Total Neonatal Mortality Research Articles

Exploring association between place of delivery and newborn care with early-neonatal mortality in Bangladesh.

Bangladesh achieved the fourth Millennium Development Goal well ahead of schedule, with a significant reduction in under-5 mortality between 1990 and 2015. However, the reduction in neonatal mortality has been stagnant in recent years. The purpose of this study is to explore the association between place of delivery and newborn care with early neonatal mortality (ENNM), which represents more than 80% of total neonatal mortality in Bangladesh. In this study, 2014 Bangladesh Demographic and Health Survey data were used to assess early neonatal survival in children born in the three years preceding the survey. The roles of place of the delivery and newborn care in ENNM were examined using multivariable logistic regression models adjusted for clustering and relevant socio-economic, pregnancy, and newborn characteristics. Between 2012 and 2014, there were 4,624 deliveries in 17,863 sampled households, 39% of which were delivered at health facilities. The estimated early neonatal mortality rate during this period was 15 deaths per 1,000 live births. We found that newborns who had received at least 3 components of essential newborn care (ENC) were 56% less likely to die during the first seven days of their lives compared to their counterparts who received 0-2 components of ENC (aOR: 0.44; 95% CI: 0.24-0.81). In addition, newborns who had received any postnatal care (PNC) were 68% less likely to die in the early neonatal period than those who had not received any PNC (aOR: 0.32; 95% CI: 0.16-0.64). Facility delivery was not significantly associated with the risk of early newborn death in any of the models. Our study findings highlight the importance of newborn and postnatal care in preventing early neonatal deaths. Further, findings suggest that increasing the proportion of women who give birth in a healthcare facility is not sufficient to reduce ENNM by itself; to realize the theoretical potential of facility delivery to avert neonatal deaths, we must also ensure quality of care during delivery, guarantee all components of ENC, and provide high-quality early PNC. Therefore, sustained efforts to expand access to high-quality ENC and PNC are needed in health facilities, particularly in facilities serving low-income populations.

Evaluation of breastfeeding care and education given to mothers with low-birthweight babies by healthcare workers at a hospital in urban Tanzania: a qualitative study

BackgroundThe total neonatal mortality in Tanzania remains high reaching as much as 44,900 deaths per year, particularly among low birthweight (LBW) babies. This makes Tanzania the fourth African country with the highest number of annual neonatal deaths. Studies have shown the advantages of breast milk for LBW babies and the effectiveness of interventions from healthcare workers (HCWs) to encourage mothers to achieve exclusive breastfeeding (EBF). Although these interventions can substantially reduce mortality in this vulnerable group, they remain insufficient in practice particularly in resource-limited countries. Therefore, there is an urgent need to establish the most appropriate interventions for mothers with LBW babies, particularly in these countries. To help address this need, we evaluated the breastfeeding care and education given to mothers with LBW babies by HCWs during hospitalization in Tanzania.MethodsA qualitative study using semi-structured interviews with mothers of LBW babies at an urban hospital in Tanzania was conducted. We assessed their understanding of breastfeeding at discharge. All the interviews were conducted in local Swahili and then translated to English. Data were analyzed using content analysis.ResultsAmong the 19 mothers interviewed, only four breastfed their baby within an hour after birth. Nine mothers received no support from HCWs when they breastfeed their baby for the first time. Ten mothers received no education on EBF, and there were mothers who misunderstood the EBF definition. Eight answered that they had difficulty breastfeeding their baby at discharge. Four mothers were dissatisfied with the care and education given by HCWs, and six mothers provided suggestions for improvements. Although six mothers had a high reliance on HCWs, they had difficulty asking HCWs questions because of their authoritative attitude and behavior.ConclusionsMothers with LBW babies need special support to increase their ability to breastfeed and ensure EBF continuance. To address the gaps between the currently provided breastfeeding interventions and the ideal breastfeeding interventions, improvements in the quality and quantity of breastfeeding care and education are required. Training HCWs to systematize standard interventions, confirming mothers’ understanding, and ensuring a comfortable environment for mothers are absolutely needed.

The Mortality of Periviable and Extremely Premature Infants and Their Impact on the Overall Neonatal Mortality Rate

To investigate mortality in periviable neonates ≤23 weeks gestational age and calculate its impact on overall neonatal mortality rate over a 12-year period (1998–2009). Verify if periviable mortality decreased in the period (2010–2015). Retrospective review. Neonatal mortality rate per 1000 live births was 11.4. Three hundred forty-nine live birth infants weighed ≤500 g and 336 died. Their proportion to the total neonatal mortality rate was 48.6%; out of 298 periviables 146 (43%) were ≤20 weeks gestational age. In 269 (80%) we could not determine the cause of death. Two hundred ninety-seven neonates (88.3%) died in the delivery room. Sixteen (5%) had an autopsy. Neonatal mortality rate from periviability was 96.2% and constituted half of the overall rate in the period (1998–2009). There was not significant reduction of periviable mortality between 2010 and 2015. Current live birth definition and a reporting system that considers a 100 g periviable live birth infant as a neonatal death has placed Ohio and the United States at a significant disadvantage compared to other countries using different reporting systems.

Cross-sectional study of the quality of neonatal care services in Armenia.

The purpose of this paper is to report the assessment results of the quality of neonatal care services in Armenia and to describe the identified obstacles to improving the quality of care for newborn infants. The study carried out a cross-sectional descriptive design. The data were collected in health facilities with different levels of neonatal care that were selected employing a multi-stage, stratified purposeful sampling design. The quality of neonatal services was assessed using the generic WHO tool. Data collection was performed using face-to-face semi-structured interviews, hospital statistics, medical records and direct observations. In 31 study hospitals, 31,976 deliveries were performed resulting in 31,701 live births and 734 stillbirths. About 85 percent of all neonatal deaths was attributable to early neonatal deaths with over 48 percent occurring during the first 24 h of life. The proportion of neonatal deaths was highest in infants with low birth weight constituting 92.8 percent of all neonatal deaths. The total neonatal mortality rate was 3.50 per 1,000 live births, whereas stillbirth rate and perinatal mortality rate were 22.60 and 25.26 per 1,000 total births in 2015. Specific indicators with relatively lower mean scores included neonatal resuscitation, early breastfeeding, monitoring of newborn conditions, neonatal sepsis, feeding standards, total parenteral nutrition, and infection treatment. Given the limited scope of research on quality assessment, this paper provides valuable information on the status of quality of neonatal care services in Armenian health facilities. This work also extends the existing studies focused on quality assessment through applying the model of Avedis Donabedian with the structure-process-outcomes approach as a theoretical basis.

Incidence of bronchopulmonary dysplasia and mortality of very low birth weight infants in Vojvodina

Introduction/Objective. The incidence of bronchopulmonary dysplasia (BPD) varies depending on the prematurity rate, definition, and therapy that are applied at a certain center. The average incidence of BPD for very low birth weight infants (VLBW) in developed countries ranges 4?53%. The mortality of VLBW infants is high and represents 50% of the total neonatal and infant mortality. In recent years, the survival limits are shifted towards lower gestations. The aim of our study was to determine the incidence and severity of BPD in VLBW infants in Vojvodina and the overall mortality. Methods. This retrospective study was conducted from January 2006 to December 2011 and included 504 infants with birth weight < 1,500 g. Results. In the total premature infants? population, 82.3% survived by the gestational age of 36 weeks. According to the original definition of BPD, as supplemental oxygen use at 28 days of life, BPD had 45.4% of infants. According to the severity based definition 19.4% had mild BPD, 19.8% moderate BPD and 6.5% severe BPD. If BPD is observed as supplemental oxygen use at 36 weeks postmenstrual age, BPD had 26% of infants. Conclusion. The overall mortality and incidence of BPD in our study are comparable to those in some developed countries and lower compared to underdeveloped countries.

What is the Link between Malaria Prevention in Pregnancy and Neonatal Survival in Nigeria?

Neonatal mortality has been recognized as a global public health challenge and Nigeria has the highest prevalence in Africa. Malaria during pregnancy jeopardizes neonatal survival through placental parasitaemia, maternal anaemia, and low birth weight. This study investigated association between the malaria prevention in pregnancy and neonatal survival using a nationally representative data - Nigeria Demographic Health Survey 2013. Child recode data was used and the outcome variable was neonatal death. The main independent variables were the use of at least 2 doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPT-SP) and proportion of pregnant women who reported Insecticide Treated Net (ITN) use the night before the survey. Data were analyzed using Pearson Chi-square (x 2 ) test of association and survival analysis techniques. Total neonatal mortality rate was 38 per1000 live births. Cox proportional hazard model showed that low birth weight (HR 1.49, 95% CI (1.15 - 1.93 p=0.003) and adequate number of ANC visits (≥ 4 visits) (HR 0.68, 95% CI (0.53 - 0.93) were associated with neonatal survival. The use of at least 2 doses of IPT-SP was not an independent factor for neonatal survival (HR 0.72, 95% CI (0.53 - 1.15). Malaria prevention in pregnancy is crucial for neonatal survival through the prevention of low birth weight.

Critical appraisal of the proposed defenses for planned home birth

Two prominent proposed defenses have been offered of planned home birth. The first focuses on the very low absolute risk of planned home birth, which is considered to be safe because it is so low, irrespective of its significantly elevated relative risk. The second invokes an analogy between trial of labor after cesarean delivery and planned home birth. Because trial of labor after cesarean delivery and planned home birth have similar, very low absolute risks and because the former is an acceptable clinical practice, defenders of planned home birth argue that the latter should be considered acceptable. This article presents a critical appraisal of these 2 proposed defenses of planned home birth. Question 1: Are proposed defenses of planned home birth focused on its low absolute risks consistent with the commitment to patient safety? This commitment to patient safety requires the identification of variation in the processes of patient care and reduction of variation when reduction improves outcomes. Relative, as well as absolute, risks therefore must be identified. Compared with hospital midwives, planned home births have a significantly higher relative total neonatal mortality risk of 3.87 (1.26 vs 0.32 per 1000 births; P<.001) and a significantly higher relative risk of 5-minute Apgar score of zero of 18.11 (1.63 vs 0.0/1000 births; P<.001). Planned hospital birth prevents these risks. It follows that planned home birth as a variant in birth setting is not consistent with the commitment to patient safety. Question 2: Is the analogy to trial of labor after cesarean delivery consistent with the philosophic rules of analogic reasoning? The long-established philosophic rules for analogic reasoning require that the 2 cases that are compared are similar in all relevant respects and that all relevant analogies have been considered. The 2 cases are dissimilar because the perinatal risks of planned home births are approximately 3 times higher than trial of labor after cesarean delivery. At least 8 clinical analogies to other situations of very low absolute, but unacceptable, risks are ignored. The clinical implication of the results of this critical appraisal is that obstetricians should respond to expressions of interest in planned home birth based on these proposed defenses with a respectful explanation of the inadequacies, the failure to commit to patient safety, and a recommendation for planned hospital birth.

Neonatal mortality and morbidity in the post-implementation period of a neonatal teaching program in provincial hospitals in Laos

ObjectivesAim of this study was to analyze neonatal mortality and morbidity in the post-implementation period of a neonatal teaching program to examine a possible impact on neonatal outcomes. Study designThis study is a retrospective data analysis of all neonatal patients treated in five provincial hospitals in Laos after implementation of a neonatal teaching program. MethodsA simulation-based teaching program aims to have positive impact on the theoretical and practical skill of hospital staff in the field of newborn care. A comparison between pre-implementation and post-implementation data of newborns admitted to provincial hospitals in Laos was used to quantify the effect of repetitive teaching on neonatal outcomes. ResultsNeonatal mortality and morbidity as well as case fatality rates of infections and asphyxia decreased in the post-implementation period. In contrast, neonatal mortality rate as well as case fatality rate of prematurity increased. The total neonatal mortality rate increased in the post-implementation period. ConclusionsThe pre-implementation and post-implementation data enable longitudinal comparisons between hospitals and highlight the differences between hospitals concerning neonatal mortality and morbidity in provincial hospitals in Laos. These data can serve as a basis for an individual adaption of the teaching program to the unique requirements of each single hospital.

Assessment of the quality of neonatal care in the Solomon Islands.

To identify strengths and obstacles for improving the quality of newborn care in the Solomon Islands. Improving the quality of newborn care is a priority in the Sustainable Development Goals and the Action Plan for Healthy Newborns in the Western Pacific. The neonatal mortality rate in the Solomon Islands, a lower-middle-income country, has improved slower than overall child mortality. In 2013, neonatal mortality (13.2/1000) constituted 44% of under-5 deaths (30.1/1000). A cross-sectional study of newborn care in five provincial hospitals using a World Health Organization assessment tool for hospital quality of care. Twelve months of neonatal records of the National Referral Hospital (NRH) labour ward and nursery were audited. Essential medications and basic equipment were generally available. Challenges included workforce shortages and lack of expertise, high costs, organisation and maintenance of equipment, infection control and high rates of stillbirth. Over 12 months at the NRH labour ward, there were 5412 live births, 65 (1.2%) 'fresh' stillbirths and 96 (1.8%) 'macerated' stillbirths. Over the same period, there were an associated 779 nursery admissions, and the main causes of mortality were complications of prematurity, birth asphyxia, congenital abnormalities and sepsis. Total neonatal mortality at NRH was 16 per 1000 live births, and 77% of deaths occurred in the first 3 days of life. Infrastructure limitations, technical maintenance and equipment organisation were obstacles to newborn care. Greater health-care worker knowledge and skills for early essential newborn care, infection control and management of newborn complications is needed.

Neonatal mortality trends at Al-Nasser paediatric hospital in Gaza, occupied Palestinian territory: a retrospective analysis of hospital records

BackgroundNeonatal mortality accounts for nearly 60% of infant mortality, with this percentage slowly decreasing in developing countries. The aim of this study was to describe the pattern of neonatal mortality rates among neonates who were admitted to the neonatal intensive care unit (NICU) in Al-Nasser Paediatric Hospital (NPH) during a span of 2 years. MethodsThis was a retrospective descriptive study that included 2 years of data (from January 2011 to December 2012) of all neonatal admissions and deaths in the NICU in NPH collected from the medical records. Neonatal mortality rates in 2011 and 2012 were analysed, using R software (version 3.1.0). FindingsThe total number of neonatal admissions to hospital were 1541; 1915 during 2011 and 2012, respectively. 57 and 28 infants died during the each year. The total neonatal mortality rate (NMR) in 2011 (0·037 per 1000 admissions) was significantly higher than NMR in 2012 (0·0146 per 1000 admissions), with the difference being 0·0224 per 1000 admissions (95% CI 0·0114–0·0334, p<0·0001). The most common causes of neonatal deaths were prematurity and its complications followed by congenital anomalies. InterpretationNeonatal mortality in NPH in 2012 was reduced compared with 2011. Whether this reduction was due to renovation of the NICU, equipment improvement, new medical supplies, or improvement in data quality and registration system, or mostly due to human resources training for implementation of neonatal guidelines, is unclear. These findings would not necessarily represent overall changes in NMR between the 2 years since our data are only representative for neonates admitted to the NPH NICU. Further research about other NICUs in Gaza is warranted and could be easily undertaken when the registration systems in Palestinian paediatric hospitals are computerised, unified, and linked. This new system will be the first step to design and develop Gaza Neonatal Network to establish easy communication between NICU in other hospitals and to solve problems, consultation, and finally to estimate causes of NMR. FundingNone.

Spectrum of neonatal diseases requiring respiratory support in UBTH, Benin City, Edo State, Nigeria

Introduction: In Nigeria, eighty two percent of the three leading causes of neonatal mortality may require respiratory support for their management, yet this is unavailable.Objective: To review the spectrum of respiratory disorders that were ventilated, their outcomes and the contribution of such support to survivalMethods: A data base of cases managed in the unit is maintained and reviewed regularly for enhancement of quality of care. Such prospectively documented information on babies who received respiratory support over the period 1st January to 31st June 2014 were analysed.Results: Five hundred and seventy six babies were admitted. Fortynine (8, 5%) received ventilator support. These comprised preterm (77.6%) and term (22.4%) babies with mean gestational age of 33.2 weeks (range 28-41). The spectrum of disorders supported were: respiratory distress syndrome (RDS) 55.1%, asphyxia 20.4%, sepsis12.3%, acute bilirubin encephalopathy (ABE) 8.2%, transient tachypnoea of the new-born (TTNB) 2% and neonatal tetanus (NT) 2%. They were non- invasive support (NIVRS) 33(67.3%) for respiratory distress; invasive support (IVRS) 16(32.7%) for respiratory failure. NIVRS was mostly for RDS (88.9%); ABE (100%) received invasive support. Mortality was: NIVRS7/33(21.2%); IVRS 11/16(68.75 %). Respiratory dysfunction contributed 25.4% of the total neonatal mortality of 123 per thousand. Survival was 63.3%.Conclusion: The morbidities were: asphyxia, prematurity, sepsis, ABE, and tetanus. Ventilator support was non-invasive with bubble CPAP and invasive with mechanical ventilation through endotracheal intubation. Survival was improved. There is the urgent need to commence and sustain basic non -invasive respiratory support in all neonatal units in Nigeria.Keywords: Spectrum; Neonatal diseases; Respiratory support

Globalization and women’s and girls’ health in 192 UN-member countries

Purpose – The purpose of this paper is to explore the relationship between the ratification of the United Nations’ (UN’s) Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and women’s and girls’ health outcomes using a unique longitudinal data set of 192 UN-member countries that encompasses the years from 1980 to 2011. Design/methodology/approach – The authors focus on the impact of CEDAW ratification, number of reports submitted after ratification, years passed since ratification, and the dynamic impact of CEDAW ratification by utilizing ordinary least squares (OLS) and panel fixed effects methods. The study investigates the following women’s and girls’ health outcomes: total fertility rate, adolescent fertility rate, infant mortality rate, maternal mortality ratio, neonatal mortality rate, female life expectancy at birth (FLEB), and female to male life expectancy at birth. Findings – The OLS and panel country and year fixed effects models provide evidence that the impact of CEDAW ratification on women’s and girls’ health outcomes varies by global regions. While the authors find no significant gains in health outcomes in European and North-American countries, the countries in the Northern Africa, sub-Saharan Africa, Southern Africa, Caribbean and Central America, South America, Middle-East, Eastern Asia, and Oceania regions experienced the biggest gains from CEDAW ratification, exhibiting reductions in total fertility, adolescent fertility, infant mortality, maternal mortality, and neonatal mortality while also showing improvements in FLEB. The results provide evidence that both early commitment to CEDAW as measured by the total number of years of engagement after the UN’s 1980 ratification and the timely submission of mandatory CEDAW reports have positive impacts on women’ and girls’ health outcomes. Several sensitivity tests confirm the robustness of main findings. Originality/value – This study is the first comprehensive attempt to explore the multifaceted relationships between CEDAW ratification and female health outcomes. The study significantly expands on the methods of earlier research and presents novel methods and findings on the relationship between CEDAW ratification and women’s health outcomes. The findings suggest that the impact of CEDAW ratification significantly depends on the country’s region. Furthermore, stronger engagement with CEDAW (as indicated by the total number of years following country ratification) and the submission of the required CEDAW reports (as outlined in the Convention’s guidelines) have positive impacts on women’s and girls’ health outcomes.

Clinical outcome and cost of treatment and care for neonates less than 1000 grams admitted to Vali-e ASR Hospital.

BackgroundThe aim of this study is to estimate the cost of care and treatment for extremely low birth weight (ELBW) neonates admitted to a teaching and referral hospital. This cost estimation project can help health policy makers and planners make decisions and develop plans for perinatal service staging programs and better management of NICUs (Neonatal Intensive Care Units).MethodsThis cohort study performed on 50 extremely low birth weight neonates (w ≤ 1000gr) born in Vali-e Asr Hospital, Tehran-Iran in the period of March 2012 to September 2013. This teaching and referral hospital had 15 NICU beds as well as an active neonatal growth and development follow-up clinic with a pediatric neurodevelopment specialist during the period of the study. Cases would undergo initial developmental visits and preventative measures immediately after being admitted to the ward. Also after discharge, they were followed up monthly for six months and then every two months, during first year of life.ResultsOveralls, 23 newborns -46% of ELBW and 40% of total neonatal mortality rate (that amounted 55) died during hospital stay. Beside hospitalization, the major part of expenses was related to medication and medical supplies. All neonates needing rehabilitation underwent this type of intervention for one year. The mean cost of rehabilitation in neonates with no insurance coverage was 6700 US Dollars per year, which is reduced by half (3350 US Dollars) when covered by insurance.ConclusionMedication, medical supplies and equipment cost was significantly high. This is especially due to the fact that the present types of insurances do not cover such expenses very well, forcing parents to pay themselves. Insurance systems are expected to take this issue into immediate account.

English

OBJECTIVE: Aim was to evaluate clinical and associated risk factors for still births and neonatal deaths at tertiary health care centre. METHODS: A retrospective analytical study of new born at birth conducted at tertiary health care centre for three consecutive years. Demographic variables, status of new born at birth, NICU care and neonatal causes of death were analyzed. RESULTS: There were 1072,990,995 births for 2011, 2012, and 2013 year respectively Still births were 30, 36 and 41 and newborn deaths were 15,8,15 for three consecutive years. Mean age of mother was 25.35 yrs standard deviation 4.4. 82 % of still births were preterm. Maximum 67% of still births birth weight was less than 1.5 kg. NICU admission included 51% full term neonate, 44% preterm and 5% post term neonate. Maximum (51%) NICU admissions neonatal birth weight was less < 1.5 kg.79% of dead neonates were preterm. Life threatening congenital defects was seen in 26%. Cause of death birth asphyxia 37% hyaline membrane disease 15%. CONCLUSION: Statistically significant mean gestational age of baby with mother was 38.26 weeks (SD 2.260), NICU neonates 36.70 weeks (SD 3.3) and still births 31.34 weeks (SD 4.6). Maternal urinary tract infection, Hypertensive diseases, diabetes mellitus were major reasons for stillbirths. Neonatal mortality from 26% reduced to 8% with increasing birth weight. Major neonatal deaths are because of birth asphyxia, congenital defects. Low Birth Weight and prematurity were overlapping factor for neonatal death. Still birth rate was 35; perinatal mortality rate was 44/1000 live births. Early neonatal mortality rate & Total neonatal mortality rate was 12 /1000 live births each.

Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009

We examined neonatal mortality in relation to birth settings and birth attendants in the United States from 2006 through 2009. Data from the Centers for Disease Control and Prevention-linked birth and infant death dataset in the United States from 2006 through 2009 were used to assess early and total neonatal mortality for singleton, vertex, and term births without congenital malformations delivered by midwives and physicians in the hospital and midwives and others out of the hospital. Deliveries by hospital midwives served as the reference. Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births. Our study shows a significantly increased total and early neonatal mortality for home births and even higher risks for women of 41 weeks or longer and women having a first birth. These significantly increased risks of neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births.

Expectant Management of Severe Preeclampsia Remote From Term

Preeclampsia occurs in ∼2% to 12% of all pregnancies, and early severe preeclampsia accounts for ∼25% of all cases. The only known treatment for preeclampsia is delivery, yet an early preterm delivery increases the risk for adverse neonatal outcomes. This randomized, multicenter, parallel, open-label clinical trial was undertaken to determine whether expectant management of severe preeclampsia at less than 34 weeks’ gestation results in better perinatal outcomes compared with prompt delivery (PD) after steroid administration. Pregnant women with severe hypertensive disorders at 28 to 33 weeks’ gestation were randomly allocated to the PD or expectant management (EXM) group. Prompt delivery patients received glucocorticoid therapy followed by delivery in 24 to 72 hours. Patients in the EXM group were treated with glucocorticoid therapy followed by delivery only for specific maternal/fetal indications or reaching 34 weeks’ gestation. The primary outcome was perinatal mortality (fetal and neonatal death). Secondary outcomes were composite neonatal morbidities, neonatal birth data, and maternal morbidities and death. Of 267 women, the final cohort included 131 patients (138 births) in the EXM group and 133 (137 births) in the PD group. The 2 groups did not differ significantly in baseline characteristics. Reasons for delivery in the EXM group were uncontrollable blood pressure (40.4%), fetal compromise (29%), persistent symptoms (28.2%), reaching 34 weeks’ gestation (26.0%), and maternal complications (21.3%). Perinatal mortality rates were 9.4% in the PD group and 8.7% in the EXM group, not a significant difference. Composite neonatal morbidities were 56.4% in the PD group and 55.6% in the EXP group (relative risk, 1.01; 95% confidence interval, 0.81–1.26; P = 0.89). The PD group had lower birth weights at delivery (1543 ± 438 vs 1659 ± 509 g), but the EXM group had more small-for-gestational age infants (13 [9.4%] vs 30 [21.7%]; P = 0.005) and abruptio placentae (2 [1.5%] vs 10 [7.6%]; P = 0.01). Rates of total neonatal morbidity and mortality stratified by gestational age at randomization were 85% (63/75), 66.3% (65/98), and 36.2% (37/102), respectively, for 28 to 29 weeks, 30 to 31 weeks, and 32 to 33 weeks, with no significant differences between the PD and EXM groups. The average pregnancy prolongation in the EXM group was 10.3 ± 8 days compared with 2.2 ± 0.8 days in the PD group (P = 0.0001). No maternal deaths occurred. Oral antihypertensive medications to maintain blood pressure at less than 160/110 mm Hg were used in 61 women (46.5%) in the EXM group. No significant differences in perinatal mortality were noted between women with or without oral antihypertensive medications (7 [11.48%] vs 5 [7.14%]; P = 0.29). The incidence of severe hypertension was 41% and 38.6% in these 2 groups, respectively (P = 0.81). Five women in each oral antihypertensive group had abruptio placentae. Higher maternal morbidity (37.7% vs 14.3%; P = 0.02) was found in the EXM group receiving oral antihypertensive medications. The only curative treatment for severe preeclampsia is delivery of the fetus. At very early preterm, the consequences of neonatal prematurity must be weighed against potential maternal morbidity by prolonging gestation. The most important factors for improved neonatal outcome are gestational age on presentation, use of corticosteroids, and providing intensive neonatal care. Severe preeclampsia before 34 weeks should be managed with PD after corticoid administration.

Neonatal mortality in Nepal: A multilevel analysis of a nationally representative

ObjectivesThis study investigated individual, community and district level factors associated with neonatal mortality among a national sample of Nepalese women. MethodsData were drawn from the 2006 Nepalese Demographic and Health Survey on women aged 15–49 who delivered within three years prior to the survey (N=4136). Multilevel logistic regression models with three levels were fitted to assess the influences of measured individual, community and district level variables on neonatal mortality. ResultsThe total neonatal mortality in three years preceding the survey was 4.5 deaths per 100 live births (N=190), with neonatal mortality rate (NMR)=46 per 1000 live births. Having a partner with no formal education, being in the middle on the wealth index and residing in less developed district were associated with neonatal death in bivariate analysis. Women who were assisted by skilled personnel during delivery were less likely to have neonatal death (adjusted OR for no assistance = 2.26, 95% CI=1.19–4.26). Having prenatal care with skilled attendant was associated with less likelihood of neonatal death (adjusted OR for no care = 1.75, 95% CI=1.17–2.62). Older women, mother’s education, parity and wealth index were associated with neonatal mortality. Considerable variations in neonatal mortality at community and district levels were found. ConclusionsThese findings emphasize the need for interventions at the individual level with regard to access and utilization of healthcare in order to reduce the neonatal mortality in Nepal.

Predictors of mortality of extremely low birthweight babies in a tertiary care centre of a developing country

IntroductionPerinatal care has changed dramatically over last decade contributing to improved survival of extremely low birthweight (ELBW) babies.ObjectiveWe conducted the present study with the objective to identify immediate obstetric causes...

757: Interdisciplinary obstetric simulation training improves team performance

regression. RESULTS: 10,705 VLBW: 3846(1995-2000), 3475 (2001-2005), 3384 (2006-2010):total neonatal mortality decreased significantly (p 0.0001) : OR 1; 0.78 ( 0.67-0.90); 0.72 (0.62-0.84) respectively. The significant lower threshold of this improvement pattern was BW 500 & GA 25wks, and lost significance 31 weeks. All severe morbidities decreased significantly (Table). A significant increase in maternal age (p 0.0001),high education ( 13 y) p 0.0001, antenatal care started 12 weeks (72.6% women to 82.0%) (p 0.0001) and fertility therapy (p 0.0003) occured. Hypertension and antepartum bleeding showed no change, while GDM increased (p 0.005). Interestingly, significant decrease in premature labor (p 0.0001), PPROM (p 0.0001) and chorioamnionitis (p 0.0001) observed. The cesarean raised significantly (60.8% to 67.9%) (P 0.0001); with no significant change in GA at birth (28.3 / 2.3) and its distribution, BW, gender and SGA. However, there was a significant decrease in delivery room resuscitation (p 0.0001) and 5’Apgar 7 (p 0.0006). CONCLUSION: The comparison of VLBW infants outcomes born five years apart showed a significant decrease of mortality and morbidity, paralleled by noteworthy changes in the maternal demographic characteristics. This analysis emphasizes the need to continuously follow and update neonatal outcomes. The provision of an appropriate estimate of neonatal risks is mandatory in counseling families.

Assistência pré-natal na rede básica de fortaleza-ce: uma avaliação da estrutura, do processo e do resultado - doi: 10.5020/18061230.2012.p344

Avaliar a assistência pré-natal na rede básica de Fortaleza-CE, Brasil, considerando a estrutura, o processo e o resultado. Métodos: Estudo transversal e descritivo, com abordagem quantitativa, desenvolvido entre outubro de 2009 e fevereiro de 2011, em 30 Unidades de Saúde, selecionadas aleatoriamente, mantendo a proporção por cada Secretaria Executiva Regional. Para análise da estrutura, as informações obtidas foram pontuadas e classificadas como: ótima, satisfatória, precária ou insuficiente. Utilizou-se um formulário validado por quatro especialistas. Na avaliação do processo e resultado, os dados foram disponibilizados pela Secretaria Municipal de Saúde de Fortaleza para obtenção dos indicadores preconizados pelo Ministério da Saúde. Resultados: Observou-se uma estrutura, de um modo geral, satisfatória. Quanto ao processo e resultado, obteve-se: gestantes que realizaram, no mínimo, seis consultas pré-natais (7,6%); gestantes que receberam imunização antitetânica (22,8%); recém-nascidos com sífilis congênita (1,4%); recém-nascidos com tétano neonatal (0%); razão de mortalidade materna (78,5% em 2008 e 51% em 2009); e coeficiente de mortalidade neonatal total (10,1% em 2008 e 11,2% em 2009). Conclusões: Apesar dos bons resultados no que concerne à estrutura, os reflexos nos indicadores de processo e resultado não foram positivos, com índices baixos em relação ao esperado pela Organização Mundial da Saúde ou Ministério da Saúde, ou quando comparado a outras regiões.