Risk Factors For Neonatal Mortality Research Articles

Ethnic differences in risk factors for neonatal mortality and morbidity in the neonatal intensive care unit

Although our knowledge about how to care for high-risk neonates who require intensive care is continually improving, disparities in health outcomes among various ethnic groups living in developed countries are becoming more evident. The purpose of this study was to identify the risk factors for neonatal intensive care unit (NICU) mortality among Canadian-born minority infants and, furthermore, to determine whether ethnicity was in itself an independent predictor of mortality or major morbidity in the NICU. Data were prospectively gathered on 6528 infants admitted to nine regionally located NICUs across Canada. Multiple logistic regressions were used to develop risk-adjusted models for NICU mortality and major morbidity. Despite adjusting for differences in small for gestational age (SGA), outborn status and gestational age less than or equal to 28 weeks, South Asian infants still had significantly greater odds of mortality in the NICU. Neonatal sepsis was the strongest predictor of mortality among African infants, even greater than birth at 28 weeks or less. At significantly greater odds of survival with major morbidity were Aboriginal males and East Asian females. There are ethnic disparities in the risks of neonatal mortality and morbidity in the NICU. Understanding these differences is important to be able to determine specific areas to target in improving healthcare delivery and reducing disparities in health outcomes among Canada's diverse population.

Risk factors for neonatal mortality in rural areas of Bangladesh served by a large NGO programme

Neonatal deaths account for about half of all deaths among children under 5 years of age in Bangladesh, making prevention a major priority. This paper reports on a study of neonatal deaths in 12 areas of Bangladesh served by a large NGO programme, which had high coverage of reproductive health outreach services and relatively low neonatal mortality in recent years. The study aimed to identify the main factors associated with neonatal mortality in these areas, with a view to developing appropriate strategies for prevention. A case-control design was adopted for collection of data from mothers whose children, born alive in 2003, died within 28 days postpartum (142 cases), or did not (617 controls). Crude and adjusted odds ratios (AOR) were calculated as estimates of relative risk for neonatal death, using 'neighbourhood' controls (241) and 'non-neighbourhood' controls (376). A similar proportion of case and control mothers had received NGO health education and maternal health services. The main risk factors for neonatal death among 122 singleton babies, based on the two sets of controls, were: complications during delivery [AOR, 2.6 (95% CI: 1.5-4.5) and 3.1 (95% CI: 1.8-5.3)], prematurity [AOR, 7.2 (95% CI: 3.6-14.4) and 8.3 (95% CI: 4.2-16.5)], care for a sick neonate from an unlicensed 'traditional healer' [AOR, 2.9 (95% CI 0.9-9.5 and 5.9 (95% CI: 1.3-26.3)], or care not sought at all [AOR, 23.3 (95% CI: 3.9-137.4)]. The strongest predictor of neonatal death was having a previous sibling not vaccinated against measles [AOR, 5.9 (95% CI: 2.2-15.5) and 12.0 (95% CI: 4.5-31.7)]. The findings of this study indicate the need for identification of babies at high risk and early postpartum interventions (40.2% of the deaths occurred within 24 hours of delivery). Relevant strategies include special counselling during pregnancy for mothers with risk characteristics, training birth attendants in resuscitation, immediate postnatal check-up in the home for high-risk babies identified at delivery, advice for mothers on appropriate care-seeking for sick babies, improving the capacity of sub-district hospitals for emergency obstetric and newborn care, and promotion of institutional deliveries.

Neuroprotective effect of topiramate on hypoxic ischemic brain injury in neonatal rats

Perinatal hypoxia–ischemia is one of the most common risk factors for neonatal mortality and permanent neurodevelopmental disability. Topiramate [2,3:4,5-bis- o-(1-methylethylidene) β- d-fructo-pyranose sulfamate; TPM] is widely used as an antiepileptic agent with multiple targets. In the present study, we found that treatment with TPM reduced the neuronal damage induced by oxygen–glucose deprivation in vitro with strong inhibition of the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) receptor. Because perinatal hypoxia is mediated, at least in part, by aberrant glutamatergic excitation, we tested whether treatment with TPM was effective against perinatal brain hypoxia–ischemia. Intraperitoneal or oral pretreatment with TPM was found to reduce the brain damage and subsequent cognitive impairments induced by transient hypoxia–ischemia in perinatal rats. A potent neuroprotective effect of TPM was also observed in a post-treatment regime although post-treatment window appears to be relatively narrow (<2 h). These results suggest that TPM treatment may be beneficial for perinatal hypoxia–ischemia and related damage.

Via de parto e risco para mortalidade neonatal em Goiânia no ano de 2000

To determine factors associated to vaginal delivery and increased neonatal mortality in cohort studies of newborns. A retrospective cohort study was carried out using linkage data from the Information System on Live Births and Mortality Data System database, which included all newborns in Goiânia for the year 2000. A stratified analysis of delivery routes and maternity hospitals by risk factors of neonatal mortality was conducted through the calculation of relative risk at a 5% significance level. Statistical analyses were carried out using the Chi-square test at a 5% significance level. Vaginal deliveries were more commonly seen than cesarean sections in situations where there was an increased risk of neonatal mortality. Public hospitals, where vaginal deliveries predominated, were sought by the majority of those pregnant women with an increased risk of neonatal mortality. Private hospitals, not affiliated to the public-funded Brazilian Healthcare System (SUS) and where the incidence of cesarean section was as high as 84.9%, opted for vaginal delivery in situations of greater risk, such as extreme prematurity and very-low-birth-weight infants. The association between vaginal delivery and increase neonatal mortality resulted from a selection bias due to the distribution of pregnant women in the hospital network. In addition, this selection bias also resulted from an almost universal preference for cesarean sections in low-risk pregnancies as opposed to vaginal delivery for pregnancies with an increased risk of neonatal mortality.

Fatores de risco para mortalidade neonatal em Blumenau, Santa Catarina: linkage entre bancos de dados

OBJETIVOS: investigar os fatores de risco para a mortalidade neonatal no município de Blumenau, Santa Catarina, empregando como possíveis fatores de risco as variáveis apresentadas nas "Declarações de Nascidos Vivos". MÉTODOS: trata-se de um estudo de coorte com apresentação de 3812 nascidos vivos, entre os quais ocorreram 26 óbitos neonatais. Os fatores de risco foram estimados utilizando a regressão logística. RESULTADOS: no modelo final apresentaram associação significativa com o óbito no período neonatal os nascidos com peso menor que 2500 gramas (OR=4,70 IC95%: 1,31-16,87); menor que 36 semanas (OR=4,16; IC95%: 1,22-14,20); Apgar no 5° minuto menor que oito (OR=62,38; IC95%: 22,31-174,39) e presença de anomalia (OR=63,19: IC95%: 15,17-263,15). As variáveis socioeconômicas, médico-assistenciais e de serviços de saúde não apresentaram associação significativa, estando confundidas com os fatores de risco biológicos. CONCLUSÕES: os dados mostram a importância de identificação dos principais fatores de risco de óbito para período neonatal, reafirmando a influência dos fatores biológicos fortemente relacionados ao componente neonatal da mortalidade infantil.

Risk factors for neonatal mortality among extremely-low-birth-weight infants

The purpose of this study was to examine characteristics associated with neonatal mortality among extremely low-birth-weight infants (< or = 1000 g). A population-based, case-control study using linked Missouri birth and death certificates from 1989 to 1997 was conducted. Cases (n = 835) were defined as extremely low-birth-weight infants that died within 28 days of birth. Controls (n = 907) were randomly selected from extremely low-birth-weight infants that were alive at 1 year and were frequency matched to subjects by birth year and birth weight. Infants born with severe congenital anomalies and at the youngest gestational ages were at greatest risk for neonatal mortality. Other significant risk factors included maternal age (< 18 and > 34 years), vaginal delivery, nontertiary hospital care, malpresentation, male gender, and small for gestational age. Black race and preeclampsia were protective against early death. The risk of neonatal mortality among extremely low-birth-weight infants was associated with several maternal, infant, and obstetric factors, some of which may be preventable.

Hydramnios and small for gestational age are independent risk factors for neonatal mortality and maternal morbidity.

The objective was to evaluate the contribution of hydramnios and small for gestational age (SGA) as a combined pathology to maternal and neonatal morbidity and mortality. The study population consisted of 192 SGA neonates with hydramnios, 5,515 SGA neonates with a normal amount of amniotic fluids, 3,714 appropriate for gestational age (AGA) neonates with polyhydramnios and 83,763 AGA neonates with a normal amount of amniotic fluid. A cross-sectional population based study was designed between the four study groups. Multiple logistic regression analysis was used to assess the contribution of these abnormalities and different risk factors to maternal and perinatal complications. The combination of hydramnios/SGA was found to be an independent risk factor for perinatal mortality (OR 20.55; CI 12.6-33.4). Congenital anomalies, prolapse of cord, hydramnios, SGA and grand multiparity were also independent risk factors for perinatal mortality. Independent risk factors for neonatal complications were prolapse of umbilical cord (OR 4.13; 95% CI 1.48-11.5), hydramnios/SGA (OR 2.72; 95% CI 1.81-4.07), chronic hypertension (OR 2.45; 95% CI 1.02-5.9), congenital malformations (OR 1.93; 95% CI 1.14-3.24) and SGA (OR 1.47; 95% CI 1.07-2). Significant independent risk factors for medical interventions during labor were fetal distress (OR 198.46; 95% CI 47.27-825.27), GDM Class B-R (OR 21.22; 95% CI 2.34-192.25), GDM class A (OR 4.64; 95% CI 2.62-8.21), severe pregnancy-induced hypertension (PIH; OR 7.74; 95% CI 2.35-25.42), hydramnios (OR 1.95; 95% CI 1.3-2.91), hydramnios/SGA (OR 1.84; 95% CI 1.12-3.02) and malpresentation (OR 1.56; 95% CI 1.32-1.84). The combination of hydramnios and SGA is an independent risk factor for perinatal mortality and maternal complications. We suggest that the growth restriction of these fetuses is responsible for the neonatal complications, while the hydramnios contributes mainly to maternal complications.

Risk Factors For Neonatal Mortality In A Regional Tertiary Hospital In Nigeria

Objective: To determine the causes of neonatal mortality in a referral centre in Nigeria with a view to developing strategies that will help in reducing it. Methods: This is a retrospective patient record review of the records of 166 infants that died in the newborn unit between 1998 when the unit was established and April 2001. Results: During the study period of 38 months, the mortality was 166 (19.4%) out of a total of 854 admissions. Prematurity, birth asphyxia and sepsis topped the list of causes of death with 30.7%, 24.1%, and 19.3% respectively while postmaturity and intrauterine growth restriction (IUGR) were least with 1.2% each respectively. Conclusions: To reduce this magnitude of mortality among this group of babies there is need to establish more centres with trained personnel that will offer optimal management for the high-risk pregnancies and strategies to reduce the incidence of prematurity and low birth weight babies must be instituted. Nigerian Journal of Clinical Practice Vol. 7(2) 2004: 50-52

The impact of neonatal mortality on subsequent survival in rural Ethiopia.

In countries where most deliveries occur at home and most available information is hospital-based, accurate information on neonatal mortality is difficult to obtain. This study was conducted in a rural community in Ethiopia that has been under monthly demographic surveillance since 1987. The analysis in this paper was based on data collected in the 1st decade (1987-96) and this database was used to calculate mortality incidence rates and analyse survival. The overall neonatal mortality rate was 27/1000 live births (95% CI 24.5-29.5). The rates in the early and late neonatal periods were 20 and 8/1000 live births, respectively (95% CIs 18.0-22.9 and 6.6-9.4). The mortality incidence rates show that, every day, three of every 1000 newborns die in their 1st week of life. Neonatal mortality accounted for 43% of infant mortality. If all neonates survived the 1st week of life, life expectancy would increase by 1 year. Increased risk of neonatal mortality was found to be associated with living in a rural lowland area, twin births and male gender. This paper also addresses the need for further identification of the complex environmental and behavioural risk factors for neonatal mortality and for instituting appropriate and affordable interventions to reduce neonatal mortality.

Risk Factors for Neonatal Mortality in Low-Income Population Subgroups in Karachi, Pakistan

This paper assesses the risk factors for neonatal mortality (0–28 days of life) for full-term singleton live births. The study sample comprised 1,011 ever-married women who were residents of four multi-ethnic, multi-religious low-income areas of Karachi, Pakistan during 1995. The analysis sample was restricted to 4,488 live births to 912 women. Results showed that 4.8% (n = 217) of all births ended in death in the neonatal period, and 76% (n = 164) of these neonatal deaths occurred in the first week of life. While neonatal mortality rates had declined appreciably over time, a large proportion of neonatal deaths were clustered in a small group of women. The univariate analysis showed a statistically significant association between a number of maternal-level parameters (e.g., mother’s age at birth, level of formal education, employment status, religious affiliation, and consanguinity) and child-level parameters (e.g., birth order, birth interval, survival status of the preceding child, sex of the neonate, year of death). At the multivariate level, consanguinity, birth order and year of death were found to be statistically significant risk factors for neonatal mortality analyses despite adjustment for death clustering. The study highlights the importance of inbreeding as a determinant of early offspring death, and points to the need for better understanding of why deaths are clustered in certain families. Given the widespread practice of close cousin marriages in Pakistan across all socio-economic groups, there is a need to validate the findings in less economically disadvantaged population subgroups within the country.

Breech presentation is a risk factor for intrapartum and neonatal death in preterm delivery

Objectives: To determine the prevalence of malpresentation among preterm births and to evaluate the clinical significance of malpresentation as a predictor of neonatal complications in preterm delivery. Study design: A cross-sectional study was conducted comparing 692 nonvertex preterm deliveries of singleton births (24–36 weeks) to 4685 vertex preterm deliveries. Women with gestational age less than 24 weeks and birthweight <500 g were excluded from the study. Results: The study population included 5377 women who met the inclusion criteria. The prevalence of malpresentation was 12.8% (692/5377); 73% in the breech presentation, 22% in the transverse lie, and 5% in other positions. The mean gestational age at birth was significantly lower in the nonvertex group (32.4± 3.5 vs. 34.2±2.6; P<0.0001). Higher rates of perinatal mortality (23.1% vs. 10.1%; P<0.0001) were observed in the nonvertex group when compared with vertex births, as well as other complications such as oligohydroamnion (9.2% vs. 3.2%; P<0.0001); small-for-gestational-age; (10.5% vs. 5.9%; P<0.001); congenital anomalies (11% vs. 5.9%; P<0.001); placental abruption (8.7% vs. 4.1%; P<0.0001); placenta previa (6.8% vs. 2.5%; P<0.0001); premature rupture of membranes (25.4% vs. 16.6%; P<0.0001); chorioamnionitis (7.9% vs. 2.9%; P<0.001); prolapse of cord (2.3% vs. 0.6%; P<0.0001) and cesarean section rate (63.9% vs. 19.1%; P<0.0001). Neonatal mortality was found to be higher for breech presentation, odds ratio (OR)=4 (confidence interval [CI]=2.76–4; P<0.0001), transverse lie, OR=2.1 (1.1–4.12; P<0.02) and for other malpositions, OR=7.3 (2.72–20; P<0.0001). After multivariate adjustment for birthweight, cesarean section, placental pathology and chorioamnionitis, a strong association remained between the presence of breech presentation and neonatal mortality, with an adjusted OR of 2.2 (CI=1.36–3.63; P<0.01). The adjusted OR for the two other groups of malpresentation was not statistically significant. Conclusion: Breech presentation in preterm delivery is an independent risk factor for neonatal mortality after simultaneous adjustment for birthweight, chorioamnionitis and placental pathology. Cesarean section was found to have a protective effect on neonatal mortality rates.

Birth weight in offspring of women with epilepsy.

Epilepsy is the most common neurologic disorder in pregnant women. The prevalence is 0.2-0.6 percent (1-3). Research on epilepsy and pregnancy has mainly been on treatment with antiepileptic drugs and the risk of congenital malformations (4), and a number of studies have demonstrated an increased risk (5-8). We know less about the effect of epilepsy and antiepileptic drug treatment on preterm delivery and intrauterine growth restriction. Both of these events are frequent, and both are important risk factors for neonatal mortality (9, 10) and for childhood morbidity such as cerebral palsy and cognitive dysfunction (11, 12). Furthermore, the consequences of intrauterine growth restriction seem to go far beyond childhood (13). Until now, the studies on the association between epilepsy and preterm delivery and intrauterine growth restriction have led to no overall conclusions. Preterm delivery is defined as delivery before 37 completed weeks of gestation (14). Gestational age may be estimated from the last menstrual period, from ultrasound scanning, or from a postnatal assessment (15). Estimates from the last menstrual period may be biased because the incidences of oral contraceptive failure and vaginal bleeding in pregnancy are increased in women with epilepsy (16, 17). On the other hand, the use of ultrasound may overestimate the risk of preterm delivery in women with epilepsy if early fetal growth restriction is more pronounced in women with epilepsy than in healthy women (18, 19). The most commonly used proxy measure for intrauterine growth restriction is small for gestational age, defined by birth weight below the 10th percentile for the specific gestational age at birth. The 10th percentile is often derived from cross-sectional birth weight for gestational age standards, but standard percentiles vary up to 500 g for term deliveries and may not be specific for gender or race (20). Being small for gestational age may therefore reflect a

Risk factors for neonatal mortality: Harare Central Hospital Neonatal Unit

To assess risk factors for neonatal mortality in a tertiary level neonatal unit. Case control analysis of routine neonatal data for 1998. Harare Central Hospital Neonatal Unit. All neonates delivered at Harare Maternity Hospital and admitted to the neonatal unit for care between January and December 1998. Neonatal mortality in hospital. A total of 5,305 neonatal admissions were studied of which 19.3% died in hospital. The median age at death was two days (Q1 = 1, Q3 = 3) and the median age at hospital discharge was 3 days (Q1 = 1, Q3 = 6). Risk factors for mortality were un-booked mother odds ratio (OR) 2.36 (95% CI = 1.98 to 2.81), breech delivery OR: 1.76 (95% CI = 1.39 to 2.22), low birth weight OR: 4.67 (95% CI = 3.92 to 5.57), prematurity OR: 2.36 (95% CI = 2.09 to 2.66), congenital malformations OR: 2.80 (95% CI = 1.72 to 4.53) and birth asphyxia OR: 1.79 (95% CI = 1.51-2.12). Being admitted for respiratory distress was associated with better survival OR: 0.22 (95% CI = 0.17 to 0.28). Having a Caesarian section was also protective OR: 0.60 (95% CI = 0.47 to 0.76). Mother's age, parity, time of delivery and sex were not significantly associated with mortality odds ratios (95% CI) of 1.07 (0.86 to 1.34), 0.94 (0.78 to 1.13), 1.10 (0.93 to 1.30) and 0.89 (0.78 to 1.03) respectively. On regression analysis birth weight greater than 2,500 g, being un booked and breech delivery were predictive of mortality with OR (95% CI) of 0.99 (0.99 to 0.99), 1.31 (1.12 to 1.61) and 1.15 (1.04 to 1.28) respectively. Low birth weight is the highest risk factor for mortality in this tertiary level hospital. Strategies targeted at low birth weight infants such as antenatal corticosteroid use, improved intrapartum care, appropriate antibiotic use, improved efficiency and access to neonatal intensive care will have the most impact on neonatal mortality.

Small for gestational age: risk factor for neonatal mortality

Variables of birth certificates were analysed as risk factors of SGA (Small for Gestational Age) infantis, and with a view to discovering if retarded intra-uterine growth was a risk factor neonatal mortality. Data were obtained directly from 11 hospital medical records. A cohort of 2.251 hospital live births was obtained. Linkage of the death and birth certificates was undertaken to identify the neonatal deaths. The study was carried out in Santo André county in the S. Paulo Metropolitan area in the period from 1/1 to 30/6/1992. There were 4.3% of SGA live births. A higher statistically significant proportion of SGA was found in pre-term and post-term live births, among live births of mothers with 35 years of age and over and in those whose mothers had less than complete primary education. The SGA live births showed a higher risk of neonatal death, even when allowing for gestational age. In areas where there is a low proportion of low birthweight, the presence of retarded intra-uterine growth may be an important risk factor to pre-term live births, due to the association between the pre-term and SGA. It would be easier to evaluate signs of retarded intra-uterine growth in the live birth population, if the gestational age data were registered, on the birth certificate in weeks.

Discordance Between Male and Female Deaths Due to the Respiratory Distress Syndrome

General neonatal mortality statistics and those for the respiratory distress syndrome (RDS) were examined for the State of Wisconsin from 1979 through 1982. The objectives were to ascertain whether there are differences in total neonatal mortality related to sex and birth weight, to determine the veracity of reported gender differences in deaths due to RDS, and to assess the contribution of other risk factors for neonatal mortality to overall and sex-specific deaths occurring secondary to RDS. Additionally, a prospective analysis was performed at one perinatal center during a 5-year period in attempts to determine whether gender remained a significant factor in deaths due to RDS after adjusting for incidence. Overall, the most frequent diagnoses in those who died were RDS (15.6%), deaths due to complications of pregnancy (8%), immaturity (4.2%), and asphyxia (3.4%). The majority of fatalities for both sexes occur in neonates weighing less than 1 kg and the percentage of deaths attributable to RDS is greatest between 1 and 1.5 kg. The difference between sexes is also maximal in the latter weight group. Deaths secondary to RDS are greater for males regardless of Apgar score at one and five minutes, mode of delivery, maternal age, or ancillary diagnosis. These data suggest that deaths secondary to RDS are consistently greater in male neonates and that delivery within a limited "window" of time during gestation increases male susceptibility to fatal RDS.