poor implementation and mixed outcomes. We designed and evaluated a technology-based (mHealth) intervention package 'inSCALE' (Innovations At Scale For Community Access and Lasting Effects) to support iCCM programmes and increase appropriate treatment coverage for children with MDP. This superiority cluster randomised controlled trial allocated all 12 districts in Inhambane Province in Mozambique to receive iCCM only (control) or iCCM plus the inSCALE technology intervention. Population cross-sectional surveys were conducted at baseline and after 18 months of intervention implementation in approximately 500 eligible households in randomly selected communities in all districts including at least one child less than 60 months of age where the main caregiver was available to assess the impact of the intervention on the primary outcome, the coverage of appropriate treatment for malaria, diarrhoea and pneumonia in children 2-59months of age. Secondary outcomes included the proportion of sick children who were taken to the CHW for treatment, validated tool-based CHW motivation and performance scores, prevalence of cases of illness, and a range of secondary household and health worker level outcomes. All statistical models accounted for the clustered study design and variables used to constrain the randomisation. A meta-analysis of the estimated pooled impact of the technology intervention was conducted including results from a sister trial (inSCALE-Uganda). The study included 2740 eligible children in control arm districts and 2863 children in intervention districts. After 18 months of intervention implementation 68% (69/101) CHWs still had a working inSCALE smartphone and app and 45% (44/101) had uploaded at least one report to their supervising health facility in the last 4 weeks. Coverage of the appropriate treatment of cases of MDP increased by 26% in the intervention arm (adjusted RR 1.26 95% CI 1.12-1.42, p<0.001). The rate of care seeking to the iCCM-trained community health worker increased in the intervention arm (14.4% vs 15.9% in control and intervention arms respectively) but fell short of the significance threshold (adjusted RR 1.63, 95% CI 0.93-2.85, p = 0.085). The prevalence of cases of MDP was 53.5% (1467) and 43.7% (1251) in the control and intervention arms respectively (risk ratio 0.82, 95% CI 0.78-0.87, p<0.001). CHW motivation and knowledge scores did not differ between intervention arms. Across two country trials, the estimated pooled effect of the inSCALE intervention on coverage of appropriate treatment for MDP was RR 1.15 (95% CI 1.08-1.24, p <0.001). The inSCALE intervention led to an improvement in appropriate treatment of common childhood illnesses when delivered at scale in Mozambique. The programme will be rolled out by the ministry of health to the entire national CHW and primary care network in 2022-2023. This study highlights the potential value of a technology intervention aimed at strengthening iCCM systems to address the largest causes of childhood morbidity and mortality in sub-Saharan Africa.

Causes of death in children with congenital anomalies up to age 10 in eight European countries

BackgroundCongenital anomalies (CAs) increase the risk of death during infancy and childhood. This study aimed to evaluate the accuracy of using death certificates to estimate the burden of CAs on...

A Comprehensive Review of Causes and Determinants of Maternal and Infant Mortality in Uttarakhand

India is trying to achieve the target of sustainable development goals of reducing maternal mortality ratio to 70/1,00,000 live births by the year 2030. The maternal mortality in Uttarakhand is 89/100,000 live birth (2015–2017), against the national average of 122. Daley in the care during the labour process, poor transport system, and inadequate health care facilities for maternal care leading to maternal and infant mortality are not well understood, including other contributing factors. In Uttarakhand, maternal haemorrhage (22.9%), eclampsia (14.6%), sepsis (10.6%), rupture of the uterus (6.2%), ectopic pregnancy (2.1%), and pulmonary embolism (2.1%) were the direct causes for maternal mortality; the indirect causes were anaemia (16.6%), jaundice (12.5%), heart diseases during pregnancy (6.2%), and other communicable diseases (6.3%). Age at pregnancy, not having health schemes, health care accessibility, presence of complications, and residing in a rural area were additional risk factors. Being multigravida adds to a higher risk for women to die (66.7%). Common causes of neonatal mortality were birth asphyxia (20.4%) and preterm birth (15.4%), whereas pneumonia (26.1%), septicaemia (12.5%), diarrhoeal and acute gastroenteritis (19%) were common causes for post-neonatal deaths. It was also reported that prematurity with respiratory distress syndrome (37.7%), septicaemia (16.8%), and perinatal asphyxia (13.9%) were the leading causes in Uttarakhand, while neonatal seizures (3.54%), congenital anomalies (3.23%), intrauterine growth restriction (IUGR) (2.6%), and neonatal jaundice (2.3%) were fewer common causes reported. Multidirectional contributing factors had been reported for maternal and infant mortality, so it needs a multidimensional approach to address the issue.

Maternal Opioid Use Disorder and the Risk of Postneonatal Infant Mortality

The risk of serious long-term outcomes for infants born to individuals with opioid use disorder (OUD) is not fully characterized, nor is it well understood whether risks are modified by infant diagnosis of neonatal opioid withdrawal syndrome (NOWS). To characterize the risk of postneonatal infant mortality among infants with a NOWS diagnosis or born to individuals with OUD. The study team conducted a retrospective cohort study of 390 075 infants born from 2007 through 2018 to mothers who were enrolled in Tennessee Medicaid from 183 days prior to delivery through 28 days post partum (baseline). Maternal and infant baseline characteristics were measured using administrative claims and birth certificates, and infants were followed up from day 29 post partum through day 365 or death. Deaths were identified using linked death certificates through 2019. These data were analyzed from February 10, 2022, through March 3, 2023. Infant exposures included birth to an individual with OUD or postnatal diagnosis of NOWS. The study team defined a pregnant individual's OUD status (maternal OUD) as having OUD diagnosis or a maintenance medication prescription fill during baseline; this study defined NOWS as having NOWS diagnosis up to day 28. Groups were categorized by exposures as maternal OUD with NOWS (OUD positive/NOWS positive), maternal OUD without NOWS (OUD positive/NOWS negative), no documented maternal OUD with NOWS (OUD negative/NOWS positive), and no documented maternal OUD or NOWS (OUD negative/NOWS negative, unexposed). The outcome was postneonatal infant death, confirmed by death certificates. Cox proportional hazards models were used, adjusting for baseline maternal and infant characteristics, to estimate adjusted hazard ratios (aHRs) and 95% CIs for the association between maternal OUD or NOWS diagnosis with postneonatal death. Pregnant individuals in the cohort had a mean (SD) age of 24.5 (5.2) years; 51% of infants were male. The study team observed 1317 postneonatal infant deaths and incidence rates of 3.47 (OUD negative/NOWS negative, 375 718), 8.41 (OUD positive/NOWS positive, 4922); 8.95 (OUD positive/NOWS negative, 7196), and 9.25 (OUD negative/NOWS positive, 2239) per 1000 person-years. After adjustment, the risk of postneonatal death was elevated for all groups, relative to the unexposed: OUD positive/NOWS positive (aHR, 1.54; 95% CI, 1.07-2.21), OUD positive/NOWS negative (aHR, 1.62; 95% CI, 1.21-2.17), and OUD negative/NOWS positive (aHR, 1.64; 95% CI, 1.02-2.65). Infants born to individuals with OUD or with a NOWS diagnosis had an increased risk of postneonatal infant mortality. Future work is necessary to create and evaluate supportive interventions for individuals with OUD during and after pregnancy to reduce adverse outcomes.

Risk of Postneonatal Infant Mortality Associated With Prior Founded Allegations of Child Abuse.

Context: There are ∼7500 postneonatal deaths (28 days to under 1 year) in the US annually, of which a majority are preventable. Previous studies have reported a child's prior encounter with child protective services (CPS) as a risk factor for preventable death but few studies have evaluated this in relation to subsequent postneonatal deaths. Objective: To measure the association between prior reports of child abuse and subsequent postneonatal death. Study Design/Analysis: Secondary data analysis from the case-control Chicago Infant Mortality Study (CIMS). Conditional logistic regression modeling determined the odds of postneonatal death when there was a founded prior allegation. Setting and Population Studied: CIMS included all sudden, unexplained infant deaths up to 1 year in Chicago (November 1993-April 1996) (n=469), and matched living controls (n=472). Information on prior child abuse reports and outcomes was obtained through the Illinois Department of Children and Family Services (DCFS) State Central Registry for each case and control. Instrument: Cause of death was determined by Cook County Medical Examiners based on autopsy, death scene investigation and review of the medical history. DCFS database was searched on infant's name, mother's name, screening number and other identifiers. Only "founded" allegations that occurred prior to the date of death (cases) and date of interview (controls) were included Outcome measures: Founded allegations for cases by cause of death. Odds of death by prior allegations and other socio-demographic factors. Results: DCFS founded allegations were identified in 119 cases (25%) and/or their families and in 35 controls (7%; OR = 4.25, 95% CI, 2.86, 6.35). There were no clear patterns when frequency of allegations was analyzed by cause of death. Families with founded allegations were almost 4 times more likely to experience a postneonatal death (aOR =3.79, 95% CI, 1.56, 9.10). Lower maternal education, age, inadequate prenatal care and infant-parent bedsharing were also associated with higher odds of postneonatal death. Conclusions: Child protective services involvement is an opportunity for education to help reduce the incidence of potentially preventable infant deaths. Families should have access to appropriate acute and preventive care and receive ongoing education about child abuse prevention, infant safety, reducing the risk of preventable deaths such as SIDS, and when to seek medical attention.

Risk factors related to preventable infant mortality in Espirito Santo, Brazil

ObjectiveTo analyse the factors associated with preventable of infant mortality, in Espirito Santo, Brazil. MethodsData were collected from records of notifiable of infant death of the Mortality Information System. A total of 5,089 infant deaths were classified as preventable and non-preventable according to the International Collaborative Effort on Infant Mortality (ICE) and the State System of Data Analysis Foundation (SEADE) methods. To investigate the factors associated with preventable of deaths, it was applied the logistic regression. ResultsApproximately, 73% of the deaths were preventable according to the ICE, while 76% were preventable according to the SEADE method. Using to both methods, it was observed that preterm birth, postneonatal death and birth weight between 3000 and above 4,000 g represented higher chances for preventable infant deaths. Furthermore, the medical care was more likely to preventable infant death only for ICE method. ConclusionsThe factors related to the quality of care offered in the prenatal, prepartum and childbirth periods were more relevant for the occurrence of preventable infant death. Accordingly, it is recommended to strengthen mother-child care to detect risk pregnancies during prenatal care, as well as a hierarchical, regionalized and integrated perinatal network.

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia.

The global burden of stillbirth has declined over time. However, the problem is still prominent in South Asian and Sub-Saharan African countries. Ethiopia is one of the top stillbirth-reporting countries worldwide. Despite several measures taken to reduce the burden of stillbirth; the pace of decline was not as good as the post-neonatal death. Thus, this study is aimed at identifying potential factors related to stillbirth in Ethiopia based on nationally reviewed perinatal deaths. The national perinatal death surveillance data were used for this study. A total of 3,814 reviewed perinatal death were included in the study. Two model families,namely generalized estimating equation, and alternating logistic regression models from marginal model family were employed to investigate the risk factors of stillbirth. The alternating logistic regression model was selected as the best fit for the final analysis. Among reviewed perinatal deaths nearly forty percent (37.4%) were stillbirths. The findings from the multivariate analysis demonstrated that the place of birth (in transit and at home), cause of death (infection, and congenital and chromosomal abnormalities), maternal health condition (women with complications of pregnancy, placenta, and cord), delay one (delay in deciding to seek care) and delay three (delay in receiving adequate care) were associated with an increased risk of having a stillbirth. On the other hand, maternal education (women with primary and above education level) and the type of health facility (women who were treated in secondary and tertiary health care) were associated with a decreased risk of having a stillbirth. The study identified that both individual (place of delivery, cause of death, maternal health condition, maternal education, and delay one) and facility level (type of health facility and delay three) factors contributed to stillbirth outcome. Therefore, policies that are aimed at encouraging institutional delivery, improving health seeking behavior, and strengthening facility-level readiness should be devised to reduce the high burden of stillbirth in Ethiopia.

Performance of host-response biomarkers to risk-stratify children with pneumonia in Bhutan

Pneumonia is the leading cause of post-neonatal death amongst children under five years of age; however, there is no simple triage tool to identify children at risk of progressing to severe and fatal disease. Such a tool could assist for early referral and prioritization of care to improve outcomes and enhance allocation of scarce resources. We compared the performance of inflammatory and endothelial activation markers in addition to clinical signs or scoring scales to risk-stratify children hospitalized with pneumonia at the national referral hospital of Bhutan with the goal of predicting clinical outcome. Of 118 children, 31 evolved to a poor prognosis, defined as either mortality, admission in the paediatric intensive care unit, requirement of chest drainage or requirement of more than five days of oxygen therapy. Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) was the best performing biomarker and performed better than clinical parameters. sTREM-1 levels upon admission had good predictive accuracy to identify children with pneumonia at risk of poor prognosis. Our findings confirm that immune and endothelial activation markers could be proactively used at first encounter as risk-stratification and clinical decision-making tools in children with pneumonia; however, further external validation is needed.

Factors associated with post-neonatal mortality in Ethiopia: Using the 2019 Ethiopia mini demographic and health survey.

Post-neonatal mortality is the number of deaths of infants aged 28 days through 11 months and is expressed as post-neonatal deaths per 1000 live births per year. This study aimed to identify the factors that influence post-neonatal death using the 2019 Ethiopia mini demographic and health survey (EMDHS2019). The study included 2126 post neonates born from mothers who had been interviewed about births in the five years before the survey. The survey gathering period was carried out from March 21, 2019, to June 28, 2019. The data were first analyzed with a chi-square test of association, and then relevant factors were evaluated with binary logistic regression models and the results were interpreted using adjusted odds ratio (AOR) and confidence interval(CI) of parameters. The prevalence of post neonatal death was 16% (95% CI: 15.46, 17.78). The study also showed that not vaccinated post-neonates (AOR = 2.325, 95% CI: 1.784, 3.029), mothers who were not receiving any tetanus injection (AOR = 2.891, 95% CI: 2.254, 3.708), mothers age group 15-24(AOR = 1.836, 95% CI: 1.168, 2.886), Afar (AOR = 2.868, 95% CI: 1.264, 6.506), Somali(AOR = 2.273, 95% CI: 1.029, 5.020), Southern Nations, Nationalities, and People's Region(SNNP) (AOR = 2.619, 95% CI: 1.096, 6.257), 2-4 birth orders (AOR = 1.936, 95% CI: 1.225, 3.060), not attend antenatal care(ANC) visit (AOR = 6.491, 95% CI: 3.928, 10.726), and preceding birth interval less than 24 months (AOR = 1.755, 95% CI: 1.363,2.261) statistically associated with a higher risk of post neonatal death. Although not given anything other than breast milk (AOR = 0.604, 95% CI 0.462, 0.789), urban residents (AOR = 0.545, 95% CI: 0.338, 0.877), single births (AOR = 0.150, 95% CI: 0.096, 0.234), less than 3 children in a family (AOR = 0.665, 95% CI 0.470, 0.939) and the head of the male household (AOR = 0.442, 95% CI: 0.270, 0.724) were statistically associated with a lower risk of post-neonatal mortality. It is highly suggested that maternal and child health care services (including antenatal care visits, postnatal care visits, and immunization) be strengthened and monitored during the early stages of infancy. Mothers from Somali, Afar, and SNNP regions, as well as multiple births, rural residents, and those giving birth to a child with a birth gap of fewer than 24 months, demand special care.