Agho Kingsley; Dibley Michael J; Titaley Christiana R; Roberts Christine L; Hall John
Abstract Background Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002. Methods The data source for the analysis was the 2002–20...
Bjerregaard, P; Steinglass, R; Mutie, D M;
In a house-to-house survey in Kilifi District, Kenya, mothers of 2556 liveborn children were interviewed about neonatal mortality, especially from neonatal tetanus (NNT). The crude birth rate was 60.5 per 1000 population, the neonatal mortality rate 21.1 and the NNT mortality rate 3.1 per 1000...
Full Text Available BACKGROUND Infant Mortality Rate (IMR is high in India. Identification of risk factors of mortality in neonatal illness is essential to reduce Neonatal Mortality Rate (NMR and ultimately the IMR. AIM To identify the risk factors of mortality in neonatal illness. SETTING AND DESIGN It was a nested case control study done at the sick neonatal unit of urban tertiary referral centre. METHODS AND MATERIALS After obtaining ethical committee approval, retrospective analysis of 150 out born neonatal case records of babies admitted during the period from October 2015 to December 2015 was done. Data such as demographic features, maternal details, referral details, perinatal events, clinical features, laboratory reports and outcome were recorded. STATISTICAL ANALYSIS These risk factors were subjected to univariate and multivariate logistic regression analysis and P value calculated for the same to find out significant risk factors of mortality in neonatal illness. RESULTS Neonatal mortality rate was 22%. Male-to-female ratio was 2:1, death occurred more commonly in female neonates (23.1%. Home deliveries carried more risk of mortality. Birth order 4 and above had 25% mortality. Neonates of mother who had primary education and below had higher mortality. Perinatal asphyxia and sepsis were the most common causes of neonatal mortality. By univariate analysis, preterms had 4.9 times increased risk of mortality than term babies. Apnoeic spells, chest retractions and shock had 8 times, 3 times and 3.6 times increased risk of mortality respectively. By multivariate analysis, birth weight below 2 kilograms (kg carried 11.8 times more risk of mortality with a p value 0.00 (95% C.I 3.2, 30.4 and poor maternal intake of iron and folic acid tablets was 3.9 times more risk p value 0.003 (95% C.I 1.6, 9.6, apnoeic spells were 5.8 times more risk of mortality with p value 0.02 (95% C.I 1.3, 26.2. CONCLUSION Birth weight below 2 kg, poor maternal intake of iron and folic
Full Text Available Abstract Background Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002. Methods The data source for the analysis was the 2002–2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants. Results At the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00, and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03 compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00 and for infants born to father who were unemployed (OR = 2.99, p = 0.02. The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00, male infants (OR = 1.49, p = 0.01, smaller than average-sized infants (OR = 2.80, p = 0.00, and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00. Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03. Conclusion Public health interventions directed at reducing neonatal death should
Full Text Available Research question: Which are the maternal, socio-demographic and neonatal attributes responsible for neonatal mortality in rural areas of Gujarat? Objectives: (i To know various maternal, socio-demographic and neonatal factors responsible for neonatal mortality in rural areas of Gujarat (ii To estimate neonatal mortality rate in the area. Setting: Rural areas of six Primary Health Centers of Jamnagar district of Gujarat State. Study design: Community based cohort study. Sample size: Population of 40512 Participants: Members of the family in which neonatal deaths occurred. Outcome variable: Neonatal mortality Analysis: Sample proportions. Results: Neonatal mortality rate on the basis of follow-up of births during one year was found to be 47.27 per thousand live births. The major maternal and socio-demographic factors responsible for neonatal mortality were; maternal age, illiteracy, lack of antenatal care, closely spaced pregnancies, delivery conducted at home, delivery conducted untrained personnel and delayed initiation of breast feeding. The major neonatal factors responsible for mortality in neonates were; low birth weight, prematurity, first order of birth, early phase of neonatal period, male gender of the child. The leading causes of neonatal mortality were found to be prematurity, birth asphyxia, neonatal infections and congenital anomalies.
Lawler, D F; Monti, K L
The mortality patterns of 294 Domestic Shorthair kittens indicated that birth weight was closely related to survivability. Slightly over half of the nonsurviving kittens lost at 0 to 3 days of life were stillborn. Abnormal gross anatomy did not appear to be a major factor in neonatal kitten death. Mortality was lowest at the 5th parity and in litters of 5 kittens. Litters of 1 kitten experienced high mortality. Smaller queens tended to deliver fewer kittens per litter, but with improved kitten viability. Overweight queens experienced increased mortality of kittens. Further examination of mortality by litter size also revealed that low birth weight kittens tended to survive less often than normal birth weight kittens, even within the same litter. PMID:24049917
Anuradha S; Madhuri R Rathi; Mathur, Meenakshi M
Background: Multidrug resistant Acinetobacter infection has emerged as an important pathogen in neonatal sepsis in the recent years causing morbidity as well as mortality. Materials and Methods: A retrospective analysis was performed over a one and a half year period of all neonates admitted with sepsis in our neonatal intensive care unit (NICU), who developed Acinetobacter infection and to identify mortality-associated risk factors in these neonates. Results: Incidence of neonatal septicaemi...
Blencowe, Hannah; Lawn, Joy; Vandelaer, Jos; Roper, Martha; Cousens, Simon
Background Neonatal tetanus remains an important and preventable cause of neonatal mortality globally. Large reductions in neonatal tetanus deaths have been reported following major increases in the coverage of tetanus toxoid immunization, yet the level of evidence for the mortality effect of tetanus toxoid immunization is surprisingly weak with only two trials considered in a Cochrane review. Objective To review the evidence for and estimate the effect on neonatal tetanus mortality of immuni...
Lawrence D.E. Ikamari
Full Text Available This paper seeks to establish the effect of region of residence on neonatal and post-neonatal mortality inKenya, using the 2003 Kenya Demographic and Health Survey data. The results show significant regionalvariation in neonatal and post-neonatal mortality. Both neonatal and post-neonatal mortality were alsofound to vary significantly according to household wealth status, household water supply, and toilet facility,maternal age at birth, preceding birth interval; antenatal visits and type of place of delivery. It was only postneonatalmortality that also varied significantly according to maternal education.The study recommends that concerted efforts be made to reduce high neonatal and post-neonatal mortalityin the high mortality areas. These could entail strengthening existing family planning, child survival and HIV/AIDS programmes alongside improving households’ access to piped water supply and household hygiene practices.
Anuradha S De
Full Text Available Background: Multidrug resistant Acinetobacter infection has emerged as an important pathogen in neonatal sepsis in the recent years causing morbidity as well as mortality. Materials and Methods: A retrospective analysis was performed over a one and a half year period of all neonates admitted with sepsis in our neonatal intensive care unit (NICU, who developed Acinetobacter infection and to identify mortality-associated risk factors in these neonates. Results: Incidence of neonatal septicaemia due to Acinetobacter species was 9.18%. All were cases of early onset sepsis. Predominant species isolated was Acinetobacter baumanii (67.5%. The major symptoms were lethargy and poor feeding. The major signs were tachypnoea, rib retraction, and respiratory distress. The major fetal risk factors were low birth weight and prematurity. Overall, 53.75% were multidrug resistant (MDR Acinetobacter. Resistance to more than two drugs (MDR was statistically significant in A. baumanii as compared with nonbaumanii. Overall mortality due to Acinetobacter neonatal sepsis was 20%. Septicemia due to A. baumanii was associated with higher mortality than those due to nonbaumanii isolates. Lethargy, tachypnoea, rib retraction, tachycardia, respiratory distress, and mechanical ventilation were significant predictors of mortality. Conclusion: Multidrug resistant Acinetobacter infection is fatal, particularly in premature and low birth weight neonates. Therefore, an effective infection control policy and rational antibiotic use are mandatory in neonatal intensive care areas of each hospital in order to control Acinetobacter infection and improve outcome.
Trieu, Huynh T; Lubis, Inke N; Qui, Phan T; Yen, Lam M; Wills, Bridget; Thwaites, C Louise; Sabanathan, Saraswathy
We report a 66% reduction in neonatal tetanus mortality after introducing a new management bundle integrating antibiotic therapy, muscle relaxation and invasive monitoring. The latter allowed rapid detection of autonomic instability which was treated with magnesium sulphate. This is the first report of its use in neonatal tetanus. PMID:26407289
Full Text Available Background Neonatal mortality remains a major concern in developing countries. Identifying potential risk factors is important in order to decrease the neonatal mortality rate. In Moewardi Hospital, Surakarta, the risk factors for neonatal mortality have not been assessed. Objective To evaluate potential risk factors of neonatal mortality. Methods We reviewed medical records of all neonates hospitalized in the neonatal intensive care unit (NICU at Dr. Moewardi Hospital from January to December 2011. Analyzed variables were sex, birth weight, gestational age, maternal age, place of delivery, mode of delivery, and sepsis. Data were analyzed by Chi square and binary logistic regression with 95% confidence intervals (CI. Results Out of 841 neonates, the mortality rate was 212 (25.2%. Univariate logistic regression revealed that the significant risk factors for neonatal mortality were preterm (OR 4.41; 95%CI 4.24 to 4.57; P=0.0001, low birth weight (OR 4.30; 95%CI 4.13 to 4.47; P=0.0001, sepsis (OR 2.99; 95%CI 2.81 to 3.17; P=0.0001, maternal age ≥35 years (OR 1.53; 95%CI 1.37 to 1.70, and non-spontaneous delivery (OR 1.67; 95%CI 1.50 to 1.84. Further multivariate regression analysis revealed that the significant risk factors were preterm (OR 2.27; 95%CI 2.05 to 2.48; P=0.0001, low birth weight (OR 2.49; 95%CI 2.27 to 2.71; P= 0.0001, and sepsis (OR 2.50; 95%CI 2.30 to 2.69; P= 0.0001. Conclusion The risk factors for neonatal mortality in the NICU are preterm, low birth weight, and sepsis. [Paediatr Indones. 2014;54:219-22.].
Surveys to determine mortality from neonatal tetanus were conducted in March and April 1985 in accessible areas of Burma, where pregnant women had been immunized with tetanus toxoid and, for comparison, also in areas where such immunization had not been given. Neonatal mortality rates were three times greater in areas where tetanus toxoid immunization had only recently or had not yet been introduced by the national expanded programme on immunization. Analysis of the data indicates that the im...
Fottrell, E.; Osrin, D.; Alcock, G; Azad, K.; Bapat, U; Beard, J.; Bondo, A.; Colbourn, T; Das, S; King, C.; Manandhar, D.; S Manandhar; Morrison, J; Mwansambo, C; Nair, N.
Objective Understanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data. Design We prospectively recorded births, neonatal deaths and stillbirths in seven population surveillance sites. VAs w...
Full Text Available The objective of this study is to determine risk factors causing increase in very low birth way (VLBW neonatal mortality. The medical files of all neonates weighing ≤1500 g, born in Vali-e-Asr hospital (2001-2004 were studied. Two groups of neonates (living and dead were compared up to the time of hospital discharge or death. A total of 317 neonates were enrolled. A meaningful relationship existed between occurrence of death and low gestational age (P=0.02, low birth weight, lower than 1000 g (P=0.001, Apgar score <6 at 5th minutes (P=0.001, resuscitation at birth (P=0.001, respiratory distress syndrome (P=0.001 need for mechanical ventilation (P=0.001, neurological complications (P=0.001 and intraventricular hemorrhage (P=0.001. Regression analysis indicated that each 250 g weight increase up to 1250 g had protective effect, and reduced mortality rate. The causes of death of those neonates weighting over 1250 g should be sought in factors other than weight. Survival rate was calculated to be 80.4% for neonates weighing more than 1000 g. The most important high risk factors affecting mortality of neonates are: low birth weight, need for resuscitation at birth, need for ventilator use and intraventricular hemorrhage.
Full Text Available Aim: To define the prognostic value of Doppler ultrasonographic morphology of ductus venosus (DV waveform on canine neonatal mortality. Materials and Methods: Fifty-four healthy pregnant bitches underwent fetal ultrasonographic assessment. The DV waveforms were classified as diphasic (dDVw or triphasic (tDVw and compared with neonatal mortality. Results: Ninety-three fetuses were evaluated. Twenty fetuses belonged to litters with neonatal mortality, in which tDVw was observed. Seven fetuses belonged to litters without neonatal mortality, in which tDVw was observed. Fifty-eight fetuses belonged to litters without neonatal mortality, in which only dDVw was observed. Eight fetuses belonged to litters with neonatal mortality, in which only dDVw was observed. The correlation between tDVw and neonatal mortality was statistically significant (odds ratio [OR], 20.7; p<0.0001. Considering only pregnancies with one or two fetuses with the same DV waveform: Two fetuses with tDVw belonged to litters with neonatal mortality; 1 foetus with tDVw belonged to litter without neonatal mortality and 26 fetuses showed dDVw without neonatal mortality. The correlation between tDVw and neonatal mortality even in litters up to two pups was statistically significant (OR, 88.3; p=0.01. Conclusion: Echo-Doppler assessment of DV is feasible in canine fetuses, and the presence tDVw seems to be related to neonatal mortality.
Full Text Available Objective: This study aims to assess the utility of a scoring system as predictor of neonatal mortality rate among the neonates admitted within one year to the neonatal intensive care unit (NICU of the Childrens Medical Center in Tehran, Iran.Material & Methods: Data were gathered from 213 newborns admitted to the NICU from September 2003 to August 2004. In addition to demographic data, Apgar scores at 1 minute and 5 minutes, history and duration of previous hospitalization, initial diagnosis and final diagnosis, and scoring system by using the score for the neonatal acute physiology-perinatal extension II (SNAP-PE II were carried out within 12 hours after admission to the NICU. All of the parameters were prospectively applied to the admitted newborns. The exclusion criteria were discharge or death in less than 24 hours after NICU admission.Findings: 198 newborn infants met the inclusion criteria. The mean and standard deviation (SD of the variables including postnatal age, birth weight, SNAP, and finally Apgar scores at 1 minute and 5 minutes of neonates under this study were 7.6 (0.5 days, 2479.8 (29.4 grams, 21.6 (1.1, 7.47 0.08(, and 7.71 (0.06, respectively. Twenty five of the 198 patients died (12.6%. Gestational age (P=0.03, birth weight (P=0.02, Apgar score at 5 minutes (0.001, and SNAP-PE II (P=0.04 were significantly related to the mortality rate. By Analyzing through logistic regression to evaluate the predictive value of these variables in relation to the risk of mortality, it was shown that only SNAP-PE II and Apgar score at 5 minutes could significantly predict the neonatal mortality.Conclusion: According to this study SNAP-PE II and Apgar score at 5 minutes can be used to predict mortality among the NICU patients. SNAP-PE II score had the best performance in predicting mortality in this study. More studies with larger samples are suggested to evaluate all of the above-mentioned parameters among neonates who are admitted to NICUs
Gosselin, Véronique Bernier; Fecteau, Gilles; Nichols, Sylvain
An 18-day-old heifer was presented with fever, depression, tachycardia, tachypnea, and prolonged bleeding time. Blood tests revealed severe anemia, thrombocytopenia, and leucopenia. The animal was negative by PCR for bovine virus diarrhea virus antigen. The findings supported a diagnosis of bovine neonatal pancytopenia. Treatments included fresh whole blood transfusion and antibiotics. The animal recovered fully. PMID:22210946
Gabriele Barella; Stefano Faverzani; Massimo Faustini; Debora Groppetti; Alessandro Pecile
Aim: To define the prognostic value of Doppler ultrasonographic morphology of ductus venosus (DV) waveform on canine neonatal mortality. Materials and Methods: Fifty-four healthy pregnant bitches underwent fetal ultrasonographic assessment. The DV waveforms were classified as diphasic (dDVw) or triphasic (tDVw) and compared with neonatal mortality. Results: Ninety-three fetuses were evaluated. Twenty fetuses belonged to litters with neonatal mortality, in which tDVw was observed. Seven ...
Barella, Gabriele; Faverzani, Stefano; Faustini, Massimo; Groppetti, Debora; Pecile, Alessandro
Aim: To define the prognostic value of Doppler ultrasonographic morphology of ductus venosus (DV) waveform on canine neonatal mortality. Materials and Methods: Fifty-four healthy pregnant bitches underwent fetal ultrasonographic assessment. The DV waveforms were classified as diphasic (dDVw) or triphasic (tDVw) and compared with neonatal mortality. Results: Ninety-three fetuses were evaluated. Twenty fetuses belonged to litters with neonatal mortality, in which tDVw was observed. Seven fetuse...
Lamshing-Salinas, Priscilla; Rend Ón-Macías, Mario Enrique; Iglesias-Leboreiro, José; Bernárdez-Zapata, Isabel; Braverman-Bronstein, Ariela
Background: multiple gestations have caused an increase in vulnerable preterm births. Our objective was to analyze neonatal morbidity and mortality in preterm triplets. Methods: we analyzed a cohort of 30 triplets in an obstetrics and gynecology hospital. Data were obtained during pregnancy, childbirth and neonatal period: birth order, sex, weight, height, malformations, advanced resuscitation, assisted ventilation, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, pulmonary hypertension, bronchopulmonary dysplasia, days of hospitalization, and death. Results: 90 infants were analyzed. There was an omphalopagus con-joined twins case; 42 (70 %) had between 30-33 weeks and six between 24-29; 19 (21 %) had low weight for gestational age, and 18 (30 %) had a major malformation; 27 % required ventilatory support, 33 % sepsis, 32 % necrotizing enterocolitis, 21 % pulmonary hypertension, 14 % bronchopulmonary dysplasia and 2 % intraventricular hemorrhage, without statistically significant differences related to the order, presentation at birth, sex and number of placentas and amniotic sacs. Eight 24-week triplets died, four over 28 weeks, and a siamese (p = 38). There was no difference in hospital days between triplets. Conclusions: the triplets mortality is low and mainly associated with extreme prematurity, intrauterine growth restriction and sepsis. PMID:24290011
Rwashana, Agnes Semwanga; Nakubulwa, Sarah; Nakakeeto-Kijjambu, Margaret; Adam, Taghreed
Background Of the three million newborns that die each year, Uganda ranks fifth highest in neonatal mortality rates, with 43,000 neonatal deaths each year. Despite child survival and safe motherhood programmes towards reducing child mortality, insufficient attention has been given to this critical first month of life. There is urgent need to innovatively employ alternative solutions that take into account the intricate complexities of neonatal health and the health systems. In this paper, we ...
Allison J. Pollock
Full Text Available Background - Eosinophilic endomyocarditis (EEM is a rare diagnosis that is extremely uncommon in newborns. This case report aimed to present a case of neonatal mortality from acute cardiac failure due to EEM. Case - Our report presents a term male neonate with minor complications in the immediate postnatal course, who was discharged at 48 hours of life, but who developed unexpected respiratory distress, followed by cardiac arrest and death at 3 days of life. One day after discharge, the infant developed respiratory distress and cool skin, and then developed cardiac arrest at the pediatrician's office, undergoing resuscitation with intravenous fluid, cardiopulmonary resuscitation, epinephrine, atropine, and failed intubation. Autopsy revealed EEM, an inflammatory infiltrative process involving the endomyocardium. Pathology - Pathogenesis involves three stages: (1 myocarditis with an acute eosinophilic inflammatory infiltrate followed by (2 myocyte necrosis and eventually (3 fibrosis in the final stage of the disease. Discussion - The cause of death was acute cardiac failure due to intense eosinophilic infiltration and degranulation with early subendocardial myocyte necrosis but before development of extensive myocyte necrosis. This case appears to be the youngest patient reported with EEM.
Pollock, Allison J; Hitt, Stacy L; Stier, Michael A; Houser, Laura M
Background Eosinophilic endomyocarditis (EEM) is a rare diagnosis that is extremely uncommon in newborns. This case report aimed to present a case of neonatal mortality from acute cardiac failure due to EEM. Case Our report presents a term male neonate with minor complications in the immediate postnatal course, who was discharged at 48 hours of life, but who developed unexpected respiratory distress, followed by cardiac arrest and death at 3 days of life. One day after discharge, the infant developed respiratory distress and cool skin, and then developed cardiac arrest at the pediatrician's office, undergoing resuscitation with intravenous fluid, cardiopulmonary resuscitation, epinephrine, atropine, and failed intubation. Autopsy revealed EEM, an inflammatory infiltrative process involving the endomyocardium. Pathology Pathogenesis involves three stages: (1) myocarditis with an acute eosinophilic inflammatory infiltrate followed by (2) myocyte necrosis and eventually (3) fibrosis in the final stage of the disease. Discussion The cause of death was acute cardiac failure due to intense eosinophilic infiltration and degranulation with early subendocardial myocyte necrosis but before development of extensive myocyte necrosis. This case appears to be the youngest patient reported with EEM. PMID:26495174
Bezzaoucha, A; El Kebboub, A; Aliche, A
Within the framework of the active information system set up by the department of epidemiology on hospital mortality at the Blida (Algeria) University Teaching Hospital (CHU), a study was carried out to assess the importance and evolution of neonatal mortality recorded at the CHU in the last eight years (1999-2006) as well as the causes of neonatal death. The International Classification of Diseases (ICD-9) was used to encode the nature of the causal disease. Using the software EpiInfo™ in its sixth version performed data entry, monitoring and analysis. On the whole, 2,167 neonatal deaths were recorded at the CHU during the study period, representing a proportional mortality of 25.4%. Early neonatal mortality (0-6 days) accounted for 83.4% of all neonatal mortality. Nearly two thirds of early neonatal deaths occurred in the first three days of life. The monthly evolution of the number of early neonatal deaths revealed a significant rising trend during the study period (P < 0.05) without identification of seasonal effect. The sex ratio was practically the same for early and late neonatal mortality, respectively 1.4 and 1.5. Prematurity accounted for 42.1% of the deaths in early neonatal deaths, followed by respiratory distress syndrome and infection, respectively 17.0 and 14.4%. Infections, with a relative frequency of 36.2%, represented the most common cause for the late neonatal mortality. The rate of early neonatal mortality during the study period, when this one took for denominator the number of newborns admitted in neonatology to express the mortality of service, was 15.6%. Throughout the study period, the rate of early neonatal mortality, without counting the deaths among transferred newborms, could be estimated at 19.2 per 1,000 live births, while the overall neonatal mortality rate could be estimated at 22.3 per 1,000 live births. No significant temporal tendency was pointed out. The CHU of Blida is not characterized by a lower risk of neonatal mortality
VANDALE SUSAN; DE LA LUZ KAGEYAMA MARÍA; RASCÓN-PACHECO RAMÓN ALBERTO
Objective. This article analyzes the time-trends and causes of infant, neonatal, and postneonatal mortality in Mexico during the 1980s. Material and methods. Data on infant deaths came from yearly tabulations (1980 to 1990) published by the Mexican government. Time-trends of mortality rates were determined by simple linear regression models. The parallelism test was performed for evaluating similarities in trends in neonatal and postneonatal mortality rates by causes. Results. During th...
Full Text Available Background and Objectives: Little is known about the natural history of neonates born in the rural and tribal areas in India. The Neonatal Disease Surveillance Study (NDSS measures the incidence of high-priority neonatal diseases, neonatal health events and associated risk factors to plan appropriate and effective actions. Materials and Methods: The NDSS is being conducted in Ramtek Revenue Block, Nagpur district, Maharashtra state, given its considerably high level of neonatal mortality. All households from five selected primary health centers were screened. Both active and passive surveillance systems were used for systematic collection of mother′s health during pregnancy and of baby′s health from birth to 4 months after birth. First-year results from November 2006 to October 2007 are presented. Results: Pregnancy outcomes were available for 1,136 women, with an overall neonatal mortality of 73 per 1,000 live births. The pregnancy outcomes varied by gestational age of the baby; miscarriages and abortions were higher in tribal than in non-tribal women, and tribal women had higher rates of low-birth weight (LBW neonates than non-tribal women. The main cause of neonatal mortality was LBW, followed by sepsis and respiratory illness. The mortality of non-tribal babies was most strongly associated with pre term. For tribal babies, mortality was also associated with maternal morbidity and delay in the initiation of breastfeeding. Interpretation and Conclusions: The NDSS provides valuable information on the potentially modifiable factors associated with increased likelihood of neonatal mortality and morbidity. The Neonatal Health Research Initiative is now developing community-based interventions to reduce the high rate of neonatal mortality and morbidity in the rural areas of India.
Lawrence N Kazembe
Full Text Available BACKGROUND: Neonatal mortality contributes a large proportion towards early childhood mortality in developing countries, with considerable geographical variation at small areas within countries. METHODS: A geo-additive logistic regression model is proposed for quantifying small-scale geographical variation in neonatal mortality, and to estimate risk factors of neonatal mortality. Random effects are introduced to capture spatial correlation and heterogeneity. The spatial correlation can be modelled using the Markov random fields (MRF when data is aggregated, while the two dimensional P-splines apply when exact locations are available, whereas the unstructured spatial effects are assigned an independent Gaussian prior. Socio-economic and bio-demographic factors which may affect the risk of neonatal mortality are simultaneously estimated as fixed effects and as nonlinear effects for continuous covariates. The smooth effects of continuous covariates are modelled by second-order random walk priors. Modelling and inference use the empirical Bayesian approach via penalized likelihood technique. The methodology is applied to analyse the likelihood of neonatal deaths, using data from the 2000 Malawi demographic and health survey. The spatial effects are quantified through MRF and two dimensional P-splines priors. RESULTS: Findings indicate that both fixed and spatial effects are associated with neonatal mortality. CONCLUSIONS: Our study, therefore, suggests that the challenge to reduce neonatal mortality goes beyond addressing individual factors, but also require to understanding unmeasured covariates for potential effective interventions.
Chaman, R. (PhD); K Holakouie Naieni; B. Golestan; H Nabavizadeh; M. Yunesian
"nBackground: Due to complex causal framework of neonatal mortality, improvement of this health indicator is quite gradual and it's decreasing trend is not as great as other health indicators such as infant and under 5 mortality rates.This study was conducted to evaluate neonatal mortality risk factors based on nested case-control design."nMethods: The study population was 6900 neonates who were born in rural areas of Kohgiluyeh and Boyerahmad province (South of Iran)...
Bhalotra, S.; van Soest, A.H.O.
A dynamic panel data model of neonatal mortality and birth spacing is analyzed, accounting for causal effects of birth spacing on subsequent mortality and of mortality on the next birth interval, while controlling for unobserved heterogeneity in mortality (frailty) and birth spacing (fecundity). The model is estimated using micro data on about 29000 children of 6700 Indian mothers, for whom a complete retrospective record of fertility and child mortality is available. Information on steriliza...
Spasojević Slobodan; Konstantinidis Georgios; Doronjski Aleksandra
Introduction. Infertility occurs in approximately10% of couples and in vitro fertilisation (IVF) is its most efficient treatment method. The National IVF Programme started in October 1st, 2006. Objective. Examination of morbidity and mortality of premature neonates conceived by IVF after initiation of the National IVF Programme. Methods. Retrospective analysis of history charts of IVF premature neonates treated at the Neonatal Intensive Care Unit (NICU) of the Institute of Child and Youth Hea...
Marchant, Tanya; Willey, Barbara; Katz, Joanne;
Low birth weight and prematurity are amongst the strongest predictors of neonatal death. However, the extent to which they act independently is poorly understood. Our objective was to estimate the neonatal mortality risk associated with preterm birth when stratified by weight for gestational age ...
US Fish and Wildlife Service, Department of the Interior — This report discusses the evaluation of techniques for assessing neonatal caribou calf mortality in the Porcupine caribou herd in Arctic National Wildlife Refuge....
Full Text Available "nBackground: Due to complex causal framework of neonatal mortality, improvement of this health indicator is quite gradual and it's decreasing trend is not as great as other health indicators such as infant and under 5 mortality rates.This study was conducted to evaluate neonatal mortality risk factors based on nested case-control design."nMethods: The study population was 6900 neonates who were born in rural areas of Kohgiluyeh and Boyerahmad province (South of Iran. They were under follow up till the end of neonatal period and the outcome of interest was neonatal death. By using risk set sampling method, 97 cases and 97 controls were selected in study cohort."nResults: Prematurity (OR= 5.57, LBW (OR= 7.68, C-section (OR= 7.27, birth rank more than 3 (OR=6.95 and birth spacing less than 24 months (OR= 4.65 showed significant statistical association (P< 0.05 with neonatal mortality. The Population Attributable Fraction (PAF was 0.45 for LBW, 0.40 for prematurity, 0.28 for C-section, 0.30 for birth rank more than 3, and 0.16 for birth spacing less than 24 months."nConclusion: Prematurity, low birth weight, C-section, birth spacing less than 24 months and birth rank more than 3 are important risk factors for neonatal mortality.
Ramaiya, Astha; Kiss, Ligia; Baraitser, Paula; Mbaruku, Godfrey; Hildon, Zoe
Worldwide, approximately 14 million mothers aged 15 - 19 years give birth annually. The number of teenage births in Sub Saharan Africa (SSA) is particularly high with an estimated 50% of mothers under the age of 20. Adolescent mothers have a significantly higher risk of neonatal mortality in comparison to adults. The objective of this review was to compare perinatal/neonatal mortality in Sub Saharan Africa and it's associated risk factors between adolescents and adults. We systematically sear...
Full Text Available Objective: Several studies dealt with factors associated with childhood mortality, especially in developing countries, but less is known about former communistic countries. We therefore analyzed the factors affecting mortality rates among children in the Central Asian countries Kyrgyzstan, Kazakhstan and Uzbekistan. We focused on the impact of living place (rural versus urban and age dependency (neonatal versus under-three mortality on the mortality risk. Methods: We used the Demographic and Health Surveys data (DHS for the three Central Asian countries. The combined data set included information about 2867 children under the age of three, 135 of whom died. We studied three multiple logistic regression models: for the mortality under the age of three, for neonatal mortality (1st month of life and for mortality in 2nd-36th month of life. Results: Under-three mortality was independently associated with living in a rural versus urban area (OR 1.69 (CI 1.11-2.56, birth order and mother not being currently married vs. married (OR 0.52 (CI 0.25-1.08. There was a lower risk of mortality for children living in larger families (six or more household members vs. less than six, OR 0.45 (CI 0.30-0.65. Living in a rural area was more strongly associated with mortality in 2-36 month of life than with neonatal mortality. Differences between countries were greater in neonatal mortality than in mortality between 2nd-36th month of life. Conclusions: This study suggests that urban-rural differences with respect to childhood mortality in these countries persist after adjusting for several socioeconomic factors.
In the past 17 years neonatal mortality survey has provided important data on the trends in deaths of all live born infants born in Southern Ireland who are greater than 500 g birth weight and who die within the first 28 days of life. The aims of this study were to report neonatal mortality data for Southern Ireland for 2004, to examine trends in neonatal mortality over the past 17 years and compare Irish Neonatal Mortality rates to other countries around the world. The neonatal mortality rate for 2004 was 2.9\\/1000 with a corrected NMR of 1.9\\/1000. The response rate to the survey was 100%. Prematurity is now the leading cause of neonatal mortality representing a change from previous years. Deaths related to asphyxia have remained largely unchanged. When compared to international figures Ireland compares favourably to other countries around the world.
Full Text Available Abstract Background Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST. Methods We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where appropriate. For interventions with biological plausibility but low quality evidence, a Delphi process was undertaken to estimate effectiveness. Results Searches of 2876 titles identified 7 studies. Among these, 4 evaluated oral antibiotics for neonatal pneumonia in non-randomised, concurrently controlled designs. Meta-analysis suggested reductions in all-cause neonatal mortality (RR 0.75 95% CI 0.64- 0.89; 4 studies and neonatal pneumonia-specific mortality (RR 0.58 95% CI 0.41- 0.82; 3 studies. Two studies (1 RCT, 1 observational study, evaluated community-based neonatal care packages including injectable antibiotics and reported mortality reductions of 44% (RR= 0.56, 95% CI 0.41-0.77 and 34% (RR =0.66, 95% CI 0.47-0.93, but the interpretation of these results is complicated by co-interventions. A third, clinic-based, study reported a case-fatality ratio of 3.3% among neonates treated with injectable antibiotics as outpatients. No studies were identified evaluating injectable antibiotics alone for neonatal pneumonia. Delphi consensus (median from 20 respondents effects on sepsis-specific mortality were 30% reduction for oral antibiotics, 65% for injectable antibiotics and 75% for injectable antibiotics on pneumonia-specific mortality. No trials were
Azer Kılıç Başkan
Full Text Available Objectives: To evaluate mortality, morbidity, and invasivemechanical ventilation complications in mechanicallyventilated neonates in a tertiary care hospital, Istanbul,Turkey.Materials and methods: The neonates followed on invasivemechanical ventilation from January 2008 to December2009 were included in the study. A chart is formed foreach patient to record patient delivery room and clinicaldata prospectively.Results: The study population consisted of 236 neonates.Eighty-five percent were born at ≤37 completed weeks ofgestation (n=201. Fifty-two percent (n=123 were males.The mean gestational age was 31.9±5 weeks. The meanbirthweight was 1870.8±921.8 g. Antenatal steroid ratewas 13.3% (n=20 in 150 cases born at ≤34 weeks of gestation.Respiratory distress syndrome (n=100, 42,3%,perinatal depression and asphyxia (n=51, 21,6%, andsepsis (n=47, 19.9% were the commonest indications.Mechanical ventilation related complications (nosocomialinfection (n=57, pulmonary hemorrhage (n=30,pneumonia (n=10, pneumothorax (n=9, and atelectasis(n=4 developed in 33.5% of neonates (n=79. Bronchopulmonarydysplasia was 9.3%, intracranial hemorrhage(≥grade 3 8.47%, periventricular leukomalacia 5.93%,necrotizing enterocolitis (>stage 2 0.42%, and retinopathyof prematurity (>stage 2 2.96%. Mortality rate was30.17%. Neonates born at 1000 gram (p<0.05, p<0.05,respectively.Conclusions: Low birthweight and low gestational ageare important risk factors for neonatal mortality and morbidity.Low frequency of antenatal steroid use may be acontributing factor to increase neonatal mortality and morbidity.J Clin Exp Invest 2012; 3(4: 483-492Key words: Neonate, invasive mechanical ventilation,mortality, morbidity
Amadi, Hippolite O.; Akin O. Osibogun; Olateju Eyinade; Kawuwa, Mohammed B.; Uwakwem, Angela C.; Ibekwe, Maryann U.; Peter Alabi; Chinyere Ezeaka; Eleshin, Dada G.; Ibadin, Mike O.
Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centre...
M.N. Saulez; Gummow, B.; Slovis, N.M.; T.D. Byars; M. Frazer; K. MacGillivray; F.T. Bain
Veterinary internists need to prognosticate patients quickly and accurately in a neonatal intensive care unit (NICU). This may depend on laboratory data collected on admission, the cost of hospitalisation, length of stay (LOS) and mortality rate experienced in the NICU. Therefore, we conducted a retrospective study of 62 equine neonates admitted to a NICU of a private equine referral hospital to determine the prognostic value of venous clinicopathological data collected on admission before th...
Giadinis Nektarios D; Filliusis George; Lafi Shawkat Q.; Panousis Nikolaos; Pourliotis Konstantinos; Bojkovski Jovan; Karatzias Harilaos
A high percent of annual neonatal mortality attributed to orf infection was observed between 2001 and 2004 in 2 sheep and 2 mixed (sheep and goat) flocks of Northern Greece. In order to protect the neonatal lambs and kids from orf infection a commercially available live orf vaccine was used. Pregnant sheep and goats were vaccinated subcutaneously a month before parturition, while 10 sheep and 10 goats in each flock remained unvaccinated and were used as negative controls. The vaccine was sign...
Gurmesa Tura Debelew
Full Text Available BACKGROUND: Ethiopia is among the countries with the highest neonatal mortality with the rate of 37 deaths per 1000 live births. In spite of many efforts by the government and other partners, non-significant decline has been achieved in the last 15 years. Thus, identifying the determinants and causes are very crucial for policy and program improvement. However, studies are scarce in the country in general and in Jimma zone in particular. OBJECTIVE: To identify the determinants and causes of neonatal mortality in Jimma Zone, Southwest Ethiopia. METHODS: A prospective follow-up study was conducted among 3463 neonates from September 2012 to December 2013. The data were collected by interviewer-administered structured questionnaire and analyzed by SPSS V.20.0 and STATA 13. Verbal autopsies were conducted to identify causes of neonatal death. Mixed-effects multilevel logistic regression model was used to identify determinants of neonatal mortality. RESULTS: The status of neonatal mortality rate was 35.5 (95%CI: 28.3, 42.6 per 1000 live births. Though significant variation existed between clusters in relation to neonatal mortality, cluster-level variables were found to have non-significant effect on neonatal mortality. Individual-level variables such as birth order, frequency of antenatal care use, delivery place, gestation age at birth, premature rupture of membrane, complication during labor, twin births, size of neonate at birth and neonatal care practice were identified as determinants of neonatal mortality. Birth asphyxia (47.5%, neonatal infections (34.3% and prematurity (11.1% were the three leading causes of neonatal mortality accounting for 93%. CONCLUSIONS: This study revealed high status of neonatal mortality in the study area. Higher-level variables had less importance in determining neonatal mortality. Individual level variables related to care during pregnancy, intra-partum complications and care, neonatal conditions and the immediate
Community-level research data from a Maternal-Child Health and Family Planning (MCH/FP) program and comparison areas in rural Bangladesh indicate that 60 percent of infant deaths occurred in the neonatal period in both areas. Since the inception of the MCH/FP program, mortality rates declined relative to those in the comparison area. This decline, however, was confined to the neonatal period death rates only, with mortality rates in the postneonatal period remaining similar in the two areas. Prematurity accounted for approximately 40 percent of deaths in the neonatal period. Cause-of-death data indicated that the differences in the neonatal mortality rates between the two areas was mainly due to a marked decline in tetanus neonatorum deaths in the MCH/FP program area, because of the tetanus toxoid immunization of pregnant women there. The interventions in the MCH/FP area, however, did not significantly influence mortality due to any other cause. This study provides an explanation for the limited impact on infant mortality of health interventions that focus on diarrheal diseases and immunizations of children. PMID:2734810
Full Text Available Background: Neonatal intestinal obstruction (NIO is a common cause of mortality. This study determined the causes of mortality in patients with NIO at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC, Ile Ife. Patients and Methods: Records of all cases of NIO managed at OAUTHC between January 1996 and December 2005 were retrospectively reviewed and the possible factors that may result in mortality were analysed. Results: Sixty-three neonates with intestinal obstruction were managed, representing 24.3% of the neonatal admissions during the study period. Forty-two were males and 21 were females (M:F = 2:1. The majority (71.4% of the patients presented within the first week of life. Anorectal malformation constituted 57.1% of the causes of NIO. Other causes included Hirschsprung′s disease, duodenal atresia, intestinal malrotation with midgut volvulus and jejunal atresia. There were 18 deaths, with a mortality rate of 28.6%. Reoperation, postoperative bleeding and peroperative sepsis were significant determinants of mortality. Conclusion: NIO is associated with significant mortality in our centre. Repeat surgery, postoperative bleeding and sepsis were the significant factors that contributed to mortality in NIO.
Full Text Available Background: This study have conducted in order to determine of direct or indirect effective factors on mortality of neonates with low birth weight by path analysis.Methods: In this cohort study 445 paired mothers and their neonates were participated in Tehran city. The data were gathered through an answer sheet contain mother age, gestational age, apgar score, pregnancy induced hypertension (PIH and birth weight. Sampling was convenience and neonates of women were included in this study who were referred to 15 government and private hospitals in Tehran city. Live being status of neonates was determined until 24 hours after delivery.Results: The most changes in mortality rate is related to birth weight and its negative score means that increasing in weight leads to increase chance of live being. Second score is related to apgar sore and its negative score means that increasing in apgar score leads to decrease chance of neonate death. Third score is gestational age and its negative score means that increasing in weight leads to increase chance of live being. The less changes in mortality rate is due to hypertensive disorders in pregnancy.Conclusion: The methodology has been used could be adopted in other investigations to distinguish and measuring effect of predictive factors on the risk of an outcome.
West, J B
Neonatal mortality increases with altitude. For example, in Peru the incidence of neonatal mortality in the highlands has been shown to be about double that at lower altitudes. An important factor is the low inspired PO2 of newborn babies. Typically, expectant mothers at high altitude will travel to low altitude to have their babies if possible, but often this is not feasible because of economic factors. The procedure described here raises the oxygen concentration in the air of rooms where neonates are being housed and, in effect, this means that both the mother and baby are at a much lower altitude. Oxygen conditioning is similar to air conditioning except that the oxygen concentration of the air is increased rather than the temperature being reduced. The procedure is now used at high altitude in many hotels, dormitories and telescope facilities, and has been shown to be feasible and effective. PMID:26426252
Habimana Kabano, I.
Rwanda has so far paid little attention to 'healthy' intervals between pregnancies awareness programs on family planning and maternal and child health. Results of this thesis shed some light on the contribution of IPI and the type of previous pregnancy outcome on fetal survival, neonatal mortality a
Full Text Available OBJECTIVES: Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India. METHODS AND FINDINGS: Using the third round of the Indian National Family Health Survey (NFHS 2005-06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR of 0.46 (95% CI 0.26 to 0.78 after one dose and 0.45 (95% CI 0.31 to 0.66 after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27% of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms. CONCLUSIONS: Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose.
Full Text Available Bovine coronavirus (BCoV is the second most important viral agent involved in neonatal diarrhea in calves worldwide. The reports on the frequency of BCoV infection in beef cattle herds under extensive management are uncommon in Brazil. The present study analyzed 93 diarrheic fecal samples of calves up to 60 days of age from 13 commercial beef cattle herds located in the states of Mato Grosso, Mato Grosso do Sul, Minas Gerais, Paraná, and Rondônia. The fecal samples were collected during 2009-2012 and were previously analyzed for the presence of bovine rotavirus group A (BoRVA, with negative results. The presence of BCoV in the fecal samples was evaluated by the partial amplification of the N gene by using the semi-nested PCR technique. The expected products of 251 bp length were amplified 33.3% (31/93 of the analyzed diarrheic fecal samples. The results revealed that coronaviruses has important participation in the neonatal diarrhea complex of beef cattle herds reared extensively from the different geographical regions of Brazil.
Bluetongue is a disease of sheep, but cattle are the principal vertebrate reservoirs of the virus. Once established, "it is impossible to actively eradicate bluetongue virus". The virus will circulate, generally subclinically, in cattle and other ruminants, and in midges. The objective of this study was to examine the correlation between the bluetongue incidence data(2006) and the mortality data(2006). To achieve the main objective of this report, the difference in the 2006 mortality and mean...
Full Text Available Abstract Background The subject of death and bereavement in the context of randomised controlled trials in neonatal or paediatric intensive care is under-researched. The objectives of this phase of the Bereavement and RAndomised ControlLEd Trials (BRACELET Study were to determine trial activity in UK neonatal and paediatric intensive care (2002-06; numbers of deaths before hospital discharge; and variation in mortality across intensive care units and trials and to determine whether bereavement support policies were available within trials. These are essential prerequisites to considering the implications of future policies and practice subsequent to bereavement following a child's enrolment in a trial. Methods The units survey involved neonatal units providing level 2 or 3 care, and paediatric units providing level II care or above; the trials survey involved trials where allocation was randomized and interventions were delivered to intensive care patients, or to parents but designed to affect patient outcomes. Results Information was available from 191/220 (87% neonatal units (149 level 2 or 3 care; and 28/32 (88% paediatric units. 90/177 (51% eligible responding units participated in one or more trial (76 neonatal, 14 paediatric and 54 neonatal units and 6 paediatric units witnessed at least one death. 50 trials were identified (36 neonatal, 14 paediatric. 3,137 babies were enrolled in neonatal trials, 210 children in paediatric trials. Deaths ranged 0-278 (median [IQR interquartile range] 2 [1, 14.5] per neonatal trial, 0-4 (median [IQR] 1 [0, 2.5] per paediatric trial. 534 (16% participants died post-enrolment: 522 (17% in neonatal trials, 12 (6% in paediatric trials. Trial participants ranged 1-236 (median [IQR] 21.5 [8, 39.8] per neonatal unit, 1-53 (median [IQR] 11.5 [2.3, 33.8] per paediatric unit. Deaths ranged 0-37 (median [IQR] 3.5 [0.3, 8.8] per neonatal unit, 0-7 (median [IQR] 0.5 [0, 1.8] per paediatric unit. Three trials had a
Full Text Available Introduction. Infertility occurs in approximately10% of couples and in vitro fertilisation (IVF is its most efficient treatment method. The National IVF Programme started in October 1st, 2006. Objective. Examination of morbidity and mortality of premature neonates conceived by IVF after initiation of the National IVF Programme. Methods. Retrospective analysis of history charts of IVF premature neonates treated at the Neonatal Intensive Care Unit (NICU of the Institute of Child and Youth Healthcare of Vojvodina, Novi Sad, Serbia, from March 1st, 2007 to March 1st, 2008. Results. Of 189 treated premature neonates, 25 (13.23% were IVF conceived, with mean gestational age (GA of 29.46±3.28 gestational weeks (GW, one-minute Apgar score 5.44±2.45, five-minute Apgar score 7.16±1.92 and birth weight (BW 1299±484.35 g; from singleton 12 (48%, twin 10 (40%, and trigeminal 3 (12% gestations. The largest number of neonates were of GA between 29 and 31.9 GW (12; 48% and BW between 1500 and 2499 g (9; 36%. All of them were treated due to respiratory distress syndrome, complicated in 2 (8% with air leak syndromes and in 4 (16% with pulmonary haemorrhage. Congenital anomalies were detected in 2 (8% and intracranial haemorrhage developed subsequently in 21 (84% neonates. Lethal outcome occurred in 7 (28% neonates, in all cases in lower gestation groups (<29 GW. Variable analysis showed significantly higher incidence of chorioamnionitis (p=0.0004 and lower GA (p~0.00, BW (p~0.00, one-minute Apgar score (p=0.0007 as well as significant difference in prophylactic surfactant application (p~0.00 and mean arterial pressure on admission (p=0.002. Conclusion. Morbidity and mortality of IVF premature neonates does not differ significantly from that of other premature neonates treated at NICU. Prematurity and low BW are important factors in pathology of these neonates and final outcome is influenced by perinatal asphyxia, risk of systemic infection, prophylactic
T. ZAMAN, A. KHAN AND M. Z. AKHTAR
This study was carried out to investigate neonatal calf mortality (NCM) in 864 Nili-Ravi buffalo calves born during 1993-2000 at the Livestock Production Research Institute (LPRI), Bahadurnagar, Okara, Pakistan. The overall mortality in buffalo neonates was 9.4%. The NCM in relation to birth weight, sex and age of neonatal calf showed non-significant difference. The highest mortality was recorded during 2nd week of age (35.0 and 39.0%) and summer season (11.5 and 12.3%) in male and female buf...
Full Text Available Abstract Background Though promising progress has been made towards achieving the Millennium Development Goal four through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. As an option, health facility delivery is assumed to reduce this problem significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas where enabling environments are constraint. Thus, this review was conducted with the aim of determining the pooled effect of health facility delivery on neonatal mortality. Methods The reviewed studies were accessed through electronic web-based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using combination key terms. The analysis was done by using STATA-11. I2 test statistic was used to assess heterogeneity. Funnel plot, Begg’s test and Egger’s test were used to check for publication bias. Pooled effect size was determined in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator. Results A total of 2,216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19 studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies the association was not significant. Based on the random effects model, the final pooled effect size in the form of relative risk was 0.71 (95% CI: 0.54, 0.87 for health facility delivery as compared to home delivery. Conclusion Health facility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle income countries. Expansion of health facilities, fulfilling the enabling environments and promoting their utilization during childbirth are
Carla Jorge Machado
Full Text Available INTRODUCTION: Child Mortality (mortality of children less than five years has declined considerably in the developing world in the 1990s, but the Infant Mortality has declined less. Therefore, to further reduce child mortality it is important to understand the determinants of neonatal and post-neonatal mortality. MATERIAL AND METHODS: We probabilistically matched 209628 live births and 3842 infant death records from the City of São Paulo, birth cohort of 1998. Data came from SINASC and SIM. We then used logistic regression to analyze the following risk factors of neonatal and post-neonatal mortality: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. RESULTS AND CONCLUSION: Infants of older mothers were less likely to die in the neonatal period; infants of adolescent mothers were more likely to die in both periods. Parities four or higher increased the likelihood of post-neonatal death. Cesarean delivery was not found to be associated with infant mortality. Low number of prenatal care visits, low birth weight, preterm birth and low Apgar scores were associated with neonatal death; Low number of prenatal care visits, low birth weight, and low Apgar scores were associated with post-neonatal death. Finally, having a mother live in a highest developed community decreased the likelihood of infant death, suggesting that unmeasured factors are behind such association.INTRODUÇÃO: Nos países em desenvolvimento, nos anos 90, a mortalidade na infância (de menores de cinco anos apresentou declínio proporcional maior do que o da mortalidade infantil. Para a redução da mortalidade na infância, deve-se entender, logo, os determinantes da mortalidade infantil. MATERIAL E MÉTODOS: Relacionou-se probabilisticamente dados do SIM e do SINASC: 209628 nascidos vivos e 3842 óbitos infantis do Munic
Full Text Available Gilles Guerrier,1 Bukola Oluyide,2 Maria Keramarou,1 Rebecca Grais1 1Epicentre, Paris, France; 2Médecins Sans Frontières, Paris, France Background: Despite considerable efforts to reduce the maternal mortality ratio, numerous pregnant women continue to die in many developing countries, including Nigeria. We conducted a study to determine the incidence and causes of maternal mortality over an 8-month period in a rural-based secondary health facility located in Jahun, northern Nigeria. Methods: A retrospective observational study was performed in a 41-bed obstetric ward. From October 2010 to May 2011, demographic data, obstetric characteristics, and outcome were collected from all pregnant women admitted. The total number of live births during the study period was recorded in order to calculate the maternal mortality ratio. Results: There were 2,177 deliveries and 39 maternal deaths during the study period, with a maternal mortality ratio of 1,791/100,000 live births. The most common causes of maternal mortality were hemorrhage (26%, puerperal sepsis (19%, and obstructed labor (5%. No significant difference (P = 0.07 in mean time to reach the hospital was noted between fatal cases (1.9 hours, 95% confidence interval [CI] 1.1–2.6 and nonfatal cases (1.4 hours, 95% CI 1.4–1.5. Two hundred and sixty-six women were admitted presenting with stillbirth. Maternal mortality was higher for unbooked patients than for booked patients (odds ratio 5.1, 95% CI 3.5–6.2, P < 0.0001. The neonatal mortality rate was calculated at 46/1,000 live births. The main primary causes of neonatal deaths were prematurity (44% and birth asphyxia (22%. Conclusion: Maternal and neonatal mortality remains unacceptably high in this setting. Reducing unbooked emergencies should be a priority with continuous programs including orthodox practices in order to meet the fifth Millennium Development Goal. Keywords: fetal mortality, maternal mortality, Nigeria, antenatal care
Ramaiya, Astha; Kiss, Ligia; Baraitser, Paula; Mbaruku, Godfrey; Hildon, Zoe
Background Worldwide, approximately 14 million mothers aged 15 – 19 years give birth annually. The number of teenage births in Sub Saharan Africa (SSA) is particularly high with an estimated 50% of mothers under the age of 20. Adolescent mothers have a significantly higher risk of neonatal mortality in comparison to adults. The objective of this review was to compare perinatal/neonatal mortality in Sub Saharan Africa and it’s associated risk factors between adolescents and adults. Results We ...
Mercer, Alex; Haseen, Fariha; Huq, Nafisa Lira; Uddin, Nowsher; Hossain Khan, Mobarak; Larson, Charles P
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
Full Text Available Abstract Background 39% of neonatal deaths in India occur on the first day of life, and 57% during the first three days of births. However, the association between postnatal care (PNC for newborns and neonatal mortality has not hitherto been examined. The paper aims to examine the association of PNC for newborns with neonatal mortality in India. Methods Data from District Level Household Survey, waive three (DLHS-3 conducted in 2007–08 is utilized in the study. We used conditional logit regression models to examine the association of PNC with neonatal mortality. The matching variables included birth order and the age of the mother at the birth of the newborn. Results The findings suggest no association between check-up of newborns within 24 hours of birth and neonatal mortality. However, the place where the newborns were examined was significantly associated with neonatal mortality. Moreover, findings do reveal that children of mothers who were advised on ‘keeping baby warm (kangaroo care after birth’ during their antenatal sessions were significantly less likely to die during the neonatal period compared to those children whose mothers were not advised about the same. Conclusions The findings are relevant because ‘keeping baby warm’ is one of the most cost-effective and easiest interventions to save babies from dying during the neonatal period. Though randomized controlled trials have already demonstrated the effectiveness of ‘keeping baby warm’, for the first time this has been found effective in a large-scale population-based study. The findings are of immense value for a country like India where the neonatal mortality rates are unacceptably high.
Algert Charles S
Full Text Available Abstract Background Despite widespread use of neonatal hospital discharge data, there are few published reports on the accuracy of population health data with neonatal diagnostic or procedure codes. The aim of this study was to assess the accuracy of using routinely collected hospital discharge data in identifying neonatal morbidity during the birth admission compared with data from a statewide audit of selected neonatal intensive care (NICU admissions. Methods Validation study of population-based linked hospital discharge/birth data against neonatal intensive care audit data from New South Wales, Australia for 2,432 babies admitted to NICUs, 1994–1996. Sensitivity, specificity and positive predictive values (PPV with exact binomial confidence intervals were calculated for 12 diagnoses and 6 procedures. Results Sensitivities ranged from 37.0% for drainage of an air leak to 97.7% for very low birthweight, specificities all exceeded 85% and PPVs ranged from 70.9% to 100%. In-hospital mortality, low birthweight (≤1500 g, retinopathy of prematurity, respiratory distress syndrome, meconium aspiration, pneumonia, pulmonary hypertension, selected major anomalies, any mechanical ventilation (including CPAP, major surgery and surgery for patent ductus arteriosus or necrotizing enterocolitis were accurately identified with PPVs over 92%. Transient tachypnea of the newborn and drainage of an air leak had the lowest PPVs, 70.9% and 83.6% respectively. Conclusion Although under-ascertained, routinely collected hospital discharge data had high PPVs for most validated items and would be suitable for risk factor analyses of neonatal morbidity. Procedures tended to be more accurately recorded than diagnoses.
T. ZAMAN, A. KHAN AND M. Z. AKHTAR
Full Text Available This study was carried out to investigate neonatal calf mortality (NCM in 864 Nili-Ravi buffalo calves born during 1993-2000 at the Livestock Production Research Institute (LPRI, Bahadurnagar, Okara, Pakistan. The overall mortality in buffalo neonates was 9.4%. The NCM in relation to birth weight, sex and age of neonatal calf showed non-significant difference. The highest mortality was recorded during 2nd week of age (35.0 and 39.0% and summer season (11.5 and 12.3% in male and female buffalo neonatal calves, respectively. Mortality was also high in calves born to first parity dams (11.3%. Morbidity and mortality due to various disease conditions showed highly significant (P = 0.0001 difference. Neonatal calf diarrhoea (NCD rendered the highest morbidity (16.6% and mortality (5.2%, followed by pneumonia and pneumono-enteritis. Mange (3.4%, navel-ill (3.1% and umbilical hernia (1.6% lead morbidity only. Relative risk of morbidity (two and seven times and mortality (three and eight times was more in calves with intermediate and low immunoglobulins (Igs concentration, respectively as compared to calves having high Igs concentration (P = 0.000.
Nøhr, Ellen Aagaard; Vaeth, Michael; Bech, Bodil H;
-2002) who were interviewed during the second trimester. Information about pregnancy outcomes and neonatal deaths (n=230) was obtained from national registers. The association was estimated by Cox regression analyses and results were presented as hazard ratios with 95% confidence intervals (CIs). RESULTS......: Compared with infants of mothers who were at a normal weight before pregnancy (BMI of 18.5 or more but less than 25), neonatal mortality was increased in infants of mothers who were overweight (BMI of 25 or more but less than 30) or obese (BMI of 30 or more) (adjusted hazard ratios 1.7, CI 1.2-2.5, and 1.......6, CI 1.0-2.4, respectively). For preterm infants (n=3,934, 136 deaths), neonatal mortality in infants born after preterm premature rupture of membranes (PROM) was significantly increased if they were born to an overweight or obese mother (adjusted hazard ratios 3.5, CI 1.4-8.7, and 5.7, CI 2...
Kasonta, Rahel; Holsteg, Mark; Duchow, Karin; James W Dekker; Cussler, Klaus; Bendall, Justin G.; Bastian, Max
In 2006, a new haemorrhagic syndrome affecting newborn calves, Bovine Neonatal Pancytopenia (BNP), was reported in southern Germany. It is characterized by severe bleeding, destruction of the red bone marrow, and a high case fatality rate. The syndrome is caused by alloreactive, maternal antibodies that are ingested by the calf with colostrum and result from a dam vaccination with one particular vaccine against Bovine-Viral-Diarrhoea-Virus. Because bovine colostrum is increasingly gaining int...
Full Text Available Abstract Background Efforts to reduce neonatal mortality are essential if the Millennium Development Goal (MDG 4 is to be met. The impact of spatial dimensions of neonatal survival has not been thoroughly investigated even though access to good quality delivery care is considered to be one of the main priorities when trying to reduce neonatal mortality. This study examined the association between distance from the mother's home to the closest health facility and neonatal mortality, and investigated the influence of distance on patterns of perinatal health care utilisation. Methods A surveillance system of live births and neonatal deaths was set up in eight districts of Quang Ninh province, Vietnam, from July 2008 to December 2009. Case referent design including all neonatal deaths and randomly selected newborn referents from the same population. Interviews were performed with mothers of all subjects and GIS coordinates for mothers' homes and all health facilities in the study area were obtained. Straight-line distances were calculated using ArcGIS software. Results A total of 197 neonatal deaths and 11 708 births were registered and 686 referents selected. Health care utilisation prior to and at delivery varied with distance to the health facility. Mothers living farthest away (4th and 5th quintile, ≥1257 meters from a health facility had an increased risk of neonatal mortality (OR 1.96, 95% CI 1.40 - 2.75, adjusted for maternal age at delivery and marital status. When stratified for socio-economic factors there was an increased risk for neonatal mortality for mothers with low education and from poor households who lived farther away from a health facility. Mothers who delivered at home had more than twice as long to a health facility compared to mothers who delivered at a health care facility. There was no difference in age at death when comparing neonates born at home or health facility deliveries (p = 0.56. Conclusion Distance to the
Carlo Waldemar A
Full Text Available Abstract Background Of 136 million babies born annually, around 10 million require assistance to breathe. Each year 814,000 neonatal deaths result from intrapartum-related events in term babies (previously “birth asphyxia” and 1.03 million from complications of prematurity. No systematic assessment of mortality reduction from tactile stimulation or resuscitation has been published. Objective To estimate the mortality effect of immediate newborn assessment and stimulation, and basic resuscitation on neonatal deaths due to term intrapartum-related events or preterm birth, for facility and home births. Methods We conducted systematic reviews for studies reporting relevant mortality or morbidity outcomes. Evidence was assessed using GRADE criteria adapted to provide a systematic approach to mortality effect estimates for the Lives Saved Tool (LiST. Meta-analysis was performed if appropriate. For interventions with low quality evidence but strong recommendation for implementation, a Delphi panel was convened to estimate effect size. Results We identified 24 studies of neonatal resuscitation reporting mortality outcomes (20 observational, 2 quasi-experimental, 2 cluster randomized controlled trials, but none of immediate newborn assessment and stimulation alone. A meta-analysis of three facility-based studies examined the effect of resuscitation training on intrapartum-related neonatal deaths (RR= 0.70, 95%CI 0.59-0.84; this estimate was used for the effect of facility-based basic neonatal resuscitation (additional to stimulation. The evidence for preterm mortality effect was low quality and thus expert opinion was sought. In community-based studies, resuscitation training was part of packages with multiple concurrent interventions, and/or studies did not distinguish term intrapartum-related from preterm deaths, hence no meta-analysis was conducted. Our Delphi panel of 18 experts estimated that immediate newborn assessment and stimulation would
Nagarajan, Shyama; Paul, Vinod K; Yadav, Namrata; Gupta, Shuchita
The National Rural Health Mission (NRHM) has been a watershed in the history of India's health sector. As a previously unattempted investment, governance, and mobilization effort, the NRHM succeeded in injecting new energy into India's public health system. A huge expansion of infrastructure and human resources is the hallmark of the NRHM action. Demand-side initiatives led to enhanced utilization of public health facilities, especially for facility births. The impact is visible. The Mission has brought Millennium Development Goals 4 and 5 within India's grasp. Acceleration in infant and neonatal mortality reduction is especially notable. The NRHM has created conditions for the country to move toward universal health coverage. PMID:26385051
Full Text Available Maternal infection with cholera may negatively affect pregnancy outcomes. The objective of this research is to systematically review the literature and determine the risk of fetal, neonatal and maternal death associated with cholera during pregnancy.Medline, Global Health Library, and Cochrane Library databases were searched using the key terms cholera and pregnancy for articles published in any language and at any time before August 2013 to quantitatively summarize estimates of fetal, maternal, and neonatal mortality. 95% confidence intervals (CIs were calculated for each selected study. Random-effect non-linear logistic regression was used to calculate pooled rates and 95% CIs by time period. Studies from the recent period (1991-2013 were compared with studies from 1969-1990. Relative risk (RR estimates and 95% CIs were obtained by comparing mortality of selected recent studies with published national normative data from the closest year.The meta-analysis included seven studies that together involved 737 pregnant women with cholera from six countries. The pooled fetal death rate for 4 studies during 1991-2013 was 7.9% (95% CIs 5.3-10.4, significantly lower than that of 3 studies from 1969-1990 (31.0%, 95% CIs 25.2-36.8. There was no difference in fetal death rate by trimester. The pooled neonatal death rate for 1991-2013 studies was 0.8% (95% CIs 0.0-1.6, and 6.4% (95% CIs 0.0-20.8 for 1969-1990. The pooled maternal death rate for 1991-2013 studies was 0.2% (95% CIs 0.0-0.7, and 5.0% (95% CIs 0.0-16.0 for 1969-1990. Compared with published national mortality estimates, the RR for fetal death of 5.8 (95% CIs 2.9-11.3 was calculated for Haiti (2013, 1.8 (95% CIs 0.3-10.4 for Senegal (2007, and 2.6 (95% CIs 0.5-14.9 for Peru (1991; there were no significant differences in the RR for neonatal or maternal death.Results are limited by the inconsistencies found across included studies but suggest that maternal cholera is associated with adverse
Arntzen, Annett; Mortensen, Laust; Schnor, Ole;
education groups were estimated as risk differences (RD), relative risks (RR) and index of inequality ratio (RII). RESULTS: Overall, rates of infant mortality were in Denmark 5.9 per 1000 live-births, in Finland 4.2 (1987-2000), in Norway 5.3 and in Sweden 4.7. Overall the mortality decreased in all...... educational groups, and the educational level increased in the study period. The time-trends differed between neonatal and postneonatal death. For neonatal death, both the absolute and relative educational differences decreased in Finland and Sweden, increased in Denmark, whereas in Norway a decrease in......BACKGROUND: This study examined changes in the educational gradients in neonatal and postneonatal mortality over a 20-year period in the four largest Nordic countries. METHODS: The study populations were all live-born singleton infants with gestational age of at least 22 weeks from 1981 to 2000...
Jia-Jun Zhu; Ying-Ying Bao; Guo-Lian Zhang; Li-Xin Ma; Ming-Yuan Wu
Background: To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery. Methods: In this retrospective, case-control study, we evaluated neonatal mortality, medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight (VLBW) infants born between January 2005 and December 2010. Of the 710 infants, 351 were born by the cesarean and 359/710 by vaginal route. Results: There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group [56/351 (15.9%) vs. 71/359 (19.8%), P=0.20]. VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route [221/351 (63.0%) vs. 178/359 (49.6%), P Conclusions: In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants. Moreover, the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants. The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.
Ronsmans, Carine; Chowdhury, Mahbub Elahi; Alam, Nurul; Koblinsky, Marge; El Arifeen, Shams
Trends were examined in a cohort study of stillbirths and early and late neonatal deaths in Matlab, a rural area of Bangladesh between 1975 and 2002, using routinely collected demographic surveillance data. Main outcome measures were stillbirths per 1000 births, early neonatal deaths per 1000 livebirths, and late neonatal deaths per 1000 children surviving after 1 week. We performed a logistic regression examining trends over time and between two areas in the three outcome measures, controlling for the effects of parental education, religion, time, geography, parity, maternal age and birth spacing. There was a marked decline in stillbirths, early and late neonatal mortality over time in both areas, though the pace of decline was somewhat faster in the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) service area. Stillbirths declined by 24% overall in the ICDDR,B service area (crude OR comparing 1996-2002 with 1975-81: 0.76 [95% CI 0.68, 0.84]), compared with 15% in the Government service area (crude OR comparing 1996-2002 with 1975-81: 0.85 [0.76, 0.94]). The overall reduction in early and late neonatal mortality comparing the same periods was 39% and 73%, respectively, in the ICDDR,B area, compared with 30% and 63%, respectively, in the Government service area. Adjusting for socio-economic or demographic factors did not substantially alter the time or area differentials. The dramatic decline in neonatal mortality was, in large part, due to a fall in deaths from neonatal tetanus. The pace of decline was faster in the area receiving intense maternal and child health and family planning interventions, but stillbirths, early and late neonatal deaths also declined in the area not receiving such intense attention, suggesting that factors outside the formal health sector play an important role. PMID:18426522
McCullough, Laurence B.; Arabin, Birgit; Brent, Robert L.; Levene, Malcolm I.; Chervenak, Frank A.
Introduction Over the last decade, planned home births in the United States (US) have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status. Purpose The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of midwives or the home birth setting are more closely associated with the increased neonatal mortality of planned midwife-attended home births in the United States. Materials and Methods This study is a secondary analysis of our prior study. The 2006–2009 period linked birth/infant deaths data set was analyzed to examine total neonatal deaths (deaths less than 28 days of life) in term singleton births (37+ weeks and newborn weight ≥ 2,500 grams) without documented congenital malformations by certification status of the midwife: certified nurse midwives (CNM), nurse midwives certified by the American Midwifery Certification Board, and “other” or uncertified midwives who are not certified by the American Midwifery Certification Board. Results Neonatal mortality rates in hospital births attended by certified midwives were significantly lower (3.2/10,000, RR 0.33 95% CI 0.21–0.53) than home births attended by certified midwives (NNM: 10.0/10,000; RR 1) and uncertified midwives (13.7/10,000; RR 1.41 [95% CI, 0.83–2.38]). The difference in neonatal mortality between certified and uncertified midwives at home births did not reach statistical levels (10.0/10,000 births versus 13.7/10,000 births p = 0.2). Conclusions This study confirms that when compared to midwife-attended hospital births, neonatal mortality rates at home births are significantly increased. While NNM was increased in planned homebirths attended by uncertified midwives when compared to certified midwives
Full Text Available Over the last decade, planned home births in the United States (US have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status.The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of midwives or the home birth setting are more closely associated with the increased neonatal mortality of planned midwife-attended home births in the United States.This study is a secondary analysis of our prior study. The 2006-2009 period linked birth/infant deaths data set was analyzed to examine total neonatal deaths (deaths less than 28 days of life in term singleton births (37+ weeks and newborn weight ≥ 2,500 grams without documented congenital malformations by certification status of the midwife: certified nurse midwives (CNM, nurse midwives certified by the American Midwifery Certification Board, and "other" or uncertified midwives who are not certified by the American Midwifery Certification Board.Neonatal mortality rates in hospital births attended by certified midwives were significantly lower (3.2/10,000, RR 0.33 95% CI 0.21-0.53 than home births attended by certified midwives (NNM: 10.0/10,000; RR 1 and uncertified midwives (13.7/10,000; RR 1.41 [95% CI, 0.83-2.38]. The difference in neonatal mortality between certified and uncertified midwives at home births did not reach statistical levels (10.0/10,000 births versus 13.7/10,000 births p = 0.2.This study confirms that when compared to midwife-attended hospital births, neonatal mortality rates at home births are significantly increased. While NNM was increased in planned homebirths attended by uncertified midwives when compared to certified midwives, this difference was not statistically significant. Neonatal
Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold [Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna (Austria); Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Helmer, Hanns [Medical University of Vienna, Department of Obstetrics and Maternal-Fetal Medicine, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Center of Anatomy and Cell Biology, Vienna (Austria)
Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)
Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)
Cristiano Siqueira Boccolini
Full Text Available OBJETIVO: Analisar a correlação entre o percentual de amamentação na primeira hora de vida e as taxas de mortalidade neonatal. MÉTODOS: Foram utilizados dados secundários de 67 países obtidos das pesquisas realizadas com a metodologia do Demographic and Health Surveys. Inicialmente, para a análise dos dados, foram empregadas a Correlação de Spearman (IC 95% e a análise gráfica com modificação de Kernel, seguidas de regressão de Poisson Binomial Negativa, ajustando para possíveis fatores de confundimento. RESULTADOS: O percentual de aleitamento materno na primeira hora de vida esteve negativamente associado com as taxas de mortalidade neonatal (Rho = -0,245, p = 0,046, e esta correlação foi mais forte entre os países com mortalidade neonatal superior a 29 mortes/1.000 nascidos vivos (Rho = -0,327, p = 0,048. Os países com os menores tercis de aleitamento materno na primeira hora de vida tiveram uma taxa 24% maior de mortalidade neonatal (razão de taxa = 1,24, IC 95% = 1,07-1,44, mesmo ajustando para fatores de confundimento. CONCLUSÃO: O efeito protetor da amamentação na primeira hora de vida sobre a mortalidade neonatal encontrado nesse estudo ecológico é consistente com o de estudos observacionais, e aponta para a importância de se adotar a amamentação na primeira hora de vida como prática de atenção neonatal.OBJECTIVE: To analyze the correlation between breastfeeding in the first hour of life with neonatal mortality rates. METHODS: The present study used secondary data from 67 countries, obtained from the Demographic and Health Surveys. Initially, for data analysis, Spearman Correlation (95% CI and Kernel graphical analysis were employed, followed by a Negative Binomial Poisson regression model, adjusted for potential confounders. RESULTS: Breastfeeding within the first hour of life was negatively correlated with neonatal mortality (Spearman's Rho = -0.245, p = 0.046, and this correlation was stronger among
Villadsen, Sarah Fredsted; Sievers, Erika; Andersen, Anne-Marie Nybo;
stillbirth and neonatal mortality between societies in northern Europe in one minority population, the Turkish. METHOD: Data on stillbirth and neonatal deaths in 239 387 births during 1990-2005, where the mother was of Turkish origin, was drawn from birth registries or surveys in nine northern European...... countries. Rates were compared with births from mothers who were born in the society of residence. Logistic regression was used to calculate odds ratios adjusted for year of birth of the offspring. RESULTS: The risks for stillbirth were, or tended to be, elevated for Turkish mothers in all countries...... compared with the native population, with the highest risk in Austria (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.4-2.1) and Switzerland (OR 1.6; 1.4-1.9). For neonatal mortality the results were heterogeneous, indicating no excess risk for Turkish-born children in the Netherlands, the UK and...
Full Text Available Considerando que a mortalidade neonatal é indicador da qualidade da assistência prestada à gestante, ao parto e ao recém-nascido, realizamos o presente trabalho, cujo objetivo foi identificar as causas e o índice de mortalidade neonatal durante o ano de 1998 em Botucatu-SP. O coeficiente de mortalidade neonatal obtido foi de 8,3/1000 nascidos vivos e o coeficiente de mortalidade neonatal precoce foi de 7,3/1000 nascidos vivos, confirmando a importância dos óbitos na primeira semana de vida. Aproximadamente três quartos dos óbitos puderam ser classificados como reduzíveis por diagnóstico e tratamento precoces, reduzíveis por adequada atenção ao parto ou parcialmente reduzíveis por adequado controle da gravidez, evidenciando que para se reduzir os índices de morte neonatal, deveremos investir na melhoria da qualidade da assistência prestada à gestante, à parturiente e ao neonato.Considerando que la mortalidad neonatal es un indicador de la calidad de la asistencia ofrecida en la gestación, al parto y al recién- nacido, realizamos el presente trabajo, con el objetivo de estudiar la mortalidad neonatal durante el año de 1998 en Botucatu-SP. El coeficiente de mortalidad neonatal encontrado fue 8,3/1000 nacidos vivos y el coeficiente de mortalidad neonatal precoz fue de 7,3/1000 nacidos vivos, confirmando la importancia de las defunciones en la primera semana de vida. Los resultados mostraron que aproximadamente tres cuartos de las defunciones pueden ser reducidas con el control del embarazo, con el diagnóstico y tratamiento precoz o con la adecuada atención al parto, evidenciando que para reducir los índices de mortalidad neonatal, deberemos invertir en la mejoría de la calidad de la asistencia ofrecida en la gestación, en el parto y al recién-nacido.Considering that neonatal mortality is an indicator of the quality of the care provided to pregnant women, at childbirth as well as to the new born, authors developed the
Full Text Available Objective: Pneumothorax in newborns may result in a significant mortality and morbidity. To predict who will survive or die is of great importance in the clinical management. The aim of this study is to address whether assessment of pneumothorax size on chest X-ray may be a predictor of prognosis in newborns presenting with pneumothorax.Methods: Of 5929 infants admitted to our neonatal intensive care unit (NICU from January 2007 to April 2011, 60 (1.0% newborns presenting with pneumothorax were included in the present study. Pneumothorax size was calculated by measuring the widest transverse diameter of pneumothorax area in the posteroanterior view and dividing it by the widest transverse diameter of thoracic cavity above the diaphragm. Clinical data were collected from the patients’ records.Findings: Overall mortality rate was 30% (18 patients. Pneumothorax size was significantly higher in non-survivors (31.1±2.8 vs 16.4±1.4, P<0.001. The cut-off point of pneumothorax size for predicting survival was determined as 20%. The sensitivity was 72% whereas the specificity 83%. Preterm birth, low birth weight, resuscitation at birth, need for mechanical ventilation and chest tube insertion were of great significance in predicting mortality. However, of overall significant parameters, only pneumothorax size was the independent prognostic factor by regression analysis (P=0.02Conclusion: We conclude that the calculation of pneumothorax size in the newborns is a predictor of prognosis with high sensitivity and specificity. Furthermore newborns with pneumothorax size greater than 20% are likely to have worse prognosis.
Full Text Available Abstract A mysterious disease affecting calves, named bovine neonatal pancytopenia (BNP, emerged in 2007 in several European countries. Epidemiological studies revealed a connection between BNP and vaccination with an inactivated vaccine against bovine virus diarrhea (BVD. Alloantibodies reacting with blood leukocytes of calves were detected in serum and colostrum of dams, which have given birth to calves affected by BNP. To understand the linkage between vaccination and the development of alloantibodies, we determined the antigens reacting with these alloantibodies. Immunoprecipitation of surface proteins from bovine leukocytes and kidney cells using sera from dams with a confirmed case of BNP in their gestation history reacted with two dominant protein species of 44 and 12 kDa. These proteins were not detected by sera from dams, free of BVDV and not vaccinated against BVD, and from sera of animals vaccinated with a different inactivated BVD vaccine. The 44 kDa protein was identified by mass spectrometry analysis as MHC I, the other as β-2-microglobulin. The presence of major histocompatibility complex class I (MHC I in the vaccine was confirmed by Western blot using a MHC I specific monoclonal antibody. A model of BNP pathogenesis is proposed.
Stoll, Barbara J.; Hansen, Nellie I.; Bell, Edward F.; Walsh, Michele C.; Carlo, Waldemar A.; Shankaran, Seetha; Laptook, Abbot R.; Sánchez, Pablo J.; Van Meurs, Krisa P.; Wyckoff, Myra; Das, Abhik; Hale, Ellen C.; Ball, M. Bethany; Newman, Nancy S.; Schibler, Kurt; Poindexter, Brenda B.; Kennedy, Kathleen A.; Cotten, C. Michael; Watterberg, Kristi L.; D’Angio, Carl T.; DeMauro, Sara B.; Truog, William E.; Devaskar, Uday; Higgins, Rosemary D.
Importance Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality. Objective To review 20-year trends in maternal/neonatal care, complications, and mortality among extremely preterm infants born at Neonatal Research Network centers. Design, Setting, Participants Prospective registry of 34,636 infants 22–28 weeks’ gestational age (GA) and 401–1500 gram birthweight born at 26 Network centers, 1993–2012. Exposure Extremely preterm birth. Main Outcomes Maternal/neonatal care, morbidities, and survival. Major morbidities, reported for infants who survived more than 12 hours, were: severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial hemorrhage, cystic periventricular leukomalacia, and/or severe retinopathy of prematurity. Regression models assessed yearly changes, adjusting for study center, race/ethnicity, GA, birthweight for GA, and sex. Results Use of antenatal corticosteroids increased from 1993 to 2012 (348/1431 [24%] to 1674/1919 [87%], p<0.001), as did cesarean delivery (625/1431 [44%] to 1227/1921 [64%], p<0.001). Delivery room intubation decreased from 1144/1433 (80%) in 1993 to 1253/1922 (65%) in 2012 (p<0.001). After increasing in the 1990s, postnatal steroid use declined to 141/1757 (8%) in 2004 (p<0.001), with no significant change thereafter. Although most infants were ventilated, continuous positive airway pressure without ventilation increased from 120/1666 (7%) in 2002 to 190/1756 (11%) in 2012 (p<0.001). Despite no improvement from 1993 to 2004, rates of late-onset sepsis declined between 2005 and 2012 for infants of each GA (median GA 26 weeks, 109/296 [37%] to 85/320 [27%], adjusted relative risk [aRR]: 0.93 [95% CI, 0.92–0.94]). Rates of other morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants 26–27 weeks (26 weeks, 130/258 [50%] to 164/297 [55%], p<0.001). Survival increased between 2009 and 2012 for infants 23
Alain K. Koffi
Full Text Available Background The Every Newborn Action Plan calls for reducing the neonatal mortality rates to fewer than 10 deaths per 1000 live births in all countries by 2035. The current study aims to increase our understanding of the social and modifiable factors that can be addressed or reinforced to improve and accelerate the decline in neonatal mortality in Malawi. Methods The data come from the 2013 Verbal and Social Autopsy (VASA study that collected data in order to describe the biological causes and the social determinants of deaths of children under 5 years of age in Balaka and Salima districts of Malawi. This paper analyses the social autopsy data of the neonatal deaths and presents results of a review of the coverage of key interventions along the continuum of normal maternal and newborn care and the description of breakdowns in the care provided for neonatal illnesses within the Pathway to Survival framework. Results A total of 320 neonatal deaths were confirmed from the VASA survey. While one antenatal care (ANC visit was high at 94%, the recommended four ANC visits was much lower at 41% and just 17% of the mothers had their urines tested during the pregnancy. 173 (54% mothers of the deceased newborns had at least one labor/delivery complication that began at home. The caregivers of 65% (n = 75 of the 180 newborns that were born at home or born and left a health facility alive perceived them to be severely ill at the onset of their illness, yet only 44% (n = 80 attempted and 36% (n = 65could reach the first health provider after an average of 91 minutes travel time. Distance, lack of transport and cost emerged as the most important constraints to formal care–seeking during delivery and during the newborn fatal illness. Conclusions This study suggests that maternal and neonatal health organizations and the local government of Malawi should increase the demand for key maternal and child health interventions, including the recommended 4
Full Text Available Bovine perinatal mortality is an increasing problem in dairy industries internationally. The objective of this study was to determine the risk factors associated with high and low herd-level calf mortality. Thirty herds with a history of either high (case or low (control calf mortality were recruited. A herd-level questionnaire was used to gather information on management practices likely to impact bovine perinatal mortality. The questionnaire was divided into four subsections dealing with pre-calving (breeding, diet and body condition score, endemic infectious diseases and calving factors. Most of the significant differences between case and control herds were found in calving management. For example, in case herds, pregnant cattle were less likely to be moved to the calving unit two or more days and more likely to be moved less than 12 hours pre-calving, they were also less likely to calve in group-calving facilities and their calves were more likely to receive intranasal or hypothermal resuscitation. These management procedures may cause social isolation and periparturient psychogenic uterine atony leading to dystocia, more weak calves requiring resuscitation and high perinatal calf mortality. The key finding is that calving, not pre-calving, management appears to be the most important area of concern in herds with high perinatal mortality.
Babcock, Abram H.; White, Brad J.; Renter, David G.; Dubnicka, Suzanne R.; Scott, H. Morgan
Although bovine respiratory disease complex (BRDC) is common in post-weaning cattle, BRDC prediction models are seldom analyzed. The objectives of this study were to assess the ability to predict cumulative cohort-level BRDC morbidity using on-arrival risk factors and to evaluate whether or not adding BRDC risk classification and daily BRDC morbidity and mortality data to the models enhanced their predictive ability. Retrospective cohort-level and individual animal health data were used to cr...
Kalter, Henry D; Yaroh, Asma Gali; Maina, Abdou; Koffi, Alain K; Bensaïd, Khaled; Amouzou, Agbessi; Black, Robert E
Background This study was one of a set of verbal/social autopsy (VASA) investigations undertaken by the WHO/UNICEF–supported Child Health Epidemiology Reference Group to estimate the causes and determinants of neonatal and child deaths in high priority countries. The study objective was to help explain the lack of decrease in neonatal mortality in Niger from 2007 to 2010, a period during which child mortality was decreasing. Methods VASA interviews were conducted of a random sample of 453 neonatal deaths identified by the 2010 Niger National Mortality Survey (NNMS). Causes of death were determined by expert algorithm analysis, and the prevalence of household, community and health system determinants were examined along the continuum of maternal and newborn care, the Pathway to Survival for newborn illnesses, and an extended pathway for maternal complications. The social autopsy findings were compared to available data for survivors from the same cohort collected by the NNMS and the 2012 Niger Demographic and Health Survey. Findings Severe neonatal infection and birth asphyxia were the leading causes of early neonatal death in the community and facilities. Death in the community after delayed careseeking for severe infection predominated during the late neonatal period. The levels of nearly all demographic, antenatal and delivery care factors were in the direction of risk for the VASA study decedents. They more often resided rurally (P < 0.001) and their mothers were less educated (P = 0.03) and gave birth when younger (P = 0.03) than survivors’ mothers. Their mothers also were less likely to receive quality antenatal care (P < 0.001), skilled attendance at birth (P = 0.03) or to deliver in an institution (P < 0.001). Nearly half suffered an obstetric complication, with more maternal infection (17.9% vs 0.2%), antepartum hemorrhage (12.5% vs 0.5%) and eclampsia/preeclampsia (9.5% vs 1.6%) than for all births in Niger. Their mothers also
Full Text Available Continuum of care has the potential to improve maternal, newborn, and child health (MNCH by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood and space dimensions (from community-family care to clinical care. However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries.We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers' uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality.Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%. Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%.Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the
Eltayb M. Abuelzein
Full Text Available The dairy industry is a large and important business in Saudi Arabia. Although farms are administered to high international standards, some reproduction problems, of uncertain aetiology, are encountered. The most frequently seen are conception failures, abortions, stillbirths and the birth of weak or malformed calves. These conditions are suggestive of bovine viral diarrhoea virus (BVDV infection. Unfortunately, very little published information is available regarding the impact of this disease on cattle populations in Saudi Arabia. As a consequence, the present study was carried out and is the first of its kind in Saudi Arabia and the Gulf region. The aim of the study was to elucidate the role of in utero BVDV infection leading to the birth of weak or malformed calves on a large dairy farm in Saudi Arabia. The study was divided into two parts. Firstly, apparently healthy neonatal calves were sampled for the detection of pre-colostral serum antibodies to BVDV. The presence of these antibodies indicates exposure of the foetus to BVDV during the last two trimesters of gestation. Secondly, tissue samples from malformed neonatal calves were examined for the presence of BVDV antigens. Detection of such antigens confirms exposure of the foetus to the virus during the first trimester of gestation. The results of the investigation indicated that 36.1% of the neonatal calves were exposed to BVDV infection in utero. This is higher than what has been reported in the literature and suggests that dairy farmers in the Arabian Peninsula need to be made aware of the dangers of BVDV infections in their herds. The epidemiological significance of the results is discussed.
Euler Kerstin N
Full Text Available Abstract Background Bovine neonatal pancytopenia (BNP is a disease syndrome in newborn calves of up to four weeks of age, first observed in southern Germany in 2006. By now, cases have been reported in several countries around the globe. Many affected calves die within days due to multiple haemorrhages, thrombocytopenia, leukocytopenia and bone marrow depletion. A certain vaccine directed against Bovine Virus Diarrhoea Virus (BVDV was recently shown to be associated with BNP pathogenesis. Immunized cows develop alloantibodies that are transferred to newborn calves via colostrum intake. In order to further elucidate BNP pathogenesis, the purpose of this study was to characterize and compare the protein composition of the associated vaccine to another vaccine directed against BVDV not related to BNP and the cell surface proteome of MDBK (Madin-Darby Bovine Kidney cells, the cell line used for production of the associated vaccine. Results By SDS-PAGE and mass spectrometry, we were able to detect several coagulation-related and immune modulatory proteins, as well as cellular and serum derived molecules being shared between the associated vaccine and MDBK cells. Furthermore, the number of proteins identified in the BNP related vaccine was almost as high as the number of surface proteins detected on MDBK cells and exceeded the amount of proteins identified in the non-BNP related vaccine over 3.5 fold. The great amount of shared cellular and serum derived proteins confirm that the BNP associated vaccine contained many molecules originating from MDBK cells and vaccine production. Conclusions The respective vaccine was not purified enough to prevent the development of alloantibodies. To narrow down possible candidate proteins, those most likely to represent a trigger for BNP pathogenesis are presented in this study, giving a fundament for further analysis in future research.
Rita C. Silveira
Full Text Available OBJETIVOS: avaliar os escores SNAP e SNAP-PE como preditores de mortalidade neonatal na nossa UTI neonatal, comparando seus resultados. MÉTODOS: todos os recém-nascidos admitidos na UTI neonatal no período de março de 1997 a dezembro de 1998 foram avaliados prospectivamente quanto ao SNAP e SNAP-PE com 24 horas de vida. Foram critérios de exclusão o óbito ou alta da UTI nas primeiras 24 horas de vida, as malformações congênitas incompatíveis com a vida, e recém-nascidos transferidos de outros hospitais. RESULTADOS: 553 recém-nascidos foram incluídos, 54 faleceram. Os valores das medianas do SNAP e SNAP-PE foram mais elevados naqueles que não sobreviveram. Os recém-nascidos foram divididos em cinco faixas de gravidade crescente de SNAP e SNAP-PE. SNAP: até 6, 7-11, 12-15, 16-24, acima de 24 (mortalidade: 3%, 11%, 29%, 48%, 75%, respectivamente. SNAP-PE: até 11, 12-23, 24-32, 33-50, acima de 50 (mortalidade: 3%, 10%, 53%, 78%, 83%, respectivamente. A partir da Curva ROC, os pontos de corte foram 12 para SNAP e 24 para SNAP-PE, obtendo-se sensibilidade, especificidade, valor preditivo positivo (VPP e valor preditivo negativo (VPN para mortalidade. SNAP 12: sensibilidade 79,6%, especificidade 71,7%, VPP 23,4%, VPN 97%. SNAP-PE 24: sensibilidade 79,6%, especificidade 80%, VPP 30%, VPN 97,3%. A área abaixo da Curva ROC (Az para SNAP foi 81,4% e para SNAP-PE 85,1%, ambas estatisticamente significativas. A comparação entre as áreas das duas curvas não evidenciou diferença estatisticamente significativa. CONCLUSÕES: os escores SNAP e SNAP-PE são excelentes preditores de sobrevida neonatal, recomendamos sua utilização rotineiramente na admissão de recém-nascidos nas Unidades de Tratamento Intensivo Neonatal.OBJECTIVE: to evaluate the Score for Neonatal Acute Physiology and the Score for Neonatal Acute Physiology Perinatal Extension as neonatal mortality predictors in our neonatal intensive care unit, and to compare their
Benn, Christine Stabell; Diness, Birgitte R; Balde, Ibraima;
Whether neonatal vitamin A supplementation (NVAS) should be policy in areas with vitamin A deficiency is debated. We observed that a smaller dose of vitamin A may decrease mortality more than a larger dose and conducted a randomized, double-blind, placebo-controlled trial in Guinea-Bissau with the...... primary aim of comparing the effect of 50,000 with 25,000 IU neonatal vitamin A on infant mortality. The secondary aim was to study the effect of NVAS vs. placebo, including a combined analysis of NVAS trials. Between 2004 and 2007, normal-birth-weight neonates were randomly assigned in a 1:1:1 ratio to...
Wehby George L
Full Text Available Abstract Background Cleft lip and/or palate (CL/P increase mortality and morbidity risks for affected infants especially in less developed countries. This study aimed at assessing the effects of systematic pediatric care on neonatal mortality and hospitalizations of infants with cleft lip and/or palate (CL/P in South America. Methods The intervention group included live-born infants with isolated or associated CL/P in 47 hospitals between 2003 and 2005. The control group included live-born infants with CL/P between 2001 and 2002 in the same hospitals. The intervention group received systematic pediatric care between the 7th and 28th day of life. The primary outcomes were mortality between the 7th and 28th day of life and hospitalization days in this period among survivors adjusted for relevant baseline covariates. Results There were no significant mortality differences between the intervention and control groups. However, surviving infants with associated CL/P in the intervention group had fewer hospitalization days by about six days compared to the associated control group. Conclusions Early systematic pediatric care may significantly reduce neonatal hospitalizations of infants with CL/P and additional birth defects in South America. Given the large healthcare and financial burden of CL/P on affected families and the relatively low cost of systematic pediatric care, improving access to such care may be a cost-effective public policy intervention. Trial Registration ClinicalTrials.gov: NCT00097149
Objective: To determine frequency of thrombocytopenia and thrombocytosis, the MPV (mean platelet volume) and PDW (platelet distribution width) in patients with probable and culture proven neonatal sepsis and determine any association between platelet counts and mortality rate. Study Design: Descriptive analytical study. Place and Duration of Study: NICU, Fazle Omar Hospital, from January 2011 to December 2012. Methodology: Cases of culture proven and probable neonatal sepsis, admitted in Fazle Omar Hospital, Rabwah, were included in the study. Platelet counts, MPV and PDW of the cases were recorded. Mortality was documented. Frequencies of thrombocytopenia ( 450000/mm3) were ascertained. Mortality rates in different groups according to platelet counts were calculated and compared by chi-square test to check association. Results: Four hundred and sixty nine patients were included; 68 (14.5%) of them died. One hundred and thirty six (29%) had culture proven sepsis, and 333 (71%) were categorized as probable sepsis. Thrombocytopenia was present in 116 (24.7%), and thrombocytosis was present in 36 (7.7%) cases. Median platelet count was 213.0/mm3. Twenty eight (27.7%) patients with thrombocytopenia, and 40 (12.1%) cases with normal or raised platelet counts died (p < 0.001). Median MPV was 9.30, and median PDW was 12.30. MPV and PDW of the patients who died and who were discharged were not significantly different from each other. Conclusion: Thrombocytopenia is a common complication of neonatal sepsis. Those with thrombocytopenia have higher mortality rate. No significant difference was present between PDW and MPV of the cases who survived and died. (author)
Bruns, Danielle R; Brown, R. Dale; Stenmark, Kurt R.; Buttrick, Peter M.; Walker, Lori A.
Right ventricular (RV) function is a key determinant of survival in patients with both RV and left ventricular (LV) failure, yet the mechanisms of RV failure are poorly understood. Recent studies suggest cardiac metabolism is altered in RV failure in pulmonary hypertension (PH). Accordingly, we assessed mitochondrial content, dynamics, and function in hearts from neonatal calves exposed to hypobaric hypoxia (HH). This model develops severe PH with concomitant RV hypertrophy, dilation, and dys...
U.S. Department of Health & Human Services — Rates are infants (under 1 year) and neonatal (under 28 days) deaths per 1,000 live births. http://blogs.cdc.gov/nchs-data-visualization/deaths-in-the-us/
Full Text Available Background: Multiple pregnancies have increased significantly over the past decades. Birth weight discordance (BWD is a common problem between twins, but its association with an increased morbidity and mortality is still unclear. The aim of this study was to determine the frequency of BWD among twins and to evaluate its impact on perinatal morbidity.Methods: Retrospective study of 1,132 twins born in a tertiary perinatal center, over a period of 8 years (2003-2010, that were divided in two groups: concordant (intrapair birth weight difference ≤ 20% or discordant (> 20%. The two groups were compared in terms of epidemiological and obstetric data, mode of delivery, perinatal morbidity and mortality.Results: During the study period, multiple gestation occurred in 2% of cases, of which 96% were twins. BWD was found in 212 (19% twins. Multivariate analysis demonstrated that maternal age ≥ 35 years and hypoxic-ischemic placental infarction were risk factors for the occurrence of BWD. The discordant group showed a significantly higher incidence of congenital skeletal and central nervous system malformations, a higher rate of hospitalization in the neonatal intensive care unit and a longer duration of hospitalization. The percentage of those requiring assisted ventilation, pulmonary surfactant, parenteral nutrition and central venous catheters was significantly higher in the discordant group compared with the concordant one. The rate of stillbirth was significantly higher in the discordant group (3% versus 1%; mortality was also higher (3% versus 2%, but this difference was not statistically significant (p = 0.405.Conclusion: BWD was associated with increased prenatal mortality and neonatal morbidity. Diagnosis and management of pregnant women with this fetal condition in tertiary perinatal centers may improve the prognosis of these infants.
Maredza, Mandy; Chola, Lumbwe; Hofman, Karen
Background Newborn mortality, comprising a third of all under-5 deaths, has hardly changed in low and middle income countries (LMICs) including South Africa over the past decade. To attain the MDG 4 target, greater emphasis must be placed on wide-scale implementation of proven, cost-effective interventions. This paper reviews economic evidence on effective neonatal health interventions in LMICs from 2000–2013; documents lessons for South African policy on neonatal health; and identifies gaps ...
Canning, P; Canon, A; Bates, J L; Gerardy, K; Linhares, D C L; Piñeyro, P E; Schwartz, K J; Yoon, K J; Rademacher, C J; Holtkamp, D; Karriker, L
A 300-sow farrow-to-finish swine operation in the United States experienced a sudden and severe increase in mortality in neonatal piglets with high morbidity followed by vesicular lesions on the snout and feet of adult females and males. Affected live piglets were submitted for diagnostic investigation. Samples tested polymerase chain reaction (PCR) negative for foot-and-mouth disease virus, porcine delta coronavirus, porcine epidemic diarrhoea virus, porcine rotavirus types A, B and C, transmissible gastroenteritis virus, and porcine reproductive and respiratory syndrome virus. Senecavirus A (SV-A) formerly known as Seneca Valley virus was detected by real-time reverse-transcription polymerase chain reaction (rRT-PCR) from serum, skin and faeces of piglets and from serum and faeces of sows. SV-A was isolated in cell culture from piglet samples. SV-A VP1 gene region sequencing from piglet tissues was also successful. A biosecurity and disease entry evaluation was conducted and identified potential biosecurity risks factors for the entry of new pathogens into the operation. This is the first case report in the United States associating SV-A with a clinical course of severe but transient neonatal morbidity and mortality followed by vesicular lesions in breeding stock animals. Veterinarians and animal caretakers must remain vigilant for vesicular foreign animal diseases and report suspicious clinical signs and lesions to state animal health authorities for diagnostic testing and further investigation. PMID:27213868
Full Text Available Abstract Background Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity. Objectives This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent on syphilis-related stillbirths and neonatal mortality. Methods We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken. Results Moderate quality evidence (3 studies supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98% with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90% (8 studies, a 64% reduction in preterm delivery (95% c.i. 53 – 73% (7 studies and an 80% reduction in neonatal deaths (95% c.i. 68 – 87% (5 studies. Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong. Conclusion Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.
India accounts for 1.7 million child deaths, a quarter of global child mortality. The current literature has succeeded in establishing an association between domestic violence and child mortality, but has yet to present evidence of a causal relationship. In this paper we use an instrumental variable approach to analyse the causal impact of domestic violence against the mother on child mortality in the Indian context. Domestic violence is instrument ed with the real price o f gold at the time ...
India accounts for 1.7 million child deaths, a quarter of global child mortality. The current literature has succeeded in establishing an association between domestic violence and child mortality, but has yet to present evidence of a causal relationship. In this paper we use an instrumental variable approach to analyse the causal impact of domestic violence against the mother on child mortality in the Indian context. Domestic violence is instrumented with the real price of gold at the time of...
Wang, Haidong; Liddell, Chelsea A; Coates, Matthew M;
BACKGROUND: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of redu...
Bruns, Danielle R; Brown, R Dale; Stenmark, Kurt R; Buttrick, Peter M; Walker, Lori A
Right ventricular (RV) function is a key determinant of survival in patients with both RV and left ventricular (LV) failure, yet the mechanisms of RV failure are poorly understood. Recent studies suggest cardiac metabolism is altered in RV failure in pulmonary hypertension (PH). Accordingly, we assessed mitochondrial content, dynamics, and function in hearts from neonatal calves exposed to hypobaric hypoxia (HH). This model develops severe PH with concomitant RV hypertrophy, dilation, and dysfunction. After 2 wk of HH, pieces of RV and LV were obtained along with samples from age-matched controls. Comparison with control assesses the effect of hypoxia, whereas comparison between the LV and RV in HH assesses the additional impact of RV overload. Mitochondrial DNA was unchanged in HH, as was mitochondrial content as assessed by electron microscopy. Immunoblotting for electron transport chain subunits revealed a small increase in mitochondrial content in HH in both ventricles. Mitochondrial dynamics were largely unchanged. Activity of individual respiratory chain complexes was reduced (complex I) or unchanged (complex V) in HH. Key enzymes in the glycolysis pathway were upregulated in both HH ventricles, alongside upregulation of hypoxia-inducible factor-1α protein. Importantly, none of the changes in expression or activity were different between ventricles, suggesting the changes are in response to HH and not RV overload. Upregulation of glycolytic modulators without chamber-specific mitochondrial dysfunction suggests that mitochondrial capacity and activity are maintained at the onset of PH, and the early RV dysfunction in this model results from mechanisms independent of the mitochondria. PMID:25416385
Armengol, Ramon; Fraile, Lorenzo
The objective of the study was to evaluate if on-farm heat treatment of colostrum and bulk tank milk can improve calf health status and morbidity and mortality rates during the first 21d of life in neonatal Holstein calves receiving appropriate colostrum ingestion. A total of 587 calves were randomly assigned to 2 groups of males and females over 18mo. The nonpasteurized group (n=287, 143 males and 144 females) was fed frozen (-20°C) colostrum (6-8L during the first 12h of life) that was previously reheated up to 40°C. They were also fed refrigerated (4°C) raw milk from the bulk tank that was also reheated up to 40°C (1.8L every 12h). The pasteurized group (n=300, 150 males and 150 females) was also fed colostrum and milk, but both were pasteurized before freezing. Blood samples were drawn from all calves to obtain serum at 2 to 5d of life. Serum total protein (g/dL) was determined using a commercially available refractometer. Colostrum and milk underwent routine bacteriological analysis to determine total plate counts (cfu/mL) and total coliform counts (cfu/mL). All the calves underwent clinical examination every 24h during the first 21d of life. Every day, calves were clinically diagnosed either as being healthy or suffering from respiratory disease, neonatal calf diarrhea, or suffering other diseases. On-farm heat treatment for colostrum and milk reduced total plate counts and total coliform counts between 1 and 2 log10. Pasteurization of colostrum and milk significantly decreased the morbidity and mortality (5.2 and 2.8%) in comparison with calves receiving nonpasteurized colostrum and milk (15.0 and 6.5%), respectively, during the first 21d of life, even in animals receiving appropriate colostrum ingestion. PMID:26995131
Field, David John; Draper, Elizabeth S; Fenton, Alan; Papiernik, Emile; Zeitlin, J; Blondel, Beatrice; Cuttini, Marina; Maier, Rolf; Weber, Tom; Carrapato, Manuel; Kollee, Louis A; Gadzinowski, Janusz; Van Reempts, Patrick
one region). PARTICIPANTS: All births that occurred between 22+0 and 31+6 weeks of gestation in 2003. MAIN OUTCOME MEASURE: Neonatal death rate adjusted for rate of delivery at this gestation. RESULTS: Rate of delivery of all births at 22+0-31+6 weeks of gestation and live births only were calculated...... for each region. Two regions had significantly higher rates of very preterm delivery per 1000 births (Trent UK (16.8, 95% CI 15.7-17.9) and the Northern UK (17.1, 95% CI 15.6-18.6); group mean 13.2, 95% CI 12.9 to 13.5). Four regions had rates significantly below the group average: Portugal North (10.......7, 95% CI 9.6 to 11.8), Eastern and Central Netherlands (10.6, 95% CI 9.7 to 11.6), Eastern Denmark (11.2, 95% CI 10.1 to 12.4) and Lazio in Italy (11.0, 95% CI 10.1 to 11.9). Similar trends were seen in live birth data. Published rates of neonatal death for each region were then adjusted by applying: a...
Bryony A Jones
Full Text Available Bovine neonatal pancytopenia (BNP, a high fatality condition causing haemorrhages in calves aged less than 4 weeks, was first reported in 2007 in Germany and subsequently observed at low incidence in other European countries and New Zealand. A multi-country matched case-control study was conducted in 2011 to identify calf-level risk factors for BNP. 405 BNP cases were recruited from 330 farms in Belgium, France, Germany and the Netherlands by laboratory confirmation of farmer-reported cases. Up to four calves of similar age from the same farm were selected as controls (1154 calves. Risk factor data were collected by questionnaire. Multivariable modelling using conditional logistic regression indicated that PregSure®BVD (PregSure, Pfizer Animal Health vaccination of the dam was strongly associated with BNP cases (adjusted matched Odds Ratio - amOR 17.8 first lactation dams; 95% confidence interval - ci 2.4, 134.4; p = 0.005, and second or more lactation PregSure-vaccinated dams were more likely to have a case than first lactation vaccinated dams (amOR 2.2 second lactation; ci 1.1, 4.3; p = 0.024; amOR 5.3 third or more lactation; ci 2.9, 9.8; p = <0.001. Feeding colostrum from other cows was strongly associated with BNP if the dam was not PregSure-vaccinated (amOR 30.5; ci 2.1, 440.5; p = 0.012, but the effect was less if the dam was PregSure-vaccinated (amOR 2.1; ci 1.1, 4.0; p = 0.024. Feeding exclusively dam's milk was a higher risk than other types of milk (amOR 3.4; ci 1.6, 7.5; p = 0.002. The population attributable fractions were 0.84 (ci 0.68, 0.92 for PregSure vaccination, 0.13 (ci 0.06, 0.19 for feeding other cows' colostrum, and 0.15 (ci 0.08, 0.22 for feeding dam's milk. No other calf-level factors were identified, suggesting that there are other important factors that are outside the scope of this study, such as genetics, which explain why BNP develops in some PregSure-colostrum-exposed calves but not in
Impacto das malformações congênitas na mortalidade perinatal e neonatal em uma maternidade-escola do Recife Impact of congenital malformations on perinatal and neonatal mortality in an university maternity hospital in Recife
Melania Maria Ramos de Amorim
Full Text Available OBJETIVOS: determinar a incidência de malformações congênitas em recém-nascidos assistidos em uma maternidade-escola de Recife e avaliar o impacto destas malformações na mortalidade perinatal e neonatal. MÉTODOS: realizou-se um estudo longitudinal durante os meses de setembro de 2004 a maio de 2005, analisando-se todos os partos assistidos no Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Determinou-se a freqüência e o tipo de malformações congênitas e foram calculados os coeficientes de mortalidade fetal, mortalidade perinatal, mortalidade neonatal precoce e tardia. RESULTADOS: a freqüência de malformações foi de 2,8% (em 4043 nascimentos. O percentual de malformações entre os nativivos foi de 2,7%, e entre os natimortos foi de 6,7%. Dentre as malformações, as mais freqüentes foram as do sistema nervoso central (principalmente hidrocefalia e meningomielocele, as do sistema osteomuscular e as cardiopatias. Não houve associação entre malformações e sexo, porém a freqüência de prematuridade e baixo peso foi maior entre os casos de malformações. Constatou-se, entre os malformados, mortalidade neonatal precoce de 32,7% e tardia de 10,6%. Os casos de malformações representaram 6,7% dos natimortos, 24,2% das mortes neonatais precoces e 25,8% do total de mortes neonatais. CONCLUSÕES: a freqüência de malformações correspondeu a 2,8% dos nascimentos. As malformações representaram a segunda causa mais freqüente de mortes neonatais, depois da prematuridade.OBJECTIVES: to determine the incidence of congenital malformations in newborns in a university maternity hospital in Recife and assess the impact of malformation in perinatal and neonatal mortality. METHODS: a longitudinal study was performed from September 2004 to May 2005 with all deliveries at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP analyzed. The type and incidence of congenital malformations were determined, and fetal mortality
Diferenças no padrão de ocorrência da mortalidade neonatal e pós-neonatal no Município de Goiânia, Brasil, 1992-1996: análise espacial para identificação das áreas de risco Differential patterns of neonatal and post-neonatal mortality rates in Goiânia, Brazil, 1992-1996: use of spatial analysis to identify high-risk areas
Otaliba Libânio de Morais Neto
Full Text Available Este artigo refere-se à pesquisa acerca do padrão espacial dos componentes neonatal e pós-neonatal da mortalidade infantil em Goiânia, no Estado de Goiás, Brasil. A população do estudo foi a coorte de 101 mil nascidos vivos, residentes em Goiânia, de 1992 a 1996. As probabilidades de morte infantil foram estimadas mediante o cotejo dos arquivos de óbitos e de nascidos vivos. Para minimizar as flutuações aleatórias das taxas, empregou-se o método Bayesiano empírico. A unidade de análise do padrão espacial foi constituída pelos 65 distritos urbanos de planejamento. Para análise de autocorrelação espacial foram utilizados: Moran "global", Moran local e estatística Gi* local. Os componentes neonatal e pós-neonatal da mortalidade infantil evidenciaram autocorrelação espacial estatisticamente significativa. No período pós-neonatal, os distritos de risco concentram-se nas regiões periféricas do município. No período neonatal, o padrão de ocorrência é heterogêneo, havendo distritos de alto risco distribuídos em todas as regiões, inclusive na região Central de Goiânia.The aim of this study was to investigate the spatial pattern of neonatal and post-neonatal mortality in the city of Goiânia, Central Brazil. Analyses were based on linked birth and death certificates relating to 101,000 in-hospital live births from mothers residing in the city of Goiânia over the 1992-1996 period. Overall neonatal and post-neonatal mortality probabilities were calculated using the linked database. The empirical Bayes method was applied to smooth the estimated rates and minimize random fluctuation. Spatial units of analysis were 65 urban districts, corresponding to the urban planning sectors. The following exploratory spatial analyses were applied: "global" Moran's I statistic, local Moran LISA map, and Gi* local statistics. For both neonatal and post-neonatal mortality there was statistically significant spatial autocorrelation
San-Hua Leng; Fu-Er Lu
AIM: To induce the pancreatic duct cells into endocrine cells with a new natural protocol for electrophysiological study.METHODS: The pancreatic duct cells of neonatal rats were isolated, cultured and induced into endocrine oells with 15% fetal bovine serum for a period of 20 d. During this period, insulin secretion, MTT value, and morphological change of neonatal and adult pancreatic islet cells were comparatively investigated. Pancreatic β-cells were identified by morphological and electrophysiological characteristics, while ATP sensitive potassium channels(KATP), voltage-dependent potassium channels (KV), and voltage-dependent calcium channels (KCA) in β-cells were identified by patch clamp technique.RESULTS: After incubation with fetal bovine serum, the neonatal duct cells budded out, changed from duct-like cells into islet clusters. In the first 4 d, MTT value and insulin secretion increased slowly (MTT value from 0.024±0.003 to0.028±0.003, insulin secretion from 2.6±0.6to 3.1±0.8 mIU/L). Then MTT value and insulin secretion increased quickly from d 5 to d 10 (MTT value from 0.028±0.003 to 0.052±0.008, insulin secretion from 3.1±0.8to 18.3±2.6 mIU/L), then reached high plateau (MTT value ＞0.052±0.008, insulin secretion ＞18.3±2.6 mIU/L).In contrast, for the isolated adult pancreatic islet cells,both insulin release and MTT value were stable in the first 4 d (MTT value from 0.029±0.01 to 0.031±0.011,insulin secretion from 13.9±3.1 to 14.3±3.3 mIU/L), but afterwards they reduced gradually (MTT value ＜0.031±0.011, insulin secretion ＜8.2±1.5 mIU/L), and the pancrearic islet cells became dispersed, broken or atrophied correspondingly. The differentiated neonatal cells were identified as pancreatic islet cells by dithizone staining method, and pancreatic β-cells were further identified by both morphological features and electrophysiological characteristics, i.e. the existence of recording currents from KATP KV, and KCA.CONCLUSION: Islet
Full Text Available BACKGROUND: During the past two decades there has been a sustained decline in child and infant mortality, however neonatal mortality has remained relatively unchanged. Almost all neonatal deaths (99% occur in developing countries, where the majority are delivered at homes. Evidence suggests that these deaths could be prevented by simple, inexpensive practices and interventions during the pregnancy, delivery and postnatal period. In Pakistan over the last decade extensive efforts have been made by the international donors and government to implement these practices. However, limited attempts have been made to explore if these efforts have made a difference at the grass root level. This study assessed the burden of neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan. METHODOLOGY/PRINCIPAL FINDINGS: A community based cross-sectional study was performed. A pre-tested structured questionnaire was administered to 565 women who had recently delivered. Information was collected on neonatal morbidity, mortality and practices of women regarding care during pregnancy, child birth and for newborn, till 28th day of birth. Although 70% of women mentioned receiving antenatal care by a skilled provider, only 54.5% had four or more visits. Tetanus toxoid was received by 79% of women while only 56% delivered at a health care facility by a skilled attendant. Newborn care practices like bathing the baby immediately after birth (56%, giving pre-lacteals (79.5%, late initiation of breast feeding (80.3%, application of substances on umbilical cord (58% and body massage (89% were common. Most neonates (81.1% received BCG injection and polio drops after birth. Neonatal mortality rate was 27/1000 live births with the majority of deaths occurring during the first three days of life. CONCLUSION: Even after years of efforts by government and nongovernmental sector to reduce newborn morbidity and mortality, inadequate
Full Text Available BACKGROUND: Pregnancy induced Hypertension (PIH is one of the common complications which contributes to significant maternal and perinatal morbidity and mortality. Effective management improves outcome of both mother and the baby OBJECTIVES: To study the morbidity and mortality in babies born to mothers with pregnancy induced hypertension, assess the reasons for the outcome of the baby and monitor the growth and development till the age of 6 months. METHODS: This study was conducted at Niloufer Institute of Child Health, Hyderabad a teaching institution which caters to high risk obstetric patients and also has a tertiary level NICU care. Study was conducted over a period of 9 months and 100 cases of PIH were included over a period of 3 months and the babies were followed up till the age of 6 months. A structured proforma was designed and analyzed using Epi info for window statistical software. RESULTS: Out of 1461 deliveries, we enrolled 100 PIH cases as per inclusion criteria and studied during 3 months period. Of the study group, 48% were with mild PIH (n=48 and 52% were with severe PIH (n=52. When compared to mild PIH, severe PIH was associated with higher rates of preterm deliveries and it was statistically significant (P 2. In NICU admissions Meconium aspiration syndrome (MAS, Hyaline membrane disease (HMD, Birth asphyxia (BA and sepsis were observed. All the complications were more in severe PIH than mild PIH. After discharge infants were fallowed up till the age of 6 months. Out of 75 babies discharged, 24 cases were lost to follow up and in the remaining 51 babies, 33 were born to mild PIH mothers, 18 were born to severe PIH mothers. CONCLUSION: PIH is one of the major causes of morbidity and mortality in the fetus and newborn. The more severe the PIH, the more adverse is the outcome. Our goal is early detection and prompts Management
Aluísio J D Barros
Full Text Available OBJECTIVE: To assess the effect of hospital of birth on neonatal mortality. METHODS: A birth cohort study was carried out in Pelotas, Southern Brazil, in 2004. All hospital births were assessed by daily visits to all maternity hospitals and 4558 deliveries were included in the study. Mothers were interviewed regarding potential risk factors. Deaths were monitored through regular visits to hospitals, cemeteries and register offices. Two independent pediatricians established the underlying cause of death based on information obtained from medical records and home visits to parents. Logistic regression was used to estimate the effect of hospital of birth, controlling for confounders related to maternal and newborn characteristics, according to a conceptual model. RESULTS: Neonatal mortality rate was 12.7‰ and it was highly influenced by birthweight, gestational age, and socioeconomic variables. Immaturity was responsible for 65% of neonatal deaths, followed by congenital anomalies, infections and intrapartum asphyxia. Adjusting for maternal characteristics, a three-fold increase in neonatal mortality was seen between similar complexity hospitals. The effect of hospital remained, though lower, after controlling for newborn characteristics. CONCLUSIONS: Neonatal mortality was high, mainly related to immaturity, and varied significantly across maternity hospitals. Further investigations comparing delivery care practices across hospitals are needed to better understand NMR variation and to develop strategies for neonatal mortality reduction.OBJETIVO: Avaliar o efeito de hospital de nascimento na ocorrência de mortalidade neonatal. MÉTODOS: Uma coorte de nascimentos foi iniciada em Pelotas, em 2004. Todos os nascimentos hospitalares foram estudados em visitas diárias às maternidades da cidade, incluindo-se 4.558 recém-nascidos. As mães foram entrevistadas sobre fatores de risco em potencial e as mortes, monitoradas com visitas regulares aos
Full Text Available BACKGROUND: Low birth weight and prematurity are amongst the strongest predictors of neonatal death. However, the extent to which they act independently is poorly understood. Our objective was to estimate the neonatal mortality risk associated with preterm birth when stratified by weight for gestational age in the high mortality setting of East Africa. METHODS AND FINDINGS: Members and collaborators of the Malaria and the MARCH Centers, at the London School of Hygiene & Tropical Medicine, were contacted and protocols reviewed for East African studies that measured (1 birth weight, (2 gestational age at birth using antenatal ultrasound or neonatal assessment, and (3 neonatal mortality. Ten datasets were identified and four met the inclusion criteria. The four datasets (from Uganda, Kenya, and two from Tanzania contained 5,727 births recorded between 1999-2010. 4,843 births had complete outcome data and were included in an individual participant level meta-analysis. 99% of 445 low birth weight (< 2,500 g babies were either preterm (< 37 weeks gestation or small for gestational age (below tenth percentile of weight for gestational age. 52% of 87 neonatal deaths occurred in preterm or small for gestational age babies. Babies born < 34 weeks gestation had the highest odds of death compared to term babies (odds ratio [OR] 58.7 [95% CI 28.4-121.4], with little difference when stratified by weight for gestational age. Babies born 34-36 weeks gestation with appropriate weight for gestational age had just three times the likelihood of neonatal death compared to babies born term, (OR 3.2 [95% CI 1.0-10.7], but the likelihood for babies born 34-36 weeks who were also small for gestational age was 20 times higher (OR 19.8 [95% CI 8.3-47.4]. Only 1% of babies were born moderately premature and small for gestational age, but this group suffered 8% of deaths. Individual level data on newborns are scarce in East Africa; potential biases arising due to the non
Pieper, R; Scharek-Tedin, L; Zetzsche, A; Röhe, I; Kröger, S; Vahjen, W; Zentek, J
Artificial rearing and formula feeding is coming more into the focus due to increasing litter sizes and limited nursing capacity of sows. The formula composition is important to effectively support the development of the gut and prevent intestinal dysfunction in neonatal piglets. In this study, newborn piglets ( = 8 per group) were fed a bovine milk-based formula (FO), containing skimmed milk and whey as the sole protein and carbohydrate sources, or were suckled by the sow (sow milk [SM]). After 2 wk, tissue from the jejunum was analyzed for structural (i.e., morphometry) and functional (i.e., disaccharidase activity, glucose transport, permeability toward macromolecules, and immune cell presence) changes and concomitant expression of related genes. Formula-fed piglets had more liquid feces ( proteins lead to to the observed intestinal reactions requires further clarification. PMID:27065261
Determinantes da mortalidade neonatal a partir de uma coorte de nascidos vivos, Montes Claros, Minas Gerais, 1997-1999 Determinants of neonatal mortality in a cohort of born alive infants, Montes Claros, Minas Gerais, 1997-1999
Eunice Francisca Martins
Full Text Available OBJETIVOS: identificar os fatores de risco para a mortalidade neonatal a partir das informações contidas no Sistema de Informação de Nascidos Vivos e Sistema de Informações de Mortalidade na cidade de Montes Claros, no período de 1997 a 1999. MÉTODOS: foi utilizada a técnica de linkage para concatenar as declarações de óbitos com as respectivas declarações de nascidos vivos. A identificação dos fatores associados à mortalidade neonatal foi realizada através das análises univariada e multivariada; obteve-se o cálculo dos riscos e seus intervalos de confiança de 95%. RESULTADOS: os nascidos vivos foram 20.506 e os óbitos 275, resultando um coeficiente de mortalidade neonatal anual médio de 13,4 por mil nascidos vivos. Através da análise multivariada constituíram-se fatores de risco independentes para a ocorrência dos óbitos neonatais a prematuridade, o baixo peso ao nascer e o escore de Apgar inferior a 7 no 1º e 5º minutos de vida. CONCLUSÕES: esforços devem ser dirigidos no sentido de garantir uma assistência obstétrica e neonatal na cidade de Montes Claros que propicie condições para uma gestação e nascimento seguros, favorecendo, assim, a sobrevivência no início da vida.OBJECTIVES: to identify the factors of risk for the neonatal mortality with information from born alive information system and mortality information system in city of Montes Claros, in the period of 1997 through 1999. METHODS: the linkage technique has been used to link the declarations of death with the respective declarations of the infants who were born alive. The identification of factors associated to neonatal mortality has been done through bivaried and multi-variable analysis, obtaining the calculus of risk and its 95% confidence interval. RESULTS: the infants who were born alive were 20.506 and the deaths 275 which resulted in a coefficient of neonatal mortality of 13.4 to one thousand who were born alive. Through the multi
Costa, Sonia Carmen Lopo; de Magalhães, Vanessa Carvalho Sampaio; de Oliveira, Uillians Volkart; Carvalho, Fábio Santos; de Almeida, Clebson Pereira; Machado, Rosangela Zacarias; Munhoz, Alexandre Dias
Bovine tick-borne disease (TBD) constitutes a worldwide group of diseases that result in great losses for dairy and beef cattle. With regard to the epidemiological profile of the diseases, the importance of transplacental transmission is still not very well understood. The aim of this study was to determine the transplacental transmission of TBD agents (Anaplasma marginale, Babesia bovis and B. bigemina) in a herd of dairy cattle that had been naturally infected in an area of enzootic stability in northeastern Brazil. Blood for serology of the three agents was collected from cows within 120 days of gestation and serology, haemogram and nPCR assays were performed after birth. Blood was collected from the calves within 3h of birth, and haemogram and nPCR assays were performed in all animals. Pre-colostrum serology was achieved in 34 animals. The Student's t-test was used to compare the haemogram results between animals that were positive and negative for the haemoparasites. The cows were seropositive for all agents in at least one of the examinations. We detected 15 cases of vertical transmission of A. marginale, 4 of B. bovis and 2 of B. bigemina in the 60 cows. In infected animals, co-infection was detected for A. marginale and B. bovis in 1 of 60 calves, and a triple infection was detected in one other calf. Fatal neonatal anaplasmosis was observed in 1 of 15 calves, in which death occurred within 24h of birth. From the results, we concluded that transplacental transmission of TBD agents occurs, including in cases of co- and triple-infection. Such transplacental transmission can cause neonatal death, increasing the importance of this form of epidemiological transmission and suggesting its role as a cause of undiagnosed neonatal death. PMID:26613663
Full Text Available Abstract Background Bovine neonatal pancytopenia (BNP is a syndrome characterised by thrombocytopenia associated with marked bone marrow destruction in calves, widely reported since 2007 in several European countries and since 2011 in New Zealand. The disease is epidemiologically associated with the use of an inactivated bovine virus diarrhoea (BVD vaccine and is currently considered to be caused by absorption of colostral antibody produced by some vaccinated cows (“BNP dams”. Alloantibodies capable of binding to the leukocyte surface have been detected in BNP dams and antibodies recognising bovine MHC class I and β-2-microglobulin have been detected in vaccinated cattle. In this study, calves were challenged with pooled colostrum collected from BNP dams or from non-BNP dams and their bone marrow hematopoietic progenitor cells (HPC cultured in vitro from sternal biopsies taken at 24 hours and 6 days post-challenge. Results Clonogenic assay demonstrated that CFU-GEMM (colony forming unit-granulocyte/erythroid/macrophage/megakaryocyte; pluripotential progenitor cell colony development was compromised from HPCs harvested as early as 24 hour post-challenge. By 6 days post challenge, HPCs harvested from challenged calves failed to develop CFU-E (erythroid colonies and the development of both CFU-GEMM and CFU-GM (granulocyte/macrophage was markedly reduced. Conclusion This study suggests that the bone marrow pathology and clinical signs associated with BNP are related to an insult which compromises the pluripotential progenitor cell within the first 24 hours of life but that this does not initially include all cell types.
Gimenez-Lirola, Luis Gabriel; Rademacher, Chris; Linhares, Daniel; Harmon, Karen; Rotolo, Marisa; Sun, Yaxuan; Baum, David H; Zimmerman, Jeffrey; Piñeyro, Pablo
We performed a longitudinal field study in a swine breeding herd that presented with an outbreak of vesicular disease (VD) that was associated with an increase in neonatal mortality. Initially, a USDA Foreign Animal Disease (FAD) investigation confirmed the presence of Senecavirus A (SVA) and ruled out the presence of exotic agents that produce vesicular lesions, e.g., foot-and-mouth disease virus and others. Subsequently, serum samples, tonsil swabs, and feces were collected from sows (n = 22) and their piglets (n = 33) beginning 1 week after the onset of the clinical outbreak and weekly for 6 weeks. The presence of SVA RNA was evaluated in all specimens collected by reverse transcriptase quantitative PCR (RT-qPCR) targeting a conserved region of the 5' untranslated region (5'-UTR). The serological response (IgG) to SVA was evaluated by the weekly testing of sow and piglet serum samples on a SVA VP1 recombinant protein (rVP1) indirect enzyme-linked immunosorbent assay (ELISA). The rVP1 ELISA detected seroconversion against SVA in clinically affected and non-clinically affected sows at early stages of the outbreak as well as maternal SVA antibodies in offspring. Overall, the absence of vesicles (gross lesions) in SVA-infected animals and the variability of RT-qPCR results among specimen type demonstrated that a diagnostic algorithm based on the combination of clinical observations, RT-qPCR in multiple diagnostic specimens, and serology are essential to ensure an accurate diagnosis of SVA. PMID:27225408
Sistema hospitalar como fonte de informações para estimar a mortalidade neonatal e a natimortalidade The Brazilian hospital system as a source of information to estimate stillbirth and neonatal mortality rates
Joyce MA Schramm
Full Text Available OBJETIVO: Apesar da reconhecida importância em acompanhar a evolução temporal da mortalidade infantil precoce, a deficiência das estatísticas vitais no Brasil ainda permanece na agenda atual dos problemas que impedem o seu acompanhamento espaço-temporal. Realizou-se estudo com o objetivo de investigar o Sistema de Informações Hospitalares (SIH/SUS como fonte de informações, para estimar a natimortalidade e a mortalidade neonatal. MÉTODOS: Propõe-se um método para estimar a natimortalidade e a mortalidade neonatal, o qual foi aplicado para todos os Estados das regiões Nordeste, Sul e Sudeste e para o Pará, no ano de 1995. Para fins comparativos, o Sistema de Informações sobre Mortalidade (SIM/MS foi utilizado para estimar as taxas sob estudo, após a correção do número de nascidos vivos por um método demográfico. RESULTADOS: O SIH/SUS forneceu mais óbitos fetais e neonatais precoces do que o SIM/MS em grande parte das unidades federadas da região Nordeste. Adicionalmente para os Estados localizados nas regiões Sul e Sudeste, que apresentam, em geral, boa cobertura do registro de óbitos, as taxas calculadas pelos dois sistemas de informação tiveram valores semelhantes. CONCLUSÕES: Considerando a cobertura incompleta das estatísticas vitais no Brasil e a agilidade do SIH/SUS em disponibilizar as informações em meio magnético, conclui-se que o uso do SIH/SUS poderá trazer inúmeras contribuições para análise do comportamento espaço-temporal do componente neonatal da mortalidade infantil no território brasileiro, em anos recentes.OBJECTIVE: Studies on the evolution of infant mortality rate are very relevant. Nevertheless, lack of vital statistics in Brazil limits the temporal and spatial analysis of this indicator. This study aims to investigate the possible use of the Brazilian Hospital Information System as an alternative information source for stillbirth and neonatal mortality rates by age group. METHODS: A
Moran Neil F
Full Text Available Abstract Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia” in term babies for use in the Lives Saved Tool (LiST. Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth. We also reviewed Traditional Birth Attendant (TBA training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental, and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental. Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%, basic emergency obstetric care (40%, and skilled birth care (25%. For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational. There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for
King, Carol P; da Silva, Orlando; Filler, Guido; Lopes, Laudelino M
Objective Extremely low gestational age (ELGA) infants are at high risk of perinatal and neonatal morbidity and mortality. Accurate and relevant data are essential for developing a health care plan and providing realistic estimates of infants' outcomes. Study Design Retrospective analysis of all infants delivered between 23(0/7) and 28(6/7) weeks' gestation over 11 years at a single center. Using logistic regression analysis, gestational age (GA)-specific mortality and morbidity rates, and the effects of gender, antenatal corticosteroids, multiple gestation, and birth weight (BW) were determined. Results Of the 766 study infants, 644 (84.1%) were admitted to the neonatal intensive care unit, of which 502 (75.8%) survived to discharge. GA, antenatal corticosteroids, and BW were significant predictors of survival (GA: odds ratio [OR] = 1.83, 95% confidence interval [CI] = 1.64-2.04; corticosteroids: OR = 7.62, 95% CI = 5.19-11.18; BW: OR = 1.56, 95% CI = 1.44-1.69). Increasing BW correlated with a decreasing mortality rate. Conclusion This study provides recent outcome data of ELGA infants delivered at a tertiary level center. The results have been translated into an online counseling tool (http://murmuring-brook-6600.herokuapp.com/ELGA.html). PMID:27057769
Fulton, R W; d'Offay, J M; Dubovi, E J; Eberle, R
Bovine herpesvirus-1 (BoHV-1) causes disease in cattle with varied clinical forms. In the U.S. there are two BoHV1 subtypes, BoHV-1.1 and BoHV-1.2b. Control programs in North America incorporate modified live (MLV) or killed (KV) viral vaccines. However, BoHV-1 strains continue to be isolated from diseased animals or fetuses after vaccination. It is possible to differentiate BoHV-1 wild-type from MLV vaccine strains by determining their single nucleotide polymorphism (SNP) patterns through either whole-genome sequencing or PCR sequencing of genomic regions containing vaccine-defining SNPs. To determine the BoHV-1 subtype in clinical isolates and their relationship to MLV strains, 8 isolates from varied clinical disease at three different laboratories in the U.S. were sequenced and phylogenetically analyzed. Five samples were isolated within the past 5 years from New York and 3 were archived samples recovered 35 years prior from Oklahoma and Louisiana. Based on phylogenetic analysis, four of the cases appeared to be due to an MLV vaccine: 3 cases of aborted fetuses and one neonate with systemic BoHV-1 disease. One aborted fetus was from a herd with no reported history of MLV vaccination in two years. The remaining four isolates did not group with any MLV vaccines: two were associated with bovine respiratory disease, one with vulvovaginitis, and a fourth was determined to be a BoHV-1.2b respiratory isolate. Recovery of BoHV-1.1 that is very closely related to an MLV vaccine virus from a herd not receiving vaccines in an extended period prior to its isolation suggests that MLV viruses may remain latent or circulate within herds for long periods. PMID:27374060
Aplicação do escore CRIB como preditor de óbito em unidade de terapia intensiva neonatal: uma abordagem ampliada The use of CRIB score as mortality predictor at neonatal intensive care unit: an extended approach
Luiz Fernando C. Nascimento
Full Text Available OBJETIVOS: avaliar o uso do escore CRIB (Clinical Risk Index for Babies em todos os recém-nascidos internados em Unidade de Terapia Intensiva Neonatal (UTIN e comparar seus resultados com peso ao nascer e idade gestacional. MÉTODOS: estudo observacional, envolvendo todos os recém-nascidos internados na UTIN do Hospital Universitário de Taubaté. As variáveis foram escore CRIB, peso ao nascer, idade gestacional, uso de surfactante, cateterização umbilical, asfixia neonatal e óbito. Foram comparadas as médias do escore CRIB, peso ao nascer e idade gestacional segundo óbito. Foram estimados os valores da sensibilidade, especificidade, valores preditivos positivo e negativo e risco relativo e criadas curvas Receiver Operating Characteristic (ROC para CRIB, peso ao nascer e idade gestacional. Utilizou-se da técnica t de Student e qui-quadrado de tendência linear. A significância estatística foi alfa = 5%. RESULTADOS: óbito esteve associado a maiores valores do CRIB; houve tendência de mais casos com asfixia, uso de surfactante, cateterização umbilical e óbitos com as classes maiores do CRIB. A curva ROC relativa ao CRIB foi maior que as relativas ao peso ao nascer e idade gestacional. CONCLUSÕES: o escore CRIB foi bom preditor do óbito quando aplicado em todos os RN.OBJECTIVES: to evaluate the CRIB (Clinical Risk Index for Babies score as mortality predictor in all newborn at Neonatal Intensive Care Unit (NICU and to compare with birthweight and gestational age. METHODS: observational study with newborn admitted at NICU of University Hospital of Taubaté. The variables were CRIB score, birth weight, gestational age, use of surfactant, umbilical catheter, neonatal asphyxia and death. The association between CRIB score and other variables was estimated. The values of sensitivity, specificity, predictive and negative values and relative risk and 95% confidence interval of were estimated and created ROC (Receiver Operating
Michael Doherty; Jim Grant; Cosme Sánchez-Miguel; Mee, John F.
Simple Summary Mortality of full-term calves at calving is an increasing problem in dairy industries internationally. Multiple herd management factors contribute to such losses. This case-control study identified factors which differed between herds with high and low calf mortality. These included breeding, dietary, health and calving factors. It was concluded that calving, not pre-calving, management appears to be the most important area of concern in herds with high perinatal mortality. Thi...
Cohen, Alan A.; Tillinghast, John; Canudas-Romo, Vladimir
We test the effects of early life exposure to disease on later health by looking for differences in late-life mortality in cohorts born around the 1918-1919 flu pandemic using data from the Human Mortality Database for 24 countries. After controlling for age, period, and sex effects, residual mor...
Full Text Available We test the effects of early life exposure to disease on later health by looking for differences in late-life mortality in cohorts born around the 1918-1919 flu pandemic using data from the Human Mortality Database for 24 countries. After controlling for age, period, and sex effects, residual mortality rates did not differ systematically for flu cohorts relative to surrounding cohorts. We calculate at most a 20-day reduction in life expectancy for flu cohorts; likely values are much smaller. Estimates of influenza incidence during the pandemic suggest that exposure was high enough for this to be a robust negative result.
Paediatric and particularly neonatal neurosonography still remains a mainstay of imaging the neonatal brain. It can be performed at the bedside without any need for sedation or specific monitoring. There are a number of neurologic conditions that significantly influence morbidity and mortality in neonates and infants related to the brain and the spinal cord; most of them can be addressed by ultrasonography (US). However, with the introduction of first CT and then MRI, neonatal neurosonography is increasingly considered just a basic first line technique that offers only orienting information and does not deliver much relevant information. This is partially caused by inferior US performance – either by restricted availability of modern equipment or by lack of specialized expertise in performing and reading neurosonographic scans. This essay tries to highlight the value and potential of US in the neonatal brain and briefly touching also on the spinal cord imaging. The common pathologies and their US appearance as well as typical indication and applications of neurosonography are listed. The review aims at encouraging paediatric radiologists to reorient there imaging algorithms and skills towards the potential of modern neurosonography, particularly in the view of efficacy, considering growing economic pressure, and the low invasiveness as well as the good availability of US that can easily be repeated any time at the bedside
Riccabona, Michael, E-mail: email@example.com
Paediatric and particularly neonatal neurosonography still remains a mainstay of imaging the neonatal brain. It can be performed at the bedside without any need for sedation or specific monitoring. There are a number of neurologic conditions that significantly influence morbidity and mortality in neonates and infants related to the brain and the spinal cord; most of them can be addressed by ultrasonography (US). However, with the introduction of first CT and then MRI, neonatal neurosonography is increasingly considered just a basic first line technique that offers only orienting information and does not deliver much relevant information. This is partially caused by inferior US performance – either by restricted availability of modern equipment or by lack of specialized expertise in performing and reading neurosonographic scans. This essay tries to highlight the value and potential of US in the neonatal brain and briefly touching also on the spinal cord imaging. The common pathologies and their US appearance as well as typical indication and applications of neurosonography are listed. The review aims at encouraging paediatric radiologists to reorient there imaging algorithms and skills towards the potential of modern neurosonography, particularly in the view of efficacy, considering growing economic pressure, and the low invasiveness as well as the good availability of US that can easily be repeated any time at the bedside.
Evaluating virulence of waterborne and clinical Aeromonas isolates using gene expression and mortality in neonatal mice followed by assessing cell culture’s ability to predict virulence based on transcriptional response
Hayes, S L; Rodgers, M R; Lye, D J; Stelma, G N; McKinstry, Craig A.; Malard, Joel M.; Vesper, Sephen J.
Aims: To assess the virulence of Aeromonas spp. using two models, a neonatal mouse assay and a mouse intestinal cell culture. Methods and Results: After artificial infection with a variety of Aeromonas spp., mRNA extracts from the two models were processed and hydridized to murine microarrays to determine host gene response. Definition of virulence was determined based on host mRNA production in murine neonatal intestinal tissue and mortality of infected animals. Infections of mouse intestinal cell cultures were then performed to determine whether this simpler model system’s mRNA responses correlated to neonatal results and therefore be predictive of virulence of Aeromonas spp. Virulent aeromonads up-regulated transcripts in both models including multiple host defense gene products (chemokines, regulation of transcription and apoptosis and cell signalling). Avirulent species exhibited little or no host response in neonates. Mortality results correlated well with both bacterial dose and average fold change of up-regulated transcripts in the neonatal mice. Conclusions: Cell culture results were less discriminating but showed promise as potentially being able to be predictive of virulence. Jun oncogene up-regulation in murine cell culture is potentially predictive of Aeromonas virulence. Significance and Impact of the Study: Having the ability to determine virulence of waterborne pathogens quickly would potentially assist public health officials to rapidly assess exposure risks.
Full Text Available Abstract Background Phosphodiesterase-5 inhibition with sildenafil has been used to treat severe pulmonary hypertension and bronchopulmonary dysplasia (BPD, a chronic lung disease in very preterm infants who were mechanically ventilated for respiratory distress syndrome. Methods Sildenafil treatment was investigated in 2 models of experimental BPD: a lethal neonatal model, in which rat pups were continuously exposed to hyperoxia and treated daily with sildenafil (50–150 mg/kg body weight/day; injected subcutaneously and a neonatal lung injury-recovery model in which rat pups were exposed to hyperoxia for 9 days, followed by 9 days of recovery in room air and started sildenafil treatment on day 6 of hyperoxia exposure. Parameters investigated include survival, histopathology, fibrin deposition, alveolar vascular leakage, right ventricular hypertrophy, and differential mRNA expression in lung and heart tissue. Results Prophylactic treatment with an optimal dose of sildenafil (2 × 50 mg/kg/day significantly increased lung cGMP levels, prolonged median survival, reduced fibrin deposition, total protein content in bronchoalveolar lavage fluid, inflammation and septum thickness. Treatment with sildenafil partially corrected the differential mRNA expression of amphiregulin, plasminogen activator inhibitor-1, fibroblast growth factor receptor-4 and vascular endothelial growth factor receptor-2 in the lung and of brain and c-type natriuretic peptides and the natriuretic peptide receptors NPR-A, -B, and -C in the right ventricle. In the lethal and injury-recovery model we demonstrated improved alveolarization and angiogenesis by attenuating mean linear intercept and arteriolar wall thickness and increasing pulmonary blood vessel density, and right ventricular hypertrophy (RVH. Conclusion Sildenafil treatment, started simultaneously with exposure to hyperoxia after birth, prolongs survival, increases pulmonary cGMP levels, reduces the pulmonary
Mirta Noemi Mesquita Ramirez
Full Text Available Introduction. In developing countries, a lack of decentralization of perinatal care leads to many high-risk births occurring in facilities that do not have NICU, leading to admission to a PICU. Objective. To assess SNAP II and SNAPPE II as predictors of neonatal death in the PICU. Methodology. A prospective study of newborns divided into 3 groups according to postnatal age: Group 1 (G1, of 0 to 6 days; Group 2 (G2 of 7 to 14 days; and Group 3 (G3, of 15 to 28 days. Variables analyzed were SNAP II, SNAPPE II, perinatal data, and known risk factors for death. The Hosmer-Lemeshow test and the receiver operating characteristics (ROC curve were used with SPSS 17.0 for statistical analysis. An Alpha error <5% was considered significant. Results. We analyzed 290 newborns, including 192 from G1, 41 from G2, and 57 from G3. Mortality was similar in all 3 groups. Median SNAP II was higher in newborns that died in all 3 groups (P<0.05. The area under the ROC curve for SNAP II for G1 was 0.78 (CI 95% 0.70–0.86, for G2 0.66 (CI 95% 0.37–0.94, and for G3 0.74 (CI 95% 0.53–0.93. The area under the ROC curve for SNAPPE II for G1 was 0.76 (CI 95% 0.67–0.85, for G2 0.60 (CI 95% 0.30–0.90, and for G3 0.74 (CI 95% 0.52–0.95. Conclusions. SNAP II and SNAPPE II showed moderate discrimination in predicting mortality. The results are not strong enough to establish the correlation between the score and the risk of mortality.
Nelson Shozo Uchimura
Full Text Available O estudo da relação do baixo peso ao nascer (BPN com a mortalidade neonatal é de importância vital para o estabelecimento de estratégias de prevenção e redução dos altos percentuais encontrados em populações de países em desenvolvimento. Neste sentido, realizou-se este estudo com o objetivo de verificar o índice de proporcionalidade em crianças BPN e a sua relação com o risco de óbito, estimado através do Índice de Rohrer. A população amostral foi constituída por todas as mães biológicas e suas crianças menores de um ano de idade atendidas em cinco dias úteis nas 22 unidades de saúde do Município de Maringá, em 1998, perfazendo um total de 575. Consideraram-se BPN (baixo peso ao nascer todas as crianças com peso = 2,51, proporcionadas. Do total das crianças, 168 (29,2% foram consideradas desproporcionadas. Para as crianças BPN, o percentual foi de 76,5%. Para os outros grupos de crianças com peso insuficiente e adequado, os percentuais foram de 53,7% e 18,3%. Para o total da amostra, quando se associa o IR The study of the relation between low birthweight (LBW and mortality neonatal is most important, not only to establish preventive action, but also to reduce the high percentage of BPN in populations of developing countries. A study was carried out with the purpose of verifying the influence of LBW in neonatal mortality, appraised through the Rohrer’s Ponderal Index (IR. The sample comprised all biological mothers and their children under 1 year of age being assisted for 5 days in 22 health units of Maringá municipality in 1998. The mothers total was 575. All children born weighing =2,51 proportionate. From the total, 168(29,2% of the children were considered disproportionate. For the children LBW the percentage was 76,5%. For the others groups with insufficient and adequate weight the percentage was 53,7% and 18,3%. For the total sample, the association between the IR and length < 47cm was 23,2% for high
AH Movahedian; R Moniri; Z Mosayebi
Neonatal bacterial sepsis is one of the major cause of morbidity and mortality in neonates. This retrospective study was performed to determine the incidence of bacterial sepsis with focus on Gram negative organisms in neonates admitted at Beheshti Hospital in Kashan, during a 3-yr period, from September 2002 to September 2005. Blood culture was performed on all neonates with risk factors or signs of suggestive sepsis. Blood samples were cultured using brain heart infusion (BHI) broth accordi...
Ahmed M Kamr
Full Text Available Hypocalcemia is a frequent abnormality that has been associated with disease severity and outcome in hospitalized foals. However, the pathogenesis of equine neonatal hypocalcemia is poorly understood. Hypovitaminosis D in critically ill people has been linked to hypocalcemia and mortality; however, information on vitamin D metabolites and their association with clinical findings and outcome in critically ill foals is lacking. The goal of this study was to determine the prevalence of vitamin D deficiency (hypovitaminosis D and its association with serum calcium, phosphorus, and parathyroid hormone (PTH concentrations, disease severity, and mortality in hospitalized newborn foals.One hundred newborn foals ≤72 hours old divided into hospitalized (n = 83; 59 septic, 24 sick non-septic [SNS] and healthy (n = 17 groups were included. Blood samples were collected on admission to measure serum 25-hydroxyvitamin D3 [25(OHD3], 1,25-dihydroxyvitamin D3 [1,25(OH 2D3], and PTH concentrations. Data were analyzed by nonparametric methods and univariate logistic regression. The prevalence of hypovitaminosis D [defined as 25(OHD3 <9.51 ng/mL] was 63% for hospitalized, 64% for septic, and 63% for SNS foals. Serum 25(OHD3 and 1,25(OH 2D3 concentrations were significantly lower in septic and SNS compared to healthy foals (P<0.0001; P = 0.037. Septic foals had significantly lower calcium and higher phosphorus and PTH concentrations than healthy and SNS foals (P<0.05. In hospitalized and septic foals, low 1,25(OH2D3 concentrations were associated with increased PTH but not with calcium or phosphorus concentrations. Septic foals with 25(OHD3 <9.51 ng/mL and 1,25(OH 2D3 <7.09 pmol/L were more likely to die (OR=3.62; 95% CI = 1.1-12.40; OR = 5.41; 95% CI = 1.19-24.52, respectively.Low 25(OHD3 and 1,25(OH2D3 concentrations are associated with disease severity and mortality in hospitalized foals. Vitamin D deficiency may contribute to a pro-inflammatory state in equine
Sparkes, Andrew H; Rogers, Katherine; Henley, William E; Gunn-Moore, Danielle A; May, Julia M; Gruffydd-Jones, Timothy J; Bessant, Claire
This study was based on a convenience-sampling questionnaire study of pedigree cat breeding in the UK. Data were collated for the births of 1,056 litters from 14 different pedigree breeds and 942 different households. Significant relationships between various outcomes and relevant predictors were assessed by multiple linear regression or logistic regression as appropriate. The overall mean gestation length of 65.1 days varied significantly between the breeds (Pkittens also varied significantly according to breed (Pkittens born alive (overall mean 93.5 g) increased with longer gestation lengths (P=0.0003), decreased with larger litter sizes (Pkittens were stillborn, which varied according to breed (P=0.0003), and the risk of a stillborn kitten increased with litter size (P=0.0001), and with the presence of congenital defects in the litter (P=0.0002). The mean kitten mortality between birth and 8 weeks of age was 9.1%, and the majority of these occurred in the first week of life. Parturition intervals varied widely. The duration of first stage of labour was less than 2h in 82.9% of cats. The interval between the birth of the first and last kitten was less than 6h in 85.7%, but more than 48 h in three cats. A maximum of 48 h was recorded between the births of individual kittens in unassisted deliveries. PMID:16442825
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Background: Neonatal mortality rate is one of the main health problems which is affected by prenatal status, maternal, fetal and perinatal conditions. Low birth weight (LBW) is one of the main causes of neonatal and infantile mortality. The aim of this study is an evaluation of the LBW causes in neonates. Methods: This descriptive cross sectional study was done on 1500 neonates, born in Fatemieh Hospital, Hamedan, 2004. Data such as birth weight, sex, maternal age, gestational age, birth inte...
Emilio Vidal Borrás
INTRODUCCIÓN. Fueron objetivos de esta presentación caracterizar el comportamiento de la mortalidad neonatal precoz y su relación con la edad materna, gestacional, los factores de riesgo y las causas de muerte neonatal en el municipio San Miguel del Padrón, entre 1999 y 2008. MÉTODOS. Se realizó un estudio descriptivo, retrospectivo y longitudinal del comportamiento de la mortalidad neonatal precoz en una muestra de 49 defunciones. Se analizaron variables maternas y del recién nacido, cuyos d...
Bagwe, Siddhi; Tharappel, Leo J P; Kaur, Ginpreet; Buttar, Harpal S
Nutraceutical, a term combining the words "nutrition" and "pharmaceuticals", is a food or food product that provides health benefits as an adjuvant or alternative therapy, including the treatment and prevention of infectious diseases in children and adults. There is emerging evidence that bovine colostrum (BC) may be one of the promising nutraceuticals which can prevent or mitigate various diseases in newborns and adults. Immunity-related disorders are one of the leading causes of mortality in the world. BC is rich in immunity, growth and antimicrobial factors, which promote tissue growth and the maturation of digestive tract and immune function in neonatal animals and humans. The immunoglobulins and lactoferrin present in colostrum are known to build natural immunity in newborns which helps to reduce the mortality rate in this population. Also, the side-effect profile of colostrum proteins and possible lactose intolerance is relatively less in comparison with milk. In general, BC is considered safe and well tolerated. Since colostrum has several important nutritional constituents, well-designed, double-blind, placebo-controlled studies with colostrum products should be conducted to widen its therapeutic use. The objectives of this review are to create awareness about the nutraceutical properties of colostrum and to discuss the various ongoing alternative treatments of colostrum and its active ingredients as well as to address colostrum's future nutraceutical and therapeutic implications in humans. PMID:25781716
Fatores de risco para a mortalidade de recém-nascidos de muito baixo peso em Unidade de Terapia Intensiva Neonatal Factores de riesgo para la mortalidad de recién nacidos de muy bajo peso en Unidad de Terapia Intensiva Neonatal Risk factors for the mortality of very low birth weight newborns at a Neonatal Intensive Care Unit
Jair Almeida Carneiro
Full Text Available OBJETIVO: Identificar os fatores associados à mortalidade de recém-nascidos de muito baixo peso internados em uma Unidade de Terapia Intensiva Neonatal de referência no Norte de Minas Gerais, Brasil. MÉTODOS: Estudo transversal baseado na análise de prontuários de uma amostra aleatória de recém-nascidos admitidos em uma Unidade de Terapia Intensiva Neonatal de janeiro de 2007 a junho de 2010. Foram considerados elegíveis para o estudo recém-nascidos com peso inferior a 1500g, provenientes do bloco obstétrico da própria instituição. Foram identificadas variáveis demográficas maternas, variáveis relacionadas às condições de gestação e parto e variáveis do recém-nascido. A associação entre as variáveis foi aferida por meio do teste do qui-quadrado e Odds Ratio. As variáveis associadas até o nível de 25% (pOBJETIVO: Identificar los factores asociados a la mortalidad de recién nacidos de muy bajo peso, internados en una Unidad de Terapia Intensiva Neonatal de referencia en el Norte de Minas Gerais, Brasil. MÉTODOS: Estudio transversal, basado en el análisis de prontuarios de una muestra aleatoria de recién nacidos admitidos en una Unidad de Terapia Intensiva Neonatal desde enero de 2007 hasta junio de 2010. Fueron considerados elegibles para el estudio los recién nacidos con peso inferior a 1.500g, provenientes del bloque obstétrico de la propia institución. Fueron identificadas variables demográficas maternas, variables relacionadas a las condiciones de gestación y parto y variables del recién nacido. La asociación entre las variables fue verificada por medio de la prueba de chi cuadrado y Odds Ratio. Las variables asociadas hasta el nivel de 25% (pOBJECTIVE: To identify variables associated with mortality among very low birth weight infants admitted to a Neonatal Intensive Care Unit in Minas Gerais, Southeastern Brazil. METHODS: Cross-sectional study based on chart data of a random sample of premature
Fatores de risco para mortalidade neonatal em crianças com baixo peso ao nascer Factores de riesgo para mortalidad neonatal en niños con bajo peso al nacer Risk factors for neonatal mortality among children with low birth weight
Adolfo Monteiro Ribeiro
Informaciones sobre Mortalidad, fueron integrados por la técnica de linkage. En modelo jerarquizado, las variables de los niveles distal (factores socioeconómicos, intermedio (factores de atención a la salud y proximal (factores biológicos fueron sometidas al análisis univariado y regresión logística multivariada. RESULTADOS: Con el ajuste de las variables en la regresión logística multivariada, las variables del nivel distal que permanecieron significativamente asociadas con el óbito neonatal fueron: la cohabitación de los padres, número de hijos vivos y tipo de hospital de nacimiento; en el nivel intermedio: número de consultas en el pre-natal, complejidad del hospital de nacimiento y tipo de parto; y en el nivel proximal: sexo, edad gestacional, peso al nacer, índice de Apgar y presencia de malformación congénita. CONCLUSIONES: Los principales factores asociados a la mortalidad neonatal en los nacidos vivos con bajo peso están relacionados con la atención a la gestante y al recién nacido, reductibles por la actuación del sector salud.OBJECTIVE: To analyze the risk factors associated with neonatal deaths among children with low birth weight. METHODS: A cohort study was carried out on live births weighing between 500 g and 2,499 g from single pregnancies without anencephaly in Recife (Northeastern Brazil between 2001 and 2003. Data on 5,687 live births and 499 neonatal deaths obtained from the Live Birth Information System and the Mortality Information System were integrated through the linkage technique. Using a hierarchical model, variables from the distal level (socioeconomic factors, intermediate level (healthcare factors and proximal level (biological factors were subjected to univariate analysis and multivariate logistic regression. RESULTS: After adjusting the variables through multivariate logistic regression, the factors from the distal level that remained significantly associated with neonatal death were: cohabitation by the parents, number of
Comparação da mortalidade neonatal em recém-nascidos de muito baixo peso ao nascimento, em maternidades do Município do Rio de Janeiro, Brasil Comparison of neonatal mortality in very low birth weight newborns at maternity hospitals in the city of Rio de Janeiro, Brazil
José Luiz Muniz Bandeira Duarte
Full Text Available Foi realizada a comparação das taxas de mortalidade neonatal em quatro maternidades do Município do Rio de Janeiro, Brasil. A população estudada foi de recém-nascidos com peso inferior a 1.500g. O instrumento utilizado foi um questionário com dados informados pela mãe e o prontuário médico. Foram calculados, para cada instituição, as Razões Padronizadas de Mortalidade (RPM com o método direto e indireto, tendo como padrão a distribuição por peso do National Institute of Child Health and Human Development Neonatal Research. A amostra final apresentou 487 recém-nascidos. As padronizações pelo método direto e indireto mostraram elevadas taxas de mortalidade em todas as instituições; as que apresentaram a maior quantidade de recém-nascidos nas faixas com os menores pesos, foram aquelas que mostraram os menores valores de RPM. A menor razão de mortalidade por faixa de peso foi encontrada na faixa de peso entre 500 e 749g. Os resultados da RPM estão inversamente associados ao quantitativo populacional de recém-nascidos nas faixas com os menores pesos. Os coeficientes de mortalidade mostraram taxas altas, principalmente nas faixas de peso mais elevados. Os resultados apontam para uma qualidade deficiente na atenção perinatal.This study was a comparison of neonatal mortality rates in four maternity hospitals in the city of Rio de Janeiro, Brazil. The study population consisted of newborns with birth weight below 1,500g. The research instrument was a questionnaire with data reported by the mother and collected from the patient record. For each maternity hospital the standardized mortality ratio (SMR was calculated using the direct and indirect method, using the weight distribution of the National Institute of Child Health and Human Development Neonatal Research as the standard. The final sample consisted of 487 newborns. Standardizations by the direct and indirect method showed high mortality rates in all four institutions
Nazeer Ahmad Jeergal; Rizwan-u-zama; Naushad Ali .N. Malagi; Faisal Farooqui; Sadashiva .B. Ukkali; Ravindra Naganoor; A.N. Thobbi
Introduction: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. Procalcitonin (PCT) has emerged as the most studied and promising sepsis biomarker. Objective: To assess the role of procalcitonin (PCT) as a marker in the early diagnosis, treatment and follow-up of neonatal sepsis. Methods: Twenty five neonates with clinical (n=5), suspected (n=13) and proven sepsis (n=7) were evaluated. The PCT levels were measured by immunoluminoassay before and on ...
The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh
Tanvir M. Huda
Full Text Available Introduction: Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. Objectives: This study examines mortality differentials in children of different age groups by key social determinants of health (SDH including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities, and other geographical contextual factors (area of residence, road conditions. Design: We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. Results: The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. Conclusion: The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.
Miguel Angel Rodríguez-Weber
Full Text Available OBJETIVO: Comparar el comportamiento de un grupo de recién nacidos sépticos que fallecieron contra un grupo de recién nacidos sépticos vivos. MATERIAL Y MÉTODOS: Revisión retrospectiva de expedientes de un grupo de recién nacidos con sepsis neonatal, atendidos en el Instituto Nacional de Pediatría, de la Secretaría de Salud de México, en la Ciudad de México, D.F., entre 1992 y 2000, los cuales se dividieron en recién nacidos sépticos vivos y fallecidos a los 90 días de seguimiento máximo. Se compararon las variables entre los grupos a través de U de Mann Whitney en el caso de variables numéricas, y ji cuadrada o prueba exacta de Fisher en el caso de variables categóricas. Las variables significativas en el análisis bivariado se incluyeron en uno de riesgos proporcionales de Cox. En todos los análisis se consideró como significativo un valor de pOBJECTIVE: To compare the epidemiological, clinical and microbiological profiles between patients with neonatal sepsis who lived or died. MATERIAL AND METHODS: The medical records of patients with neonatal sepsis were retrospectively reviewed at Instituto Nacional de Pediatría (National Pediatric Institute of Secretaría de Salud (Ministry of Health in Mexico City, between 1992 and 2000. Neonatal sepsis cases were classified as surviving or not after 90 days of postnatal follow-up. The survivor and deceased groups were compared using Mann-Whitney's U test for continuous variables, and the chi-squared test or the Fisher's exact test for categorical variables. Significantly associated variables were included in a Cox proportional hazards model. A p-value <0.05 was considered statistically significant for all analyses. RESULTS: A total of 116 patients with neonatal sepsis were included (65 live and 51 dead. Multivariate analysis showed that fetal distress, respiratory distress, a delayed capillary fill up, a low platelet count, and a positive hemoculture for Klebsiella pneumoniae were
Substance P (SP) is a putative neurotransmitter in the central nervous system. In the present report the authors have used autoradiographic receptor binding techniques to investigate the distribution of SP receptor binding sites in the rat and bovine spinal cord and in the rat and cat spinal trigeminal nucleus pars caudalis. Although some quantitative differences were evident, all species appeared to have a similar distribution of SP receptor binding sites in both the spinal cord and in the spinal trigeminal nucleus pars caudalis. In the spinal cord the heaviest concentration of SP receptors is located in lamina X, while moderate to heavy concentrations were found in laminae I, II and V-IX. Very low concentrations of SP receptors were present in laminae III and IV. Examination of the cat and rat spinal trigeminal nucleus pars caudalis revealed a moderate density of SP receptor binding sites in laminae I and II, very low concentrations in laminae III and IV, and low to moderate concentrations in lamina V. Rats treated neonatally with capsaicin showed a small (11%) but significant (P < 0.02) increase in the levels of SP receptor binding sites in laminae I and II of the cervical and lumbar spinal cord while in all other laminae the levels remained unchanged. (orig.)
Mantyh, P.W.; Hunt, S.P. (Medical Research Council Centre, Cambridge (UK). Medical School, MRC Neurochemical Pharmacology Unit)
Substance P (SP) is a putative neurotransmitter in the central nervous system. In the present report the authors have used autoradiographic receptor binding techniques to investigate the distribution of SP receptor binding sites in the rat and bovine spinal cord and in the rat and cat spinal trigeminal nucleus pars caudalis. Although some quantitative differences were evident, all species appeared to have a similar distribution of SP receptor binding sites in both the spinal cord and in the spinal trigeminal nucleus pars caudalis. In the spinal cord the heaviest concentration of SP receptors is located in lamina X, while moderate to heavy concentrations were found in laminae I, II and V-IX. Very low concentrations of SP receptors were present in laminae III and IV. Examination of the cat and rat spinal trigeminal nucleus pars caudalis revealed a moderate density of SP receptor binding sites in laminae I and II, very low concentrations in laminae III and IV, and low to moderate concentrations in lamina V. Rats treated neonatally with capsaicin showed a small (11%) but significant (P < 0.02) increase in the levels of SP receptor binding sites in laminae I and II of the cervical and lumbar spinal cord while in all other laminae the levels remained unchanged.
Representación gráfica del riesgo de mortalidad neonatal en un centro perinatal regional en Mérida, Yucatán, México The graphical display of neonatal mortality risk at a regional perinatal center in Merida, Yucatan, Mexico: The joint effect of birth weight and gestational age
Full Text Available Objetivo. Determinar el riesgo de mortalidad neonatal por edad gestacional y el peso al nacer. Material y métodos. Se estudió una cohorte de 19 668 neonatos que egresaron entre el 1 de enero de 1995 y el 31 de octubre de 1999 del Centro Médico Nacional Ignacio García Téllez, del tercer nivel de atención perinatal del Instituto Mexicano del Seguro Social de la Península de Yucatán. Se registraron el peso al nacer, edad gestacional y condición de egreso. Se calculó el riesgo absoluto (RA de mortalidad para cada semana de edad gestacional y grupo de peso. Resultados. El RA de mortalidad observado en neonatos de entre 34 a 44 semanas y peso mayor o igual a 2 250 g fue de 0.4%, de 15% para aquellos de entre 26 a 32 semanas con peso mayor o igual a 1000 g, y de 73% para los de entre las 26 a las 34 semanas, con peso al nacimiento de entre 750 y 1 000 g. Conclusione. El RA de mortalidad neonatal aumentó a menor. edad gestacional y peso. Los datos pueden ser utilizados como valores de referencia para nuestro hospital y para comparación con otros hospitales.Objective. To determine the neonatal mortality risk according to gestational age and birth weight. Material and Methods. The cohort consisted of 19 668 newborns of Centro Médico Nacional (National Medical Center Ignacio García Téllez, a tertiary level healthcare institution of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS of the Yucatan Peninsula. All new-borns discharged from the hospital between January 1 st , 1995 and October 31 st , 1999 were included in the study. Birth weight, gestational age, and conditions upon discharge were recorded. Absolute risk (AR of mortality was calculated for each week-of-gestation- and birth group. Results. Observed AR in newborns 34 to 44 weeks of gestational age and weighing at least 2 250 g was 0.4, while that for those 26 to 32 weeks of gestational age and weighing between 1000 g was 15%. Conclusions. AR of
Full Text Available Background: Neonatal mortality is the death of an infant who is born alive within 7 days after birth (early neonatal mortality/perinatal, and the death of a baby born alive more than 7 days until approximately 29 days (advanced neonatal mortality. Neonatal deaths (infants aged 28 days is two thirds of infant mortality, whereas early neonatal mortality/perinatal (infant age of 7 days is two thirds of neonatal deaths. The purpose of this study was to determine neonatal mortality profiles based on socio demografic and the mother condition during pregnancy, and the data based on Riskesdas 2010. Methods: This study used cross sectional design, using data Riskesdas 2010. Result: From the analysis obtained the following results, 144 out of 163 neonatal deaths (88,6% were the early neonatal deaths (7 days of birth, the remain at 11.45% were advanced neonatal mortality. Most of neonatal deaths occur in fertil maternal age at delivery was mature enough that age group 18-34 years, but mostly with low and medium level of education that is 53% and 43% respectively. Mostly neonatal deaths occur when 2 continous birth delivery happens less than 12 months, total number is 100 (61 3%. Percentage of neonatal mortality is equal between working mothers and non working mothers. From the baby's weight with weight < 2500 grams and > 2500 grams, the percentage is nearly equal at 27-29%. Conclusion: The body weight most neonatal deaths were unknown was no significant difference between early neonatal and late neonatal. There demographic information according to both maternal, infant characteristics, or economic status. It is expected the results of this reseach can be used as reference related neonatal mortality profile and as an input in policy to improve the mother health during maternity and birth delivery and also to reduce the risk of neonatal death. Keywords: early neonatal mortality/perinatal, neonatal mortality, pregnancy
Wang, Haidong; Liddell, Chelsea A.; Coates, Matthew M.; Mooney, Meghan D.; Levitz, Carly E.; Schumacher, Austin E.; Apfel, Henry; Iannarone, Marissa; Phillips, Bryan; Lofgren, Katherine T.; Sandar, Logan; Dorrington, Rob E.; Rakovac, Ivo; Jacobs, Troy A.; Liang, Xiaofeng; Zhou, Maigeng; Zhu, Jun; Yang, Gonghuan; Wang, Yanping; Liu, Shiwei; Li, Yichong; Ozgoren, Ayse Abbasoglu; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Alemu, Zewdie Aderaw; Allen, Peter J.; AlMazroa, Mohammad AbdulAziz; Alvarez, Elena; Amankwaa, Adansi A.; Amare, Azmeraw T.; Ammar, Walid; Anwari, Palwasha; Cunningham, Solveig Argeseanu; Asad, Majed Masoud; Assadi, Reza; Banerjee, Amitava; Basu, Sanjay; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L.; Bhutta, Zulfi Qar; Blore, Jed D.; Basara, Berrak Bora; Boufous, Soufiane; Breitborde, Nicholas; Bruce, Nigel G.; Linh Ngoc Bui, [No Value; Carapetis, Jonathan R.; Cardenas, Rosario; Carpenter, David O.; Caso, Valeria; Estanislao Castro, Ruben; Catala-Lopez, Ferran; Cavlin, Alanur; Che, Xuan; Chiang, Peggy Pei-Chia; Chowdhury, Rajiv; Christophi, Costas A.; Chuang, Ting-Wu; Cirillo, Massimo; Leite, Iuri da Costa; Courville, Karen J.; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Deribe, Kebede; Dharmaratne, Samath D.; Dherani, Mukesh K.; Dilmen, Ugur; Ding, Eric L.; Edmond, Karen M.; Ermakov, Sergei Petrovich; Farzadfar, Farshad; Fereshtehnejad, Seyed-Mohammad; Fijabi, Daniel Obadare; Foigt, Nataliya; Forouzanfar, Mohammad H.; Garcia, Ana C.; Geleijnse, Johanna M.; Gessner, Bradford D.; Goginashvili, Ketevan; Gona, Philimon; Goto, Atsushi; Gouda, Hebe N.; Green, Mark A.; Greenwell, Karen Fern; Gugnani, Harish Chander; Gupta, Rahul; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Harb, Hilda L.; Hay, Simon; Hedayati, Mohammad T.; Hosgood, H. Dean; Hoy, Damian G.; Idrisov, Bulat T.; Islami, Farhad; Ismayilova, Samaya; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B.; Juel, Knud; Kabagambe, Edmond Kato; Kazi, Dhruv S.; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khang, Young-Ho; Kim, Daniel; Kinfu, Yohannes; Kinge, Jonas M.; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kumar, G. Anil; Kumar, Kaushalendra; Kumar, Ravi B.; Lai, Taavi; Lan, Qing; Larsson, Anders; Lee, Jong-Tae; Leinsalu, Mall; Lim, Stephen S.; Lipshultz, Steven E.; Logroscino, Giancarlo; Lotufo, Paulo A.; Lunevicius, Raimundas; Lyons, Ronan Anthony; Ma, Stefan; Mahdi, Abbas Ali; Marzan, Melvin Barrientos; Mashal, Mohammad Taufi Q.; Mazorodze, Tasara T.; McGrath, John J.; Memish, Ziad A.; Mendoza, Walter; Mensah, George A.; Meretoja, Atte; Miller, Ted R.; Mills, Edward J.; Mohammad, Karzan Abdulmuhsin; Mokdad, Ali H.; Monasta, Lorenzo; Montico, Marcella; Moore, Ami R.; Moschandreas, Joanna; Msemburi, William T.; Mueller, Ulrich O.; Muszynska, Magdalena M.; Naghavi, Mohsen; Naidoo, Kovin S.; Narayan, K. M. Venkat; Nejjari, Chakib; Ng, Marie; de Dieu Ngirabega, Jean; Nieuwenhuijsen, Mark J.; Nyakarahuka, Luke; Ohkubo, Takayoshi; Omer, Saad B.; Paternina Caicedo, Angel J.; Pillay-van Wyk, Victoria; Pope, Dan; Pourmalek, Farshad; Prabhakaran, Dorairaj; Rahman, Sajjad U. R.; Rana, Saleem M.; Reilly, Robert Quentin; Rojas-Rueda, David; Ronfani, Luca; Rushton, Lesley; Saeedi, Mohammad Yahya; Salomon, Joshua A.; Sampson, Uchechukwu; Santos, Itamar S.; Sawhney, Monika; Schmidt, Juergen C.; Shakh-Nazarova, Marina; She, Jun; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin Hyun; Shishani, Kawkab; Shiue, Ivy; Sigfusdottir, Inga Dora; Singh, Jasvinder A.; Skirbekk, Vegard; Sliwa, Karen; Soshnikov, Sergey S.; Sposato, Luciano A.; Stathopoulou, Vasiliki Kalliopi; Stroumpoulis, Konstantinos; Tabb, Karen M.; Talongwa, Roberto Tchio; Teixeira, Carolina Maria; Terkawi, Abdullah Sulieman; Thomson, Alan J.; Thorne-Lyman, Andrew L.; Toyoshima, Hideaki; Dimbuene, Zacharie Tsala; Uwaliraye, Parfait; Uzun, Selen Beguem; Vasankari, Tommi J.; Nogales Vasconcelos, Ana Maria; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Waller, Stephen; Wan, Xia; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G.; Westerman, Ronny; Wilkinson, James D.; Williams, Hywel C.; Yang, Yang C.; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Jin, Kim Yun; Zaki, Maysaa El Sayed; Zhu, Shankuan; Vos, Theo; Lopez, Alan D.; Murray, Christopher J. L.
Background Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reductio
Optimal management of whelping requires an understanding of normal labour as well as the clinical ability to detect abnormalities in the birthing process. A novel approach to obstetrical monitoring to evaluate progression of labour to reduce neonatal death – the tocodynomometry – is used in the US (Davidson 2002, 2003). In this study 41 bitches of 6 breeds were observed during parturition at the breeders home with the help of a fetal monitor (BMF-800 BIOSYS Co. Ltd, Korea) to evaluate labour ...
Asfixia perinatal associada à mortalidade neonatal precoce: estudo populacional dos óbitos evitáveis Asfixia perinatal asociada a la mortalidad neonatal temprana: estudio de población de los óbitos evitables Perinatal asphyxia associated with early neonatal mortality: populational study of avoidable deaths
2003. Perinatal asphyxia was considered if intrauterine hypoxia, birth asphyxia, or meconium aspiration syndrome were written in any line of the original Death Certificate. Epidemiological data were also extracted from the Birth Certificate. RESULTS: During the three years, 1.71 deaths per 1,000 live births were associated with perinatal asphyxia, which corresponded to 22% of the early neonatal deaths. From the 2,873 avoidable deaths, 761 (27% occurred in São Paulo city; 640 (22%, in the metropolitan region of São Paulo city; and 1,472 (51%, in the countryside of the state. In the first two regions, deaths were more frequent in public hospitals, among newborns with gestational age of 36 weeks or less, and among babies weighing less than 2500g. In the countryside, mortality was more frequent in philanthropic hospitals, in term newborns and in neonates weighing over 2500g. Most of these neonates were born during daytime in their hometown and died at the same institution in which they were born within the first 24 hours after delivery. Meconium aspiration syndrome was related to 18% of the deaths. CONCLUSIONS: Perinatal asphyxia is a frequent contributor to the avoidable early neonatal death in the state with the highest gross domestic product per capita in Brazil, and it shows the need for specific interventions with regionalized focus during labor and birth care.
Alain K. Koffi
Full Text Available Background Reducing preventable medical causes of neonatal death for faster progress toward the MGD4 will require Cameroon to adequately address the social factors contributing to these deaths. The objective of this paper is to explore the social, behavioral and health systems determinants of newborn death in Doume, Nguelemendouka and Abong–Mbang health districts, in Eastern Region of Cameroon, from 2007–2010. Methods Data come from the 2012 Verbal/Social Autopsy (VASA study, which aimed to determine the biological causes and social, behavioral and health systems determinants of under–five deaths in Doume, Nguelemendouka and Abong–Mbang health districts in Eastern Region of Cameroon. The analysis of the data was guided by the review of the coverage of key interventions along the continuum of normal maternal and newborn care and by the description of breakdowns in the care provided for severe neonatal illnesses within the Pathway to Survival conceptual framework. Results One hundred sixty–four newborn deaths were confirmed from the VASA survey. The majority of the deceased newborns were living in households with poor socio–economic conditions. Most (60–80% neonates were born to mothers who had one or more pregnancy or labor and delivery complications. Only 23% of the de ceased newborns benefited from hygienic cord care after birth. Half received appropriate thermal care and only 6% were breastfed within one hour after birth. Sixty percent of the deaths occurred during the first day of life. Fifty–five percent of the babies were born at home. More than half of the deaths (57% occurred at home. Of the 64 neonates born at a health facility, about 63% died in the health facility without leaving. Careseeking was delayed for several neonates who became sick after the first week of life and whose illnesses were less serious at the onset until they became more severely ill. Cost, including for transport, health care and other expenses
Timothy A. Reinhardt
Full Text Available Respiratory syncytial virus (RSV is the most common viral cause of childhood acute lower respiratory tract infections. It is estimated that RSV infections result in more than 100,000 deaths annually worldwide. Bovine RSV is a cause of enzootic pneumonia in young dairy calves and summer pneumonia in nursing beef calves. Furthermore, bovine RSV plays a significant role in bovine respiratory disease complex, the most prevalent cause of morbidity and mortality among feedlot cattle. Infection of calves with bovine RSV shares features in common with RSV infection in children, such as an age-dependent susceptibility. In addition, comparable microscopic lesions consisting of bronchiolar neutrophilic infiltrates, epithelial cell necrosis, and syncytial cell formation are observed. Further, our studies have shown an upregulation of pro-inflammatory mediators in RSV-infected calves, including IL-12p40 and CXCL8 (IL-8. This finding is consistent with increased levels of IL-8 observed in children with RSV bronchiolitis. Since rodents lack IL-8, neonatal calves can be useful for studies of IL-8 regulation in response to RSV infection. We have recently found that vitamin D in milk replacer diets can be manipulated to produce calves differing in circulating 25-hydroxyvitamin D3. The results to date indicate that although the vitamin D intracrine pathway is activated during RSV infection, pro-inflammatory mediators frequently inhibited by the vitamin D intacrine pathway in vitro are, in fact, upregulated or unaffected in lungs of infected calves. This review will summarize available data that provide parallels between bovine RSV infection in neonatal calves and human RSV in infants.
Bensaïd, Khaled; Yaroh, Asma Gali; Kalter, Henry D; Koffi, Alain K; Amouzou, Agbessi; Maina, Abdou; Kazmi, Narjis
Niger, one of the poorest countries in the world, recently used for the first time the integrated verbal and social autopsy (VASA) tool to assess the biological causes and social and health system determinants of neonatal and child deaths. These notes summarize the Nigerien experience in the use of this new tool, the steps taken for high level engagement of the Niger government and stakeholders for the wide dissemination of the study results and their use to support policy development and maternal, neonatal and child health programming in the country. The experience in Niger reflects lessons learned by other developing countries in strengthening the use of data for evidence–based decision making, and highlights the need for the global health community to provide continued support to country data initiatives, including the collection, analysis, interpretation and utilization of high quality data for the development of targeted, highly effective interventions. In Niger, this is supporting the country’s progress toward achieving Millennium Development Goal 4. A follow–up VASA study is being planned and the tool is being integrated into the National Health Management Information System. VASA studies have now been completed or are under way in additional sub–Saharan African countries, in each through the same collaborative process used in Niger to bring together health policy makers, program planners and development partners. PMID:26955472
Bensaïd, Khaled; Yaroh, Asma Gali; Kalter, Henry D; Koffi, Alain K; Amouzou, Agbessi; Maina, Abdou; Kazmi, Narjis
Niger, one of the poorest countries in the world, recently used for the first time the integrated verbal and social autopsy (VASA) tool to assess the biological causes and social and health system determinants of neonatal and child deaths. These notes summarize the Nigerien experience in the use of this new tool, the steps taken for high level engagement of the Niger government and stakeholders for the wide dissemination of the study results and their use to support policy development and maternal, neonatal and child health programming in the country. The experience in Niger reflects lessons learned by other developing countries in strengthening the use of data for evidence-based decision making, and highlights the need for the global health community to provide continued support to country data initiatives, including the collection, analysis, interpretation and utilization of high quality data for the development of targeted, highly effective interventions. In Niger, this is supporting the country's progress toward achieving Millennium Development Goal 4. A follow-up VASA study is being planned and the tool is being integrated into the National Health Management Information System. VASA studies have now been completed or are under way in additional sub-Saharan African countries, in each through the same collaborative process used in Niger to bring together health policy makers, program planners and development partners. PMID:26955472
Neonatal screening (NS) is a medical act in the context of preventive medicine aimed at the early identification of infants affected by certain conditions that threaten their life and long-term health, for which a timely intervention can lead to a significant reduction of morbidity, mortality and associated disabilities. It emerged three decades ago in the context of prevention of mental retardation. Since then, around 600 inborn metabolic disorders have been described and technological progress has been impressive; nevertheless only around 5% of the disorders have been the object of NS. The most frequently cited reasons for the limitation are low prevalence and the lack of treatment. The tandem mass spectrometry has come in place in recent years across the globe, expanding NS to include several disorders of intermediary metabolism. This has shown, in addition to a prevalence much higher than previously thought, the benefits of early detection. The present work is a review of NS, not only from the point of view of technological/medical achievements, but also considering other factors which will affect specific disease selection, according to the social and organizational infrastructure that may expand the borders of NS. PMID:12921292
Flick Louise H
Full Text Available Abstract Background Young maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. We sought to investigate the relationships between infant mortality (distinguishing neonatal from post-neonatal deaths, socioeconomic status and maternal age in a large, retrospective cohort study. Methods We conducted a population-based cohort study using linked birth-death certificate data for Missouri residents during 1997–1999. Infant mortality rates for all singleton births to adolescent women (12–17 years, n = 10,131; 18–19 years, n = 18,954 were compared to those for older women (20–35 years, n = 28,899. Logistic regression was used to estimate adjusted odds ratios (OR and 95% confidence intervals (CI for all potential associations. Results The risk of infant (OR 1.95, CI 1.54–2.48, neonatal (1.69, 1.24–2.31 and post-neonatal mortality (2.47, 1.70–3.59 were significantly higher for younger adolescent (12–17 years than older (20–34 years mothers. After adjusting for race, marital status, age-appropriate education level, parity, smoking status, prenatal care utilization, and poverty status (indicated by participation in WIC, food stamps or Medicaid, the risk of post-neonatal mortality (1.73, 1.14–2.64 but not neonatal mortality (1.43, 0.98–2.08 remained significant for younger adolescent mothers. There were no differences in neonatal or post-neonatal mortality risks for older adolescent (18–19 years mothers. Conclusion Socioeconomic factors may largely explain the increased neonatal mortality risk among younger adolescent mothers but not the increase in post-neonatal mortality risk.
Full Text Available Pradeep Mally,1 Jie Xu,2 Karen D Hendricks-Muñoz2 1Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY, USA; 2Department of Pediatrics, Division of Neonatal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Abstract: As a leading cause of neonatal morbidity and mortality, neonatal sepsis remains a significant global health challenge. Despite recent advances in the management of neonatal sepsis, including use of more potent antibiotics, timely identification continues to be a frequent and challenging problem in the management of the newborn or high-risk neonate in the neonatal intensive care unit. Lack of specific early objective diagnostic evaluations or specific signs and symptoms, especially in the preterm infant, impedes early identification. However, emerging technologies linked with enhanced understanding of the immature and developing neonatal immune system responses to early infection provide an opportunity to develop critically needed biomarkers to improve early identification in this high-risk population. This review will focus on the field of neonatal sepsis biomarker development, identifying current promising biomarkers that have been investigated and widely utilized, as well as provide insight into recent advances and the rapidly evolving technologies that are being exploited in biomarker development to improve diagnosis, treatment, and prognosis in neonatal sepsis. Keywords: biomarker, cytokines, neonatal sepsis, recent developments, morbidity, mortality, neonates
目的：了解高死亡率地区早产儿死亡的死亡路径及就医情况。方法采用典型抽样的方法在新生儿高死亡率地区的4个县开展调查，对死亡早产儿的看护人进行一对一的问卷调查。结果266例新生儿死亡中有110例（41．4％）为早产儿，这些早产儿平均死亡年龄为2．5天。89．1％的早产儿出生在医疗机构，但是大部分死于家中（45．4％），其次是县级医疗机构（27．3％）。结论加强孕期保健工作，预防早产发生，提高县级医疗机构对早产儿的护理和抢救水平是降低早产儿死亡率的主要措施。%Objective To investigate the pathway of premature death and medical care seeking behavior in areas with high mortality rate . Methods Typical sampling was used in this survey .Four counties with high neonatal mortality rate were sampled out .Caregivers of the premature death were interviewed face-to-face.Results There were 110 preterm births among 266 (41.4%) neonatal deaths .The median death age was 2.5 days.Totally 89.1% preterm infants were born in health facilities, but most of them died at home (45.4%) and secondly at the county-leveled hospitals (27.3%).Conclusion Strengthening pregnancy health care, preventing premature birth, and improving premature infant care and rescue level of county medical institutions are the main measures to reduce the mortality of premature infants.
Comparison of levels and duration of detection of antibodies to bovine viral diarrhea virus 1, bovine viral diarrhea virus 2, bovine respiratory syncytial virus, bovine herpesvirus 1, and bovine parainfluenza virus 3 in calves fed maternal colostrum or a colostrum-replacement product
Chamorro, Manuel F; Walz, Paul H.; Haines, Deborah M.; Passler, Thomas; Earleywine, Thomas; Palomares, Roberto A.; Riddell, Kay P; Galik, Patricia; Zhang, Yijing; Givens, M. Daniel
Colostrum-replacement products are an alternative to provide passive immunity to neonatal calves; however, their ability to provide adequate levels of antibodies recognizing respiratory viruses has not been described. The objective of this study was to compare the serum levels of IgG at 2 d of age and the duration of detection of antibodies to bovine viral diarrhea virus 1 (BVDV-1), bovine viral diarrhea virus 2 (BVDV-2), bovine respiratory syncytial virus (BRSV), bovine herpesvirus 1 (BHV-1)...
Bhatt Sima K; Patel Disha A; Gupta Praveg; Patel Kiran; Joshi Gurudutt
Background: Early diagnosis and proper management of neonatal septicemia can bring down the morbidity and mortality substantially.4 Hence the aim of this study was to study the bacteriological profile of neonatal septicemia cases and their antibiogram for planning strategy for the management of these cases. Methodology: A retrospective study of bacterial isolates from cases of neonatal septicemia was undertaken over a period of 13 months from January 2006 to February 2007 at B.J.Medical Colle...
Bösenberg, Adrian T
Neonates are the most vulnerable age group in terms of anesthetic risk and perioperative mortality, especially in the developing world. Prematurity, malnutrition, delays in presentation, and sepsis contribute to this risk. Lack of healthcare workers, poorly maintained equipment, limited drug supplies, absence of postoperative intensive care, unreliable water supplies, or electricity are further contributory factors. Trained anesthesiologists with the skills required for pediatric and neonatal anesthesia as well as basic monitoring equipment such as pulse oximetry will go a long way to improve the unacceptably high anesthetic mortality. PMID:24251423
Every year, around 300 000 women die from causes related to pregnancy and childbirth. 99% of these deaths occur in low and middle-income countries, and are highly preventable. This paper looks at what has been proven effective when trying to reduce maternal mortality, and the challenges the developing world faces when it comes to this matter. The effect of having a skilled provider at birth and access to emergency obstetric care has been proven effective, but the effect of antenatal care ...
Background: Neonatal sepsis is an important cause of morbidity and mortality in India. Neonatal health programmes such as the Essential Newborn Care Package focus on preventative and curative care for the reduction of neonatal sepsis. However, neonates continue to die as a consequence of sepsis, many of which deaths are preventable. This critical review examines the factors that impact on neonatal sepsis and evaluates the effectiveness of this package aimed at preventing neonatal death....
Rafael J. Manotas Cabarcas; Luis Carlos Burgos Herrera
Mediante la técnica de Udenfriend y Cooper, se midieron los niveles de tirosina en la sangre del cordón de 26 prematuros y 31 niños de término, con el fin de comparar las concentraciones según la edad gestacional y detectar la presencia de la tirosinemia neonatal. Se encontró un caso de esta entidad en un niño de 31 semanas de edad gestacional, lo cual correspondió al 3.8% de los prematuros y al 1.8% del grupo total. La concentración de tirosina en el paciente fue de 53 JJ.M. El promedio de l...
The end result of the past 40 years of experience in combating maternal mortality in Mali suggests that the emphasis should be changed, and that giving birth at a maternity hospital should be the basic strategic option chosen. This means creating “compounds set aside for mothers-to-be”, where women approaching the end of their pregnancy will be invited to come and await the onset of labour, and at the same time enjoy the rest they need. However, the prerequisites for such an initiative will b...
Lorenza Pugni; Andrea Ronchi; Bianca Bizzarri; Dario Consonni; Carlo Pietrasanta; Beatrice Ghirardi; Monica Fumagalli; Stefano Ghirardello; Fabio Mosca
Septic shock, occurring in about 1% of neonates hospitalized in neonatal intensive care unit (NICU), is a major cause of death in the neonatal period. In the 1980s and 90s, exchange transfusion (ET) was reported by some authors to be effective in the treatment of neonatal sepsis and septic shock. The main aim of this retrospective study was to compare the mortality rate of neonates with septic shock treated only with standard care therapy (ScT group) with the mortality rate of those treated w...
Pastor Durán, Xavier
PROTOCOLOS TERAPEUTICOS. TUBERCULOSIS NEONATAL 1. CONCEPTO La tuberculosis neonatal es la infección del recién nacido producida por el bacilo de Koch. Es una situación rara pero grave que requiere un diagnóstico precoz y un tratamiento enérgico..
A Sathiya Susuman
Full Text Available Ethiopia childhood mortality has continued to decline although at a swift pace. The drop in urban childhood mortality decline, duration of breastfeeding is the principle reason for the overall decline in mortality trends in Ethiopia. Data from the Ethiopian Demographic and Health Surveys 2000 and 2005 were used. Indirect estimation of Brass and Trussells methods were adopted. Selected demographic and socio-economic variables were included in the analysis with statistically significant effects. Findings clearly show neonatal and post neonatal mortality decline gradually. Even though, Ethiopia childhood mortality rates are still high. The result shows less than 2 years birth interval have higher infant mortality rates than higher birth interval (113 deaths per 1000. The proper spacing of births allows more time for childcare to make more maternal resources available for the care of the child and mother. Therefore, further research is urgent for regional level and national level investigation.
Full Text Available One of the most significant causes of neonatal morbidity and mortality is represented by neonatal sepsis that often manifests itself as a systemic inflammatory response syndrome (SIRS. The progression of SIRS usually leads to multiple organ dysfunction, occasionally culminating in multiple organ failure (MOF. The loss of endothelial barrier represents the unifying lesion of multiple organs in newborns affected by sepsis and the most important pathological change responsible for the evolution toward MOF in neonates. The aim of this study is to present the most important pathological changes occurring in neonatal sepsis. Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken
Estudo da mortalidade de recém-nascidos internados na UTI neonatal do Hospital Geral de Caxias do Sul, Rio Grande do Sul Newborn mortality study in the neonatal intensive care unit of Caxias do Sul General Hospital, Rio Grande do Sul
Breno Fauth de Araújo
Full Text Available OBJETIVOS: conhecer as causas e variáveis relacionadas com o óbito de recém-nascidos (RN de uma UTI neonatal de referência na região Sul do Brasil. MÉTODOS: estudo descritivo envolvendo 2.247 RN acompanhados até a alta. Foram analisadas variáveis maternas, do RN e variáveis da gestação, parto e atendimento. Foi utilizada a análise univariada e a regressão logística múltipla para relacionar as variáveis estudadas com o óbito. RESULTADOS: ocorreram 184 óbitos, com uma letalidade de 8,2%. A mortalidade dos RN com peso 2.500g ou a termo. As variáveis relacionadas ao óbito foram o peso OBJECTIVES: to determine causes and variables related to newborn deaths of a neonate intensive care unite (ICU in the Southern region of Brazil. METHODS: a descriptive study involving 2.247 newborns followed up until discharge date. Maternal variables were analyzed, as well as of the newborn and pregnancy, delivery and medical assistance variables. Univariate analysis and multiple logistic regression were used to relate the variables studied with death occurrence. RESULTS: 184 deaths occurred, corresponding to a 8.2% lethality rate. Newborn mortality variables were the following: weight of 2.500g or born at pregnancy term. Death related variables were weight of <2.000 grams, Apgar at 5' <4, no prenatal medical care, the need of delivery room resuscitation procedures and mechanic ventilation during hospitalization. Deaths basic causes were malformations (25.6%, maternal hypertension (17.9% and maternal infections (12.0%. CONCLUSIONS: many of the deaths occurred because of the poor medical care offered to pregnant women and newborns, a challenge that need to be faced by neonatologists, obstetricians and the government.
Full Text Available Background : Anorectal malformations (ARM are associated with congenital anomalies and other risk factors, yielding a poor prognosis, especially in neonatal life. Objectives: This study was performed to identify the congenital anomalies as a factor of poor prognosis (mortality in such patients. Settings: Department of Pediatric surgery, The Children′s Hospital and The Institute of Child Health, Lahore. Design: Prospective observational study, with statistical support. Materials and Methods: The information on the demography, clinical features, investigations, management performed, and outcome was entered in the designed proforma and analysed with the help of statistical software EpiInfo version 3.5.1. Statistical test: Chi-square test was used to determine statistical significance of the results. Results : Of 100 neonates with ARM, 77 were male and 23, female (3.4:1. The mean age at presentation was 3.4 days (range, 12 hrs to 28 days. In 60 patients (60%, the presentation was imperforate anus without a clinically identified fistula. In 28 patients (28%, associated anomalies were present. The common associated anomalies were urogenital (10%, cardiovascular (8%, and gastrointestinal (6%. Down′s syndrome was present in 8 (8% patients. A total of 15 (15% deaths occurred in this study. In patients having associated congenital anomalies, 11 deaths occurred, whereas, 4 deaths were in patients without associated anomalies (P < 0.5. Conclusion : The mortality is higher in neonates with ARM having associated congenital anomalies.
Full Text Available Neonatal septicemia remains a significant cause of morbidity and mortality in the new born, more so in developing countries like India due to delivery and post natal follow up in an unclean environment having more chances of contamination with infective organisms. Infection is more common in the neonatal period than at any other time in life . 1 This is partly attributable to exposure to large number of organisms, but is also due to a relative failure of the neonatal host defenses to clear microorganisms from blood and tissues. The rate of infection and type of organism causing sepsis in a neonate vary with demography. In India, the incidence of neonatal septicemia is 10 - 30/1000 live births , 2 whereas in western countries it is 1 - 8/1000 live births . 3 KEYWORDS: Neonatal, Sepsis, Staphylococcus, CRP, Bandemia
Full Text Available The transport o f ill neonates between hospitals and/or health care centres, plays an important role in the mortality rate o f these seriously ill neonates. It is therefore important that the ill neonate is transported under optimal conditions. A lack o f standards in this regard hampers the evaluation o f the quality o f inter hospital transport o f ill neonates. The purpose o f this study is to formulate valid standards fo r the transport o f seriously ill neonates between hospitals (and/or other health care institutions to form the basis fo r the evaluation o f the quality o f this service. Factors that need to be considered in the transport o f ill neonates include the ambulance, equipment and stock, the transport personnel and communication. These factors were systematically explored and described and standards were formulated accordingly.
Full Text Available Neonatal bacterial sepsis is one of the major cause of morbidity and mortality in neonates. This retrospective study was performed to determine the incidence of bacterial sepsis with focus on Gram negative organisms in neonates admitted at Beheshti Hospital in Kashan, during a 3-yr period, from September 2002 to September 2005. Blood culture was performed on all neonates with risk factors or signs of suggestive sepsis. Blood samples were cultured using brain heart infusion (BHI broth according to standard method. From the 1680 neonates 36% had positive blood culture for Pseudomans aeruginosa, 20.7% for Coagulase negative Staphylococci, and 17% for Klebsiella spp. Gram-negative organisms accounted for 72.1% of all positive cultures. The overall mortality rate was 19.8% (22 /111 of whom 63.6% (14 /22 were preterm. Pseudomona aeruginosa and Klebsiella spp. showed a high degree of resistance to commonly used antibiotics (ampicillin, gentamicin as well as third generation cephalosporins. Continued local surveillance studies are urged to monitor emerging antimicrobial resistance and to guide interventions to minimize its occurrence.
GB, Shantala; T, Nagarathnamma; DR, Pooja; TR, Harsha; R, Karthik
Neonatal bacterial sepsis is one of the major causes of morbidity and mortality in neonates. 10% cases of neonatal bacteraemia and septicaemia are caused by Enterococci. The increasing incidence of Vancomycin resistant enterococci (VRE) is of particular concern because of limited treatment options and increased mortality. We report here a case of neonatal sepsis in a premature baby caused by vancomycin resistant Enterococcus faecium Van A phenotype from a tertiary care Hospital in South India...
Trends in Infant mortality rate and mortality for neonates born at less than 32 weeks and with very low birth weight Tendencia de la mortalidad infantil y de neonatos menores de 32 semanas y de muy bajo peso Tendência da mortalidade infantil e dos neonatos menores de 32 semanas e de muito baixo peso
René Mauricio Barría-Pailaquilén
Full Text Available The aim of the study was to assess the trend of the infant mortality rate between 1990-2004 and the neonatal mortality between 2000-2005 in infants born at less than 32 weeks of gestational age or with very low birth-weight. Based on secondary data, infant mortality rate and by its component for Valdivia city were compared with national indicators. Mortality at Para evaluar la tendencia de la mortalidad infantil entre 1990-2004 y la mortalidad de prematuros menores de 32 semanas de edad de gestación y niños de muy bajo peso al nacer, entre 2000-2005, se compararon los datos secundarios globales por componentes del Servicio de Salud Valdivia con los totales del país, en Chile. Se calculó la mortalidad específica, por mil nacidos vivos, para los Para avaliar a tendência da mortalidade infantil, entre 1990 e 2004, a mortalidade de prematuros <32 semanas de idade gestacional e crianças de muito baixo peso ao nascer, entre 2000 e 2005, compararam-se dados secundários globais e por componentes do Serviço de Saúde Valdivia, e do total do país (Chile. Calculou-se a mortalidade específica em <32 semanas e <1.500g, por mil nascidos vivos, estabelecendo causas de óbito e avaliando sua relação com intervenções específicas, como uso de surfactante e corticoides pré-natais. A mortalidade infantil deteve sua queda a partir do ano 2000, com referência à década precedente, e a brecha que existia, entre os valores nacionais e locais antes de 2000, reduziu drasticamente. A mortalidade em <32 semanas e <1.500g variou entre 88 e 200‰ nascidos vivos, destacando a síndrome da angústia respiratória como principal causa de morte. O uso de corticoides e surfactante coincidiu com reduções da mortalidade.
NEWHINTS cluster randomised trial to evaluate the impact on neonatal mortality in rural Ghana of routine home visits to provide a package of essential newborn care interventions in the third trimester of pregnancy and the first week of life: trial protocol
Full Text Available Abstract Background Tackling neonatal mortality is essential for the achievement of the child survival millennium development goal. There are just under 4 million neonatal deaths, accounting for 38% of the 10.8 million deaths among children younger than 5 years of age taking place each year; 99% of these occur in low- and middle-income countries where a large proportion of births take place at home, and where postnatal care for mothers and neonates is either not available or is of poor quality. WHO and UNICEF have issued a joint statement calling for governments to implement "Home visits for the newborn child: a strategy to improve survival", following several studies in South Asia which achieved substantial reductions in neonatal mortality through community-based approaches. However, their feasibility and effectiveness have not yet been evaluated in Africa. The Newhints study aims to do this in Ghana and to develop a feasible and sustainable community-based approach to improve newborn care practices, and by so doing improve neonatal survival. Methods Newhints is an integrated intervention package based on extensive formative research, and developed in close collaboration with seven District Health Management Teams (DHMTs in Brong Ahafo Region. The core component is training the existing community based surveillance volunteers (CBSVs to identify pregnant women and to conduct two home visits during pregnancy and three in the first week of life to address essential care practices, and to assess and refer very low birth weight and sick babies. CBSVs are supported by a set of materials, regular supervisory visits, incentives, sensitisation activities with TBAs, health facility staff and communities, and providing training for essential newborn care in health facilities. Newhints is being evaluated through a cluster randomised controlled trial, and intention to treat analyses. The clusters are 98 supervisory zones; 49 have been randomised for
Gershwin, LJ; Van Eenennaam, AL; Anderson, ML; McEligot, HA; Shao, MX; Toaff-Rosenstein, R; Taylor, JF; Neibergs, HL; Womack, J.; Complex, BRD
Bovine respiratory disease complex (BRDC) is an important cause of mortality and morbidity in cattle; costing the dairy and beef industries millions of dollars annually, despite the use of vaccines and antibiotics. BRDC is caused by one or more of several viruses (bovine respiratory syncytial virus, bovine herpes type 1 also known as infectious bovine rhinotracheitis, and bovine viral diarrhea virus), which predispose animals to infection with one or more bacteria. These include: Pasteurella ...
The new variant of the Creutzfeldt-Jakob disease accounts for no relative increase of the Creutzfeldt-Jakob disease mortality rate in the United Kingdom; this fits ill with the new variant being the consequence of consumption of food infected with the agent of Bovine Spongiform Encephalopathy
Full Text Available Abstract Background A new variant of Creutzfeldt-Jakob disease was described in the United Kingdom. It is often claimed that it is caused by consumption of food infected with the agent of bovine spongiform encephalopathy. However, this remains open to question because the number of cases of the variant is, at the present time, less than would be expected from a major food-borne source. Discussion The EUROCJD cooperative study presents currently available epidemiological data of Creutzfeldt-Jakob disease and its new variant, for nine European countries plus Australia and Canada. Unexpectedly, for the United Kingdom where all but a few cases of the new variant have been reported, these cases have to be included in the incidence curve of the sporadic forms of the disease in order to obtain the best fit with the median curve from all the countries. This variant could be merely a rare clinical phenotype within the sporadic disease. The published clinical and experimental data which suggest that it is linked with bovine spongiform encephalopathy, lead us to propose that this link could be a common etiological origin other than consumption of bovine infected food. In any case, public health recommendations hold and further investigation is required. Summary The lack of a relative increase of the Creutzfeldt-Jakob-disease mortality rate in the United Kingdom, does not fit well with the new variant being the consequence of consumption of food infected with the agent of bovine spongiform encephalopthy.
Antônio P. Caldeira
Full Text Available OBJETIVOS: identificar os fatores de risco para a mortalidade infantil pós-neonatal por diarréia e pneumonia relacionados à qualidade da assistência médica. MÉTODOS: estudo tipo caso-controle, de base populacional, de 277 óbitos infantis pós-neonatais por diarréia e pneumonia ocorridos na Região Metropolitana de Belo Horizonte, entre maio de 1991 a abril de 1992. Os casos foram comparados com controles hospitalares, emparelhados por patologia, idade e hospital. As informações sobre casos e controles foram coletadas através de prontuários médicos e entrevistas domiciliares, sendo analisadas algumas variáveis relacionadas à qualidade da assistência médica. Utilizou-se o teste de McNemar e o método de regressão logística condicional para a definição dos fatores de risco para o óbito. RESULTADOS: a regressão logística multivariada mostrou os seguintes fatores independentemente associados a maior risco de óbito pós-neonatal por diarréia e pneumonia: atraso vacinal (OR= 2,48; IC95%=1,17-5,23, estado geral (grave à admissão hospitalar (OR=10,94; IC95%=4,91-24,34, não realização de procedimentos hospitalares (OR=10,08; IC95%= 3,55-20,59 e desnutrição presente no momento da internação (OR=3,58; IC95%=1,42-9,07. CONCLUSÕES: os resultados indicam a baixa qualidade da assistência médica como um importante fator de risco para o óbito infantil pós-neonatal por causas evitáveis. Os autores salientam a falta de integralidade entre as atividades ambulatoriais e hospitalares como importante determinante da baixa qualidade. Sem desconsiderar o papel preponderante das variáveis socioeconômicas, salienta-se a necessidade de uma ampla discussão sobre o desempenho dos serviços de saúde e mortalidade infantil evitável.OBJECTIVE: to identify the risk factors for postneonatal infant mortality caused by diarrhea and pneumonia in relation to the quality of medical assistance. METHODS: population-based case-control study of
Full Text Available Hemophilia A is a X-linked hereditary condition that lead to decreased factor VIII activity, occurs mainly in males. Decreased factor VIII activity leads to increased risk of bleeding events. During neonatal period, diagnosis is made after post-partum bleeding complication or unexpected bleeding after medical procedures. Subgaleal hemorrhage during neonatal period is a rare, severe extracranial bleeding with high mortality and usually related to traumatic labor or coagulation disorders. Subgaleal hemorrhage complications result from massive bleeding. We present a neonate with unremarkable family history and uneventful pregnancy with a vaginal delivery with no instrumentation, presenting with severe subgaleal bleeding at 52 hours of life. Aggressive support measures were implemented and bleeding managed. The unexpected bleeding lead to a coagulation study and the diagnosis of severe hemophilia A. There were no known sequelae. This case shows a rare hemophilia presentation reflecting the importance of coagulation studies when faced with unexplained severe bleeding.
Ingan Ukur Tarigan; Tati Suryati
Background: Health care for children under five year in Indonesia was still a problem that should be cope with. Infant mortality (IMR), maternal mortality (MMR), and the IMR in Indonesia, ware still ranked the highest in Southeast Asia. According Soemantri (2004), infant mortality reached 46 per 1000 live births during the period 1998-2002. According SKRT 2001, the highest cause for infant mortality was perinatal disturbances (34%) and for neonatal mortality are premature and low birth weight...
Ioanna Paulopoulou; Christina Nanou
Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific ...
Fading kitten syndrome includes noninfectious and infectious causes for neonatal death (birth to weaning age). Noninfectious causes are mostly responsible for mortality in the first week of life and include congenital disorders, low birth weights, trauma, malnutrition, environmental causes, and neonatal isoerythroylsis. Infectious causes are more prevalent at 3-4 weeks of age. This article discusses the causes, clinical signs, and management of fading kitten syndrome. PMID:10390788
K. Kamrani; Z. Sanaei; N. Khosroshahi; S. Rajabi Eslami; J. Amiri
Introduction & Objective: Hypernatremia is associated with serious complications in infants. Given the high morbidity and mortality of neonatal hypernatremia, and since some complica-tions can be prevented, this study was aimed to examine the prevalence of hypernatremia in hospitalized infants and related risk factors. Materials & Methods: This cross-sectional study was performed on 1923 neonates hospitalized in Bahrami Hospital affiliated to Tehran University from October 2011 to October 201...
H Alper Gürsu
Full Text Available Objective: With this prospective study we aimed to evaluate 60 patients with neonatal sepsis. Material and Methods: Between 07 March 2003 and 31 January 2005, the newborns with neonatal sepsis were evaluated for clinical signs and symptoms, complaints, blood culture results, risk factors and mortality. Results: Thirty two (53.4% of 60 patients with sepsis were male and 28(46.6% female. Twenty eight (46.6% had early sepsis, while 32 (53.4% late. The most common complaints were fever, poor sucking reşex and respiratory distress. Depression in newborn reşexes, fever and hypotonia were the most common symptoms. The most common bacteria isolated in blood cultures with early onset sepsis were gram (- bacilli and staphylococci in the group with late onset most common bacteria were staphylococci and gram (- bacilli. The mortality rate was 21.4% and 18.8% in early and late sepsis respectively. Mortality was higher in early onset sepsis whereas meningitis was more frequent in late onset. Mortality in preterms was 24.3%, higher than in terms as 16.1%. Conclusion: Mortality is still high in neonatal sepsis. Prevention of risk factors predisposing to neonatal sepsis, like prematurity and delivery of low birth weight newborns early diagnosis and initiation of treatment, sufficient supportive therapy would help to reduce mortality.
EVALUATING VIRULENCE OF WATERBORNE AND CLINCIAL AEROMONAS ISOLATES USING GENE EXPRESSION AND MORTALITY IN NEONATAL MICE FOLLOWED BY ASSESSING CELL CULTURE'S ABILITY TO PREDICT VIRULENCE BASED ON TRANSCRIPTIONAL RESPONSE
The virulence of multiple Aeromonas spp. were assessed using two models, a neonatal mouse assay and a mouse intestinal cell culture. Transcriptional responses to both infection models were assessed using microarrays. After artificial infection with a variety of Aeromonas spp., ...
Griese, Matthias; Westerburg, Bettina
The function of pulmonary surfactant of a group of 14 preterm neonates (birth weight 907 +/- 60 g) who suffered from severe respiratory distress syndrome (RDS) and who had received exogenous bovine lipid extracted surfactant on the first day of life was compared to that in a second group of 8 neonates (birth weight 940 +/- 110 g) with mild RDS who had not received surfactant treatment. Mechanical respiratory support from day 2 on was the same in both groups. The minimal surface tension (gamma...
Manzoni, P; Decembrino, L; Stolfi, I; Pugni, L; Rinaldi, M; Cattani, S; Romeo, M G; Messner, H; Laforgia, N; Vagnarelli, F; Memo, L; Bordignon, L; Saia, O S; Maule, M; Gallo, E; Mostert, M; Magnani, C; Quercia, M; Bollani, L; Pedicino, R; Renzullo, L; Betta, P; Ferrari, F; Magaldi, R; Mosca, F; Stronati, M; Farina, D
Late-onset sepsis (LOS) affects a large proportion of pre-term neonates in neonatal intensive care units (NICUs) worldwide, with high morbidity and related mortality, and frequent occurrence of severe late neurodevelopmental impairment. Due to the frequency, severity and difficulties in early diagnosis and prompt therapy, prevention is crucial for decreasing the burden of infection-related complications in NICUs. It is well known that feeding with fresh maternal milk, hygiene measures and the cautious use of H2-blockers are related with a decreased risk of developing sepsis. However, evidence from randomised clinical trials exists only for fluconazole in the prevention of fungal infections in the NICU. Lactoferrin is the main whey protein in mammalian milk, and is involved in innate immune host defences. Notably, human lactoferrin can be found at increased concentrations in colostrum and in milk from mothers of premature neonates. Human (hLF) and bovine lactoferrin (bLF) share a high (77%) amino-acid homology, and the same N-terminal peptide responsible for antimicrobial activity, called lactoferricin. In vitro, bLF shows potent direct antimicrobial activity against all types of pathogens, which occurs via anti-cell wall actions and leads to disintegration of the micro-organism's membranes. bLF is also synergistic with many antimicrobials and antifungals, and promotes growth and differentiation of the immature gut. Based on this background data, a randomised clinical trial was recently conducted in very low birth weight pre-term neonates given bLF alone or with the probiotic Lactobacillus GG. The aim of the trial was to assess the ability of bLF to prevent late-onset sepsis of any origin in the studied infants during their stay in the NICU. This article discusses the preliminary data from this study, along with the proposed mechanisms of action of bLF in pre-term infants. PMID:20138718
Ana C. Silvestre-Ferreira; Josep Pastor
Although feline neonatal isoerythrolysis is rare, associated mortality rate is high. It results from mating of type B blood queens with type A or AB blood toms. A comprehensive review on feline blood types and feline neonatal isoerythrolysis physiopathology, clinical features, diagnosis, treatment, and prevention is covered.
Urbón Artero, Alfonso; Reig del Moral, Celia
Los autores de este artículo revisan el screening neonatal, desde la descripción por Wilson y Jungner en 1968 de los criterios que hansido aplicados en la detección precoz de enfermedades enel recién nacido, hasta los avances actuales en la medicina genómica que han modificado sustancialmente estas bases. Se comentan los métodos diagnósticos prenatales más utilizados como los analíticos y ultrasonografia prenatal. Se describen los procedimientos que se aplican en la actualidad y se describen ...
Semwanga, Agnes Rwashana; Nakubulwa, Sarah; Adam, Taghreed
Background The most recent reports on global trends in neonatal mortality continue to show alarmingly slow progress on improvements in neonatal mortality rates, with sub-Saharan Africa still lagging behind. This emphasised the urgent need to innovatively employ alternative solutions that take into account the intricate complexities of neonatal health and the health systems in which the various strategies operate. Methods In our first paper, we empirically explored the causes of the stagnating...
Ladan Haghighi; Marzieh Nojomi; Behnaz Mohabbatian; Zahra Najmi
Background: Preterm birth (PTB) is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations. Objective: Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. Materials and Methods: This retrospective cohort study included all preterm (26-37 weeks) infants (n=1612) born alive in Shahid Akbar-abadi university hospital, during one year period (April 2010-20...
Kruse, Alexandra Yasmin; Thieu Chuong, D.H.; Phuong, C.N.; Duc, T.; Graff Stensballe, L.; Prag, J.; Kurtzhals, Jørgen; Greisen, Gorm; Pedersen, Freddy Karup
Septicemia and bloodstream infections (BSIs) are major causes of neonatal morbidity and mortality in developing countries. We prospectively recorded all positive blood cultures (BSI) among neonates admitted consecutively to a tertiary pediatric hospital in Vietnam during a 12-month period. Among...... 5763 neonates, 2202 blood cultures were performed, of which 399 were positive in 385 neonates. Among these, 64 died, 62 in relation to septicemia. Of the BSI isolates, 56% was known pathogenic and 48% was gram-negative bacteria, most frequently Klebsiella spp. (n = 78), Acinetobacter spp. (n = 58) and...
KHALESSI, Nasrin; Ladan AFSHARKHAS*
How to Cite This Article: Khalessi N, Afsharkhas L. Neonatal Meningitis: Risk Factors, Causes and Neurologic Complications.Iran J Child Neurol. 2014 Autumn;8(4): 46-50.AbstractObjectiveNeonates are at greater risk for sepsis and meningitis than other ages and in spite of rapid diagnoses of pathogens and treatments, they still contribute to complications and mortality. This study determines risk factors, causes, andneurologic complications of neonatal meningitis in ospitalized neonates.Materi...
Nøhr, Ellen Aagaard
mechanisms behind these associations remain largely unknown. Although maternal obesity is associated with a wide range of complications in the mother and neonate that may impair fetal and infant survival, the increased risk of stillbirth and infant mortality is virtually unchanged when accounting...... indicating that some of the excess risk may have a placental origin. To further understand the associations between maternal obesity and late fetal and infant death, we need better and more detailed clinical data, which is difficult to obtain on a population level given the rarity of the outcomes. The best...
Mohsin, Fauzia; Khan, Shareen; Baki, Md Abdul; Zabeen, Bedowra; Azad, Kiswhar
Women with diabetes in pregnancy, either pre-gestational Diabetes Mellitus (Type 1 & Type 2) or Gestational Diabetes, are at increased risk for adverse pregnancy outcomes, including preterm labour and increased foetal mortality rate. Adequate glycaemic control before and during pregnancy is crucial for improving foetal and perinatal outcomes in these babies. Perinatal and neonatal morbidities and mortality rates have declined since the development of specialized maternal, foetal, and neonatal care for women with diabetes and their offspring. However, infants of diabetic mothers are at risk for developing complications as macrosomia, hypoglycaemia, perinatal asphyxia, cardiac and respiratory problems, birth injuries and congenital malformations. In this review article we describe the neonatal management of the offspring of diabetic mothers. PMID:27582162
Juan Carlos Ospina Chirivi
Full Text Available Neonatal septicemia is a major cause of mortality and morbidity in horses in their first seven days of life and within their pathophysiology. It is important to consider the extrinsic and intrinsic predisposing factors which make foals susceptible to agents of primarily bacterial etiology. However, other types of infectious etiology (viruses and fungi should be considered too, as well as noninfectious etiologies. The paper mentions a wide variety of mechanisms that produce different injuries that must be addressed with measures of critical neonatal care, so it is imperative for the veterinarian to know the pathogenic mechanisms of the disease, its clinical presentation and anatomo-pathological lesions. Thus, systemic inflammatory response syndrome (SIRS, multiple organ dysfunction syndrome (MODS, and peripheral circulatory collapse or shock are some of the elements defined as the pillars of the pathophysiology of neonatal septicemia, extensively studied in equine medicine. This paper presents a short review of the triggering mechanisms of neonatal septicemia highlighting the importance of epidemiological investigations in Colombia. It shows the need for retrospective and prospective studies and for divulgation of some of the preventive measures of the disease in horses.
Necrotizing enterocolitis (NEC) is the commonest gastrointestinal emergency in neonates. It is associated with high mortality and morbidity. Present study was conducted to determine the frequency of necrotizing enterocolitis in preterm neonates along with their outcome during stay in hospital. Methods: This was descriptive case series carried out in Neonatal Intensive Care Unit (NICU) of Paediatrics department, POF Hospital Wah Cantt from August 2010 to February 2011. All the preterm neonates admitted in NICU POF Hospital were included in the study. Patients were clerked on a pre-designed proforma. Results: A total of 196 neonates were enrolled and 28 (14%) were diagnosed with NEC. Outcome analysis of these 28 patients with NEC revealed that 16 patients (57.14%) were discharged while 11 (39.28%) expired and one (3.5%) was referred. Conclusion: There is a high incidence in preterm-low birth weight babies presenting in our set-up, with high mortality rates. (author)
Hemphill, A; Gottstein, B; Kaufmann, H
Neospora caninum is a recently identified coccidian parasite which was, until 1988, misdiagnosed as Toxoplasma gondii. It causes paralysis and death in dogs and neonatal mortality and abortion in cattle, sheep, goats and horses. The life-cycle of Neospora has not yet been elucidated. The only two stages identified so far are tissue cysts and intracellularly dividing tachyzoites. Very little is known about the biology of this species. We have set up a fluorescence-based adhesion/invasion assay in order to investigate the interaction of N. caninum tachyzoites with bovine aorta endothelial (BAE) cells in vitro. Treatment of both host cells and parasites with metabolic inhibitors determined the metabolic requirements for adhesion and invasion. Chemical and enzymatic modifications of parasite and endothelial cell surfaces were used in order to obtain information on the nature of cell surface components responsible for the interaction between parasite and host. Electron microscopical investigations defined the ultrastructural characteristics of the adhesion and invasion process, and provided information on the intracellular development of the parasites. PMID:8851858
Fulton, R W; Downing, M M; Cummins, J M
The antiviral effects of bovine interferons on the replication of bovine respiratory tract viruses were studied. Bovine turbinate monolayer cultures were treated with bovine interferons and challenged with several bovine herpesvirus 1 strains, bovine viral diarrhea virus, parainfluenza type 3 virus, goat respiratory syncytial virus, bovine respiratory syncytial virus, bovine adenovirus type 7, or vesicular stomatitis virus. Treatment with bovine interferons reduced viral yield for each of the...
Objective To study the application value of domestic bovine pulmonary surfactant on the prevention of neonatal respiratory distress syndrome. Methods Ninety-four cases of premature infants were randomly divided into obser-vation group and control group, with 47 cases in each group. The newborn in the observation group were given the domestic bovine pulmonary surfactant 6 h after birth, the control group were not given. The blood gas, oxygenation index, the inci-dence of respiratory distress syndrome,the mechanical ventilation rate and fatality were compared between the two groups. Results In the observation group,PaO2 at 12, 24 h were (80. 2 ± 11. 6), (88. 6 ± 9. 1)mm Hg respectively, which were significantly higher than that in the control group (P 0. 05), after then that in the observation group was significantly higher than that in the control group (P 0. 05). Conclusions The clinical effect of domestic bovine pulmonary surfactant on the prevention of neonatal respiratory distress syndrome is re-markable, at the same time it can improve the clinical symptoms, reduce the occurrence of respiratory distress rate and im-prove the survival rate of newborn infants.%目的：研究国产牛肺表面活性物质对预防新生儿呼吸窘迫综合征的应用价值。方法将禹州市妇幼保健院94例早产儿随机分为观察组与对照组,每组47例,观察组新生儿出生6 h 后给予国产牛肺表面活性物质,对照组未应用。比较两组血气、氧合指标、呼吸窘迫综合征发生率、机械通气量率及病死率。结果观察组12、24 h PaO2分别为(80.2±11.6)、(88.6±9.1) mm Hg(1 mm Hg =0.133 kPa),显著高于对照组(P 0.05),后观察组显著高于对照组(P 0.05)。结论国产牛肺表面活性物质预防新生儿呼吸窘迫综合征的临床效果显著,同时可改善患儿临床症状,降低呼吸窘迫发生率,提高新生早产儿的存活率。
Full Text Available In this paper on neonatal sepsis, after a short presentation of etiopathogenesis and physiopathology, we will briefly present the clinical picture, the diagnosis and the therapy. Concerning diagnosis, we will focus our attention on procalcitonin (PCT, serum amyloid A (SAA, presepsin (sCD14 and metabolomics. Three practical tables complete the review. Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken
Schulman, H.; Laufer, L.; Berginer, J.; Hertzanu, Y. [Department of Radiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P. O. Box 151, Beer-Sheva 84101 (Israel); Hershkowitz, E.; Berenstein, T.; Sofer, S. [Pediatric Intensive Care Unit, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva (Israel); Maor, E. [Department of Pathology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva (Israel)
Background. Newborn infants are particularly prone to hypothermia, a condition with a high mortality. Objective. To study the CT brain patterns in infants with hypothermia and neurological symptoms. Materials and methods. We reviewed the brain CT of nine infants with neonatal hypothermia, multiple organ failure, seizures and coma. Results. Two infants had normal CT scans, acutely and at follow-up, and were clinically normal at follow-up. In seven infants, CT showed diffuse cerebral oedema, with reversal of the normal density relationship between grey and white matter and a relative increased density of the thalami, brainstem and cerebellum - the `reversal sign`. In six surviving infants with severe developmental delay, follow-up CT revealed cerebral atrophy with multicystic encephalomalacia. Conclusions. The `reversal sign` has been described in the abused child, birth asphyxia and anoxia due to drowning. Neonatal hypothermia is offered as a further cause. (orig.) With 6 figs., 1 tab., 13 refs.
Background. Newborn infants are particularly prone to hypothermia, a condition with a high mortality. Objective. To study the CT brain patterns in infants with hypothermia and neurological symptoms. Materials and methods. We reviewed the brain CT of nine infants with neonatal hypothermia, multiple organ failure, seizures and coma. Results. Two infants had normal CT scans, acutely and at follow-up, and were clinically normal at follow-up. In seven infants, CT showed diffuse cerebral oedema, with reversal of the normal density relationship between grey and white matter and a relative increased density of the thalami, brainstem and cerebellum - the 'reversal sign'. In six surviving infants with severe developmental delay, follow-up CT revealed cerebral atrophy with multicystic encephalomalacia. Conclusions. The 'reversal sign' has been described in the abused child, birth asphyxia and anoxia due to drowning. Neonatal hypothermia is offered as a further cause. (orig.)
Shrotri, A; Pratinidhi, A; Shah, U
hospital death rate was 5.7/1000 and the district referral hospital death rate was 13.9/1000. The home delivery death rate was 1.2/1000. 5 (33.3%) who died had preterm deliveries. 5 infants died perinatally, 5 died neonatally, and 1 died postneonatally. Infant mortality was 6 times greater among mothers who died. PMID:12319232
Purpose: To describe neoplasms diagnosed in children ≤ 28 days of age along with their treatment, associated congenital anomalies, and the long-term consequences of the diagnoses and treatments. Methods and Materials: Utilizing autopsy records, a computerized tumor registry, and medical records, we identified patients and stillborns at Duke University Medical Center (DUMC) diagnosed with neoplasms at ≤ 28 days of age between 1930 and 1998. Results: Twenty-three neonates with neoplasms were identified. There were 7 males (30%) and 16 females (70%). Follow-up of survivors ranged from 4 months to 27 years (mean 9 years). The 20 patients identified via the computerized registry system for 1980-1998 constitute 2% (20/925) of all neoplasms seen in patients ≤ 16 years of age over this same time period at DUMC. The histologic diagnoses were teratoma/germ cell tumor (n = 8, 35%), neuroblastoma (n = 5, 22%), retinoblastoma (n = 4, 17%), primary central nervous system (CNS) tumor (n = 3, 13%), and one case each of rhabdomyosarcoma, glossal glial choristoma, and hemangioma in the setting of Kasabach-Merritt Syndrome. Of the eight teratoma/germ cell tumor patients, 6 were female (75%) and 2 male (25%). There was one malignant germ cell tumor, 2 immature teratomas, and 5 teratomas. Two of the seven patients with immature teratomas or teratoma were long-term survivors following surgery. The one patient with malignant germ cell tumor, treated with surgery and chemotherapy, died. Associated anomalies were imperforate anus, congenital absence of a limb, left ventricular hypertrophy, fusion or absence of toes, coarctation of the aorta, and pulmonary valve dysplasia. Of the five children with neuroblastoma, 4 were female. INSS Stages were 1 (n = 1), 2A (n = 1), 3 (n = 1), and 4S (n = 2). Two were treated with surgery + chemotherapy + radiotherapy; two with surgery + chemotherapy; and one with surgery alone. Four children are long-term survivors. Associated congenital anomalies
INTRODUCTION: This paper aims to present the methods and main results from the Danish occupational mortality studies, and to set the Danish studies into the international context of occupational mortality studies. RESEARCH TOPICS: The first Danish occupational mortality study from 1970...
You, Dahui; Ripple, Michael; Balakrishna, Shrilatha; Troxclair, Dana; Sandquist, Dane; Ding, Liren; Ahlert, Terry A; Cormier, Stephania A.
Influenza infection remains a significant cause of pulmonary morbidity and mortality worldwide with the highest hospitalization and mortality rates occurring in infants and elder adults. The mechanisms inducing this considerable morbidity and mortality are largely unknown. To address this question, we established a neonatal mouse model of influenza infection to test the hypothesis that the immaturity of the neonatal immune system is responsible for the severe pulmonary disease observed in inf...
Kon, Alexander A
Despite advances in the care of infants, there remain many newborns whose medical conditions are incompatible with sustained life. At times, healthcare providers and parents may agree that prolonging life is not an appropriate goal of care, and they may redirect treatment to alleviate suffering. While pediatric palliative treatment protocols are gaining greater acceptance, there remain some children whose suffering is unrelenting despite maximal efforts. Due to the realization that some infants suffer unbearably (ie, the burdens of suffering outweigh the benefits of life), the Dutch have developed a protocol for euthanizing these newborns. In this review, I examine the ethical aspects of 6 forms of end of life care, explain the ethical arguments in support of euthanasia, review the history and verbiage of the United States regulations governing limiting and withdrawing life-prolonging interventions in infants, describe the 3 categories of neonates for whom the Dutch provide euthanasia, review the published analyses of the Dutch protocol, and finally present some practical considerations should some form of euthanasia ever be deemed appropriate. PMID:19914522
Wiehe, Lennart; Cremer, Malte; Wisniewska, Monika; Becker, Niels-Peter; Rijntjes, Eddy; Martitz, Janine; Hybsier, Sandra; Renko, Kostja; Bührer, Christoph; Schomburg, Lutz
Infectious diseases impair Se metabolism, and low Se status is associated with mortality risk in adults with critical disease. The Se status of neonates is poorly characterised, and a potential impact of connatal infection is unknown. We hypothesised that an infection negatively affects the Se status of neonates. We conducted an observational case-control study at three intensive care units at the Charité-Universitätsmedizin Berlin, Germany. Plasma samples were collected from forty-four neonates. On the basis of clinical signs for bacterial infection and concentrations of IL-6 or C-reactive protein, neonates were classified into control (n 23) and infected (n 21) groups. Plasma Se and selenoprotein P (SePP) concentrations were determined by X-ray fluorescence and ELISA, respectively, at day of birth (day 1) and 48 h later (day 3). Se and SePP showed a positive correlation in both groups of neonates. Se concentrations indicative of Se deficit in adults (500 ng/l). During antibiotic therapy, SePP increased significantly from day 1 (1·03 (sd 0·10) mg/l) to day 3 (1·34 (sd 0·10) mg/l), indicative of improved hepatic Se metabolism. We conclude that both Se and SePP are suitable biomarkers for assessing Se status in neonates and for identifying subjects at risk of deficiency. PMID:27267586
Karthik Nagesh, N; Razak, Abdul
Globally, newborn health is now considered as high-level national priority. The current neonatal and infant mortality rate in India is 29 per 1000 live births and 42 per 1000 live births, respectively. The last decade has seen a tremendous growth of neonatal intensive care in India. The proliferation of neonatal intensive care units, as also the infusion of newer technologies with availability of well-trained medical and nursing manpower, has led to good survival and intact outcomes. There is good care available for neonates whose parents can afford the high-end healthcare, but unfortunately, there is a deep divide and the poor rural population is still underserved with lack of even basic newborn care in few areas! There is increasing disparity where the 'well to do' and the 'increasingly affordable middle class' is able to get the most advanced care for their sick neonates. The underserved urban poor and those in rural areas still contribute to the overall high neonatal morbidity and mortality in India. The recent government initiative, the India Newborn Action Plan, is the step in the right direction to bridge this gap. A strong public-private partnership and prioritisation is needed to achieve this goal. This review highlights the current situation of neonatal intensive care in India with a suggested plan for the way forward to achieve better neonatal care. PMID:26944066
Early onset group B streptococcal (EOGBS) infection causes significant neonatal morbidity and mortality. We determined the incidence of EOGBS at Galway University Hospital (GUH) and examined any "missed opportunities" for preventing neonatal infection between 2004 and 2009. Our obstetric approach is risk-based. The incidence was 0.45\\/1,000 live-births; one death and one with neurological sequelae. A single mother received IAP; however we could not determine any potential for reducing cases of EOGBS by improving current IAP usage.
Full text: Hypoxic-Ischemic insults in the brain of neonates constitute major cause of morbidity and mortality. A wide range of motor, sensory, and cognitive disabilities are observed in this population spanning from slight motor deficits, school difficulties and behavioral problems up to cerebral palsy and mental retardation. Pathologically involved areas characterized by high metabolic demands and therefore with enhanced vulnerability to any reduction or cessation of energy and oxygen supply. Watershed areas of the brain (vascular end zones and vascular border zones) are predominately affected in any adverse event. Radiologic and pathologic appearance of these lesions depends both on the severity of the insult and the maturity of the brain. The dominant pathology observed in preterm neonates is white matter lesions. There are three basic patterns of brain destruction in this population. Periventricular leukomalacia (PVL focal fPVL, diffuse dPVL), germinal matrix haemorrhage (GMH) associated with intraventricular haemorrhage (IVH), and parenchymal haemorrhage (PH). fPVL is characterized by focal necrosis of all cellular elements in the periventricular white matter, resulting in the formation of cysts, and dPVL is characterized by diffuse destruction of the premyelinating oligodendrocytes (pre-OLs) the precursors of mature oligodendroglia cells responsible for the formation of myelin in a later stage. GMH is located beneath germinal matrix layer surrounding the lateral ventricles and can extend into the ventricular system resulting thus to IVH. Finally, PH is located within the parenchyma adjacent to the ventricles and is believed to represent haemorrhagic infarcts following venous drainage compromise. In term or near-term neonates, the top-ographic pattern of injuries involves mainly gray matter structures. Most frequent predilection sites include the cerebral cortex (paracentral lobule, Rolandic area, visual cortex and hippocampus), basal ganglia, thalamus, and
Asghar Marzban; Hadi Samaee; Noredien Mosavinasab
Bacterial sepsis is one of the most common causes of mortality and morbidity in neonates. It has been recognized a gradual change in spectrum of organisms responsible for neonatal sepsis. In this study we have evaluated changing trend of incidence and antibiotic susceptibility in neonatal late - onset sepsis (LOS) in 2-periods. This study is based on results of blood culture in neonatal late-onset sepsis, in 2--periods study throughout 12 - years. Neonatal LOS was defined as clinical signs su...
Full Text Available Reducing neonatal mortality is a major public health priority in sub-Saharan Africa. Numerous studies have examined the determinants of neonatal mortality, but few have explored neonatal danger signs which potentially cause morbidity. This study assessed danger signs observed in neonates at birth, determined the correlations of multiple danger signs and complications between neonates and their mothers, and identified factors associated with neonatal danger signs.A cross-sectional study was conducted in three sites across Ghana between July and September in 2013. Using two-stage random sampling, we recruited 1,500 pairs of neonates and their mothers who had given birth within the preceding two years. We collected data on their socio-demographic characteristics, utilization of maternal and neonatal health services, and experiences with neonatal danger signs and maternal complications. We calculated the correlations of multiple danger signs and complications between neonates and their mothers, and performed multiple logistic regression analysis to identify factors associated with neonatal danger signs.More than 25% of the neonates were born with danger signs. At-birth danger signs in neonates were correlated with maternal delivery complications (r = 0.20, p < 0.001, and neonatal complications within the first six weeks of life (r = 0.19, p < 0.001. However, only 29.1% of neonates with danger signs received postnatal care in the first two days, and 52.4% at two weeks of life. In addition to maternal complications during delivery, maternal age less than 20 years, maternal education level lower than secondary school, and fewer than four antenatal care visits significantly predicted neonatal danger signs.Over a quarter of neonates are born with danger signs. Maternal factors can be used to predict neonatal health condition at birth. Management of maternal health and close medical attention to high-risk neonates are crucial to reduce neonatal morbidity
Raboisson, Didier; MAIGNE, Elise; Sans, Pierre; Allaire, Gilles; Cahuzac, Eric
Herd-level risk factors for dairy calf and heifer mortality in France were identified by calculating herd-level variables (including mortality risk or rate) using the National Bovine Identification Database (2005 and 2006). Eleven dairy production areas representing different livestock systems were also included. Statistical analyses were based on a probit model (mortality risk or rate=0 or >0) and a linear model (mortality risk or rate >0) corrected by the sample bias Heckman method. The sam...
Full Text Available Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific journals during the period 2004-2013. As a main tool of retraction of bibliography was used the internet. Specific web sites and library databases: PubMed, Cinahl and Google scholar with key-words: "prevent nosocomial infections", "infection control", "neonatal care", "nursing care prematurity", "neonates nosocomial infections", "neonatal intensive care unit" (NICU. Methodology was applied thematic content analysis, which provides a careful reading of the material and recording the recurring risk factors Neonatal Neonatal Unit. Results: All researchers agree that nosocomial infections of hospitalized infants are a result of interaction of intrinsic and extrinsic factors risk. The intrinsic factors predisposing to infection is the immaturity of the immune system, the barriers of the skin and mucous membranes. Furthermore, multiple external factors contribute to the development of infection, such as low birth weight, underlying disease, broad-spectrum antibiotics, prolonged hospitalization, invasive techniques, parenteral nutrition, numerical insufficiency of staff, and poor compliance with medical professionals on hand hygiene. In recent years, the use of protocols and guidelines for each intervention in newborns has dramatically reduce the incidence of nosocomial infections. Conclusions: Nosocomial infections constitute serious threat to the population of the Neonatal Intensive Care Unit. Surveillance of infections and the use of protocols will help control
Hosseini, Mohammad-Bager; Jannati, Ali; Gholipour, Kamal; Heidarzadeh, Mohammad; Iezadi, Shabnam; Mojahed, Farokh; Vahidi, Reza Gholi
Introduction: This study was aimed to reach expert's expectations of neonatal transport system for developing neonatal transport system in Iran. Materials and Methods: This is a qualitative study conducted by using focus group discussion (FGD) to present expert's perspectives and expectancy about neonatal transport system. Participants was selected from all experts and specialist about neonatal transport in Iran countryside. Finally 48 experts, participate in this study. To data collection 4 FGD were conducted, data were analyzed by content analyses. All subthemes were categorized in main themes according to conceptual relationship as an expert panels opinions. In order to comply with the ethical issues involved in the study was voluntary, also permission for the recording session were taken and confidentiality was also ensured. Result: According to FGD results, 11 themes and 90 subthemes were founded related to neonatal transport system, the main identified themes included: Aims, necessity and models of neonatal transport system, organizing the transport system, management and quality of instruments in the transport system, Neonatal transport system staff, Human resource management and issue related to human resources, conditions and requirements of neonatal transport system, facilitating factors in neonatal transport system, information management and communication system and weakness of neonatal transport system. Conclusion: Neonatal transport systems in different countries must adapted according to situation and component of each country have different strength and weakness and in implementing a system must attend to geographical conditions, financial ability and access to professionals, health system structure, facilities related to neonatal health care, antenatal services in regain, health care related, health care program about neonates and pregnant women and epidemiological status and mortality and morbidity in deferent locals and regains in countryside
Full Text Available BACKGROUND Jaundice is the most common problem in the first week of life. About 25-50% of all term neonates and higher percentage of preterm neonates develop clinical jaundice during neonatal period. Jaundice in newborn is a medical emergency, because unconjugated hyperbilirubinemia may cause bilirubin encephalopathy and needs urgent treatment. The objective of the study was to know the aetiology of hyperbilirubinemia in neonate admitted in neonatal intensive care unit of Gauhati Medical College and Hospital. METHODS This observational study was conducted in Neonatal Intensive Care Unit, Gauhati Medical College and Hospital, over a period of one year (February 2015 to January 2016. A total number of 520 neonates with hyperbilirubinemia were included in the present study. Data collection was done by history taking, clinical examination and essential laboratory tests. RESULTS In this study, out of 520 jaundiced neonates 251 (48.26% were term babies and 269 (51.74% were preterm babies. Physiological jaundice was seen in 224 (43.07% babies and pathological jaundice were 296 (56.93% babies. Among the various aetiologies causing neonatal hyperbilirubinemia, the most common causes were physiological jaundice 224 (43.07%, ABO incompatibility 108 (20.76%, Idiopathic 54 (10.43%, neonatal sepsis 36 (6.92%, G6PD deficiency 35 (6.73% and Rh Incompatibility 31 (5.96%. Other less common causes were cephalhematoma 15 (2.88%, intrauterine infection 7 (1.34%, breast milk jaundice 6 (1.15% and hypothyroidism 4 (0.76%. CONCLUSION We should investigate all newborns with pathological jaundice to find out the aetiology. Moreover, early detection of neonatal jaundice, proper monitoring and timely interventions like phototherapy, exchange blood transfusion and treating the underlying cause will reduce the morbidity and mortality among neonates. Thus, we can prevent mental retardation and cerebral palsy due to neonatal hyperbilirubinemia at the community level.
Full Text Available In its attempt to realize the intervention program to saving newborn babies with asphyxia, the Ministry of Health will initiate to train midwives in the village in order to that they know how to operate resuscitation equipment to save neonatal baby with asphyxia. The intervention program his dubbed successful if the mortality proportion due if asphyxia decreased to half as targeted. The survey was conducted in the rural area of Cirebon district. The sample was 200 neonatal death babies, calculated using the hypothesis test with different proportion; p1 0.3 (30% neonatal death cause of asphyxia, according household health survey 2001, p2 0.15, α 0.05, β 0.2, (l-β 0.8. Neonatal dead cases happened within 12 months prior to the survey were identified by rural midwives out of their personal records. The death cases were followed up by interviewing the mother of the neonatal baby concerning its birth, illness or disorder histories before death. The diagnosis of the diseases were based on the International Classification of Diseases 10 and Wigglesworth classification, determined in union by NIHRD researchers and neonatologists. The neonatal mortality rate was 13 out of 1,000 live births. The major cause of early neonatal mortality was respiration disorder mainly caused by birth asphyxia (45%, of which 90 percent could be intervened by doing resuscitation (for babies weighed more than 1.000 gram. The second and third order of the mortality causes was infection (22% and congenital disorders (11% respectively. The major cause of late neonatal mortality was infection (56%, followed by low birth weight and prematurely born, as well as neonatal jaundice (14 percent each, and congenital disorder comes in the third place. The option to handle asphyxia with the early neonatal babies is the right effort to decrease the neonatal mortality rate. And to achieve the utmost result, it is necessary that the rural midwives maintain their standard performance (in
... RIN 0579-AC68 Bovine Spongiform Encephalopathy; Importation of Bovines and Bovine Products AGENCY... live bovines and products derived from bovines with regard to bovine spongiform encephalopathy. This.... SUPPLEMENTARY INFORMATION: On March 16, 2012, we published in the Federal Register (77 FR 15848-15913, Docket...
Venkatesh, Mohan Pammi; Pham, Don; Fein, Mindy; Kong, Lingkun; Weisman, Leonard E.
Coagulase-negative staphylococci (CoNS) and Candida are among the most common causes of single infections and coinfections in neonates after 72 h of age. In neonates, coinfection increases the rate of mortality threefold and results in significantly greater morbidity compared to those that result from single infections. In an effort to better understand this phenomenon, we developed the first neonatal animal model of coinfection (with CoNS and Candida) and evaluated its effects on mortality a...
Full Text Available With 20-80% mortality, neonatal infection caused by herpes simplex virus (HSV or neonatal herpes is among the most severe of all perinatal infections. The majority of neonatal HSV infections are acquired during delivery, although in utero and postnatal infections do occur. Primary maternal infection is associated with a high rate of transmission (~50%, compared to <3% in infants of women with reactivated disease. Other factors that influence transmission include HSV type, premature delivery, etc. Clinical manifestations have been classified into three forms: skin-eye-mouth disease, CNS and disseminated disease. The diagnosis of neonatal HSV infection includes the detection of HSV DNA by PCR in samples from neonate and mother. The incidence of neonatal herpes differs widely between different countries. In Serbia, the data about neonatal herpes incidence are scarce. The results of our pilot study showed that the minimal estimation of the national incidence of neonatal herpes is 7.5 per 100 000. Therefore, the set up and implementation of a national neonatal herpes surveillance system might provide valuable information for the accurate assessment of disease burden and development of an effective prevention strategy in Serbia. [Projekat Ministarstva nauke Republike Srbije, br. 175073
Velilla, Paula A.; Rugeles, Maria T.; Chougnet, Claire A.
Immaturity of the immune system has been suggested as an underlying factor for the high rate of morbidity and mortality from infections in newborns. Functional impairment of neonatal T cells is frequently quoted as the main underlying mechanism for such immaturity. However, recent studies suggest that neonatal antigen-presenting cells (APCs) also exhibit functional alterations, which could lead to secondary defects of adaptive T cell responses. In this review, we summarize what is known on th...
Sharma, Deepak; Choudhary, Mukesh; Lamba, Mamta; Shastri, Sweta
OBJECTIVE The objective of this study is to determine the correlation of Apgar score with asphyxial hepatic injury and neonatal mortality in moderately and severely asphyxiated newborns. MATERIAL AND METHODS This is a secondary analysis of our prospective observational case-controlled study. Sixteen neonates with severe birth asphyxia (five-minute Apgar ≤3) were compared with either 54 moderate asphyxia neonates (five-minute Apgar >3) or 30 normal neonates. Liver function tests were measured on postnatal days 1, 3, and 10 in the study and control groups. Neonatal mortality was observed in the study and control population. RESULTS Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated neonates for deranged hepatic function showed significant correlation (odds ratio [OR] 4.88, 95% CI 3.26–5.84, P = 0.01 and OR 2.46, 95% CI 1.94–3.32, P = 0.02, respectively). There was a significant increase in serum lactate dehydrogenase (LDH) and total bilirubin on day 1 and serum LDH at age of 10th postnatal life in severely asphyxiated neonates when compared to moderately asphyxiated neonates, whereas there was a significant decrease in total bilirubin and serum albumin on day 3 in severely asphyxiated neonates. There was a significant increase in serum alanine transaminase, serum LDH, and total bilirubin on day 1, serum aspartate transaminase, serum LDH, and total bilirubin on day 3, and International Normalized Ratio on day 10 of postnatal life when severely asphyxiated neonates were compared with normal neonates. There was a significant reduction in total protein and serum albumin on day 1 and direct bilirubin on day 3 in severely asphyxiated neonates when compared with normal neonates. There was a significant increase in neonatal mortality in severely asphyxiated neonates when compared to the other two groups. Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar
Cooke, R W I
Changing preterm population variables have masked improvements in neonatal survival over time. Increased use of antenatal steroids, caesarean section, and surfactant may have reduced the likelihood of mortality and periventricular haemorrhage by a third and doubled that of chronic lung disease, persistent duct, and septicaemia.
Sunil Kumar; Uday Shankar
BACKGROUND : Neonates receiving phototherapy have side effects like hypocalcemia and electrolyte changes. Our study is hereby intended to study the serum sodium changes due to phototherapy. AIMS : To evaluate the serum sodium changes in neonates receiving phototherapy f or neonatal hyperbilirubinemia. SETTINGS AND DESIGN : A prospective hospital based comparative study conducted on neonates admitted in the Neonatal Intensive Care Unit receiving photot...
Full Text Available Background: Congenital surgical anomaly is a major indication for admission of a neonate to an intensive care unit. Profile of surgical conditions is variable by system affecting the neonate and outcomes of the individual conditions depending upon treatment and post surgical facilities. This study was undertaken to highlight the surgical conditions, their burden and their prognosis encountered in our newborn care unit. Methodology: This study is a cross sectional study. All information was collected from the case records of all neonates admitted in newborn care unit of our centre between 1st April, 2011 and 31st October, 2014 with congenital surgical conditions and the following information extracted: surgical condition, age, sex, maturity, birth weight, its treatment and outcome, and other associated features were studied. Result: A total of 9213 neonates were admitted in the study period, of which 328 neonates (3.6% had surgical conditions. Surgery was performed in 225 neonates. Commonest congenital surgical condition was of gastrointestinal tract (GIT. Commonest GIT anomalies were tracheo-oesophageal fistula (28.6%, intestinal obstruction (23.7%, anorectal malformation (17.9%, and omphalocoele (7%. The overall mortality in neonates with congenital surgical condition in this study was 51.2%. Significantly, more deaths occurred in preterm than in term neonates (P = 0.00003 and low birth weight babies more than normal weight (p=0.0002. Conclusion: High mortality is found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of Gastrointestinal tract. Prematurity and low birth weight is a significant factor associated with high mortality. [Natl J Med Res 2016; 6(2.000: 168-170
Sundekilde, Ulrik K.; Barile, Daniela; Meyrand, Mickael; Poulsen, Nina A.; Larsen, Lotte B.; Lebrilla, Carlito B.; Bruce, German J.; Bertram, Hanne C.
Free oligosaccharides are key components of human milk and play multiple roles in the health of the neonate, by stimulating growth of selected beneficial bacteria in the gut, participating in development of the brain and exerting anti-pathogenic activity. However, the concentration of oligosaccharides is low in mature bovine milk, normally used for infant formula, compared with both human colostrum and mature human milk. Characterization of bovine milk oligosaccharides in different breeds is ...
Full Text Available Introduction & Objective: Hypernatremia is associated with serious complications in infants. Given the high morbidity and mortality of neonatal hypernatremia, and since some complica-tions can be prevented, this study was aimed to examine the prevalence of hypernatremia in hospitalized infants and related risk factors. Materials & Methods: This cross-sectional study was performed on 1923 neonates hospitalized in Bahrami Hospital affiliated to Tehran University from October 2011 to October 2012. Demographic data , ward ,gender ,mode of feeding ,gravidity, admission season and method of delivery related to the infants were recorded. For infants with a serum sodium above 150 meq/lit, additional information were collected, including serum urea level, gestational age, date of birth, birth weight, admission weight, head circumference and clinical symptoms. Fi-nally, the data were analyzed using the SPSS software. Results: 74 out of 1923 neonates had serum sodium above 150 meq per liter, which their mean Na was significantly associated with their age groups (P=0.04 and weight loss (P=0.008. Furthermore, the mean of urea in these neonates was significantly related to weight loss (P a few days after birth or to the non-exact weight at the birth time (risk factors. The study results confirmed that weighing the neonates at 72 to 96 hours after birth can prevent hypernatremia in infants. (Sci J Hamadan Univ Med Sci 2015; 22 (3: 203-209
Ingan Ukur Tarigan
Full Text Available Background: Health care for children under five year in Indonesia was still a problem that should be cope with. Infant mortality (IMR, maternal mortality (MMR, and the IMR in Indonesia, ware still ranked the highest in Southeast Asia. According Soemantri (2004, infant mortality reached 46 per 1000 live births during the period 1998-2002. According SKRT 2001, the highest cause for infant mortality was perinatal disturbances (34% and for neonatal mortality are premature and low birth weight babies (29% and birth asphyxia (27% (Soemantri S, et al: 2004. Baby's health is associated with several maternal factors during pregnancy and birth, infant factors, and environmental factors. The cause of death of a baby has two kinds, namely endogen and exogen. Endogen infant death or neonatal was death that happens at the first month after birth, and generally caused by factors that brought by the child since birth, obtained from the parents at the time of conception or during pregnancy. Exogen baby's death or post-neonatal mortality was happen after the age of one month until the age of one year that is affected by external environment. Obj ective: This analysis is to ascertam the probabtlity and detenninants related to the live endurance of neonatal infants. Methods: This research design was cross sectional, using data of Health Basic Research (Riskesdas 2007. Data analysis was conducted univariate, bivariate, and multivariate with the life table method, Kaplan Meier and Cox regression. Results: The analysis indicate that premature variables and barier have relationships with the live endurance of neonatal infants, where babies those are born premature have risk 1.4 times higher for death compared with infants those ware not born premature. For a baby that is born with barier haverisk 1.5 times higher for death compared with infants born without barier. Babies born premature and have barier have risk 2.02 times higher than babies born premature, and not
Gavilanes, A.; Heineman, E; Herpers, M.; Blanco, C; BURGE, D.
AIM—To evaluate the advantages, disadvantages, and short term morbidity and mortality of major surgical interventions performed in the neonatal intensive care unit. METHODS—A retrospective case review of 45 neonates was performed from April 1991 to September 1995. The characteristics of the patients were: gestational age 29 (SD 4) weeks (range 24 to 41 weeks); birthweight 1305 (870) g ( range 540 to 4040 g); presurgical weight 1430 (895) g ( range 550 to 4370 g); postconceptional age at surge...
A prospective survey of activity in neonatal nurseries associated with 17 specialist maternity units delivering some 38,700 babies in the Northern region was undertaken during 1991. Data were collected concerning the numbers of babies requiring various forms of neonatal care, using a nursing dependency scale validated by work study. Facilities for prolonged high dependency care are partially decentralised in the Northern region, with a network of five units operating on a flexible and collabo...
: Measurements of the entrance surface dose were performed for an additional group of 120 neonates, with varying birth weights, using calibrated TLD-100 dosimeters. During the entire hospitalization period, each neonate had two TLDs attached : one to its sternum and the other, at the parallel point on its back. Additionally, measurements of the doses the neonate was indirectly exposed to, due to its proximity to other neonates undergoing X-ray examinations, were also performed. Phase III: Data analysis was performed using mathematical simulation programs (Monte Carlo - MCNP code and PCXMC). The aim was to estimate the level of effective radiation dose the neonates are exposed to and their radiational lifetime risk due to this exposure. In addition, a data base was built containing coefficients for estimating equivalent and effective doses, corresponding to birth weight and other exposure parameters. Results: 1. on the average, a VLBW neonate undergoes 10.3 radiography procedures during the hospitalization period in the NICU and a BWMT (Birth Weight Quote That 1500 gr) neonate undergoes 3.1 of these procedures. 2. Out of all 499 radiographs taken in five different NICUs, none used a gonad shield. 3. The effective dose per one neonate during the entire hospitalization period, due to X-ray exposure was found to be: 0.67 mSv for VLBW neonates and 0.27 mSv for BWMT neonates. 4. According to the International Commission on Radiation Protection (ICRP) Report 60, the lifetime potential mortality as a result of neonates exposure to X-ray radiation is 0.15 neonates per year for VLBW neonates and 0.47 neonates per year, for BWMT neonates. 5. The lifetime cancer potential morbidity is 0.25 neonates per year for VLBW neonates and 0.78 neonates per year for BWMT neonates. 6. bout 50% of neonates' effective dose results from unnecessary exposure to X-ray radiation during examinations. Consequently, about 50% of the potential mortality and morbidity result from this unnecessary exposure. 7
Jayashree Purkayastha; Leslie Edward Lewis; Morakhia Jwalit V; Ranjan Shetty K; Muhammad Najih L
Fungal mycetoma or endocarditis is rare in premature neonates and it is often associated with high mortality. In the majority of the cases diagnosis is made postmortem. Here we report a 0-week-old preterm neonate who developed Candida albicans blood stream infection complicated by endocarditis and subsequent mycetoma. Initially, this neonate had Klebsiella sepsis requiring multiple antibiotic courses. A peripherally inserted central venous catheter was used to give total parenteral nutrit...
Shaffer, Thomas H.; Alapati, Deepthi; Greenspan, Jay S.; Wolfson, Marla R.
The introduction of assisted ventilation for neonatal pulmonary insufficiency has resulted in the successful treatment of many previously fatal diseases. During the past three decades, refinement of invasive mechanical ventilation techniques has dramatically improved survival of many high-risk neonates. However, as with many advances in medicine, while mortality has been reduced, morbidity has increased in the surviving high-risk neonate. In this regard, introduction of assisted ventilation h...
Larsen, Rikke W; Kiupel, Matti; Balzer, Hans-Jörg; Agerholm, Jørgen Steen
Background Canid herpesvirus-1 (CaHV-1) infection in puppies less than three weeks of age is often reported to be associated with a lethal generalized necrotizing inflammation and since the discovery of the virus in 1965 several reports of neonatal infections have been published. However, the significance of CaHV-1 for peri- and neonatal mortality in puppies remains unclear. Therefore, we examined stillborn and dead neonatal puppies in Denmark to determine the prevalence of infection and furt...
Samiya Nazeer Khan* and Siby Joseph
Neonatal sepsis is associated with increased mortality and morbidity including neurodevelopmental impairment and prolongation of hospital stay. Clinical features of sepsis are non-specific in neonates and a high index of suspicion is required for timely diagnosis. Antibiotics are a very important group of drugs for the sick neonate and have undoubtedly played a role in their improved survival. But they come with a set of risks like other drugs used in critical care which must be carefully con...
Reinhardt, Timothy A.; Nonnecke, Brian J.; Palmer, Mitchell V.; Lippolis, John D.; Jodi L McGill; Sacco, Randy E.
Respiratory syncytial virus (RSV) is the most common viral cause of childhood acute lower respiratory tract infections. It is estimated that RSV infections result in more than 100,000 deaths annually worldwide. Bovine RSV is a cause of enzootic pneumonia in young dairy calves and summer pneumonia in nursing beef calves. Furthermore, bovine RSV plays a significant role in bovine respiratory disease complex, the most prevalent cause of morbidity and mortality among feedlot cattle. Infection of ...
Full Text Available Background The use of bovine in vitro embryo production (IVP increases the reproductive potential of genetically superior cows, enabling a larger scale of embryo production when compared with other biotechnologies. However, deleterious effects such as abnormal fetal growth, longer gestation period, increased birth weight, abortion, preterm birth and higher rates of neonatal mortality have been attributed to IVP. The aim of this study was to compare the influence of in vitro embryo production and artificial insemination (AI on gestation length, complications with birth, birth weight, method of feeding colostrum, passive transfer of immunity, morbidity-mortality, and performance in Brahman calves. Results Whilst gestation length and birth weight were significantly increased in IVP-derived calves, no difference in weaning weight was observed between groups. The passive transfer of immunity (PT, was assessed in IVP (n = 80 and AI (n = 20 groups 24 hours after birth by determination of gamma-glutamyl transferase (GGT and gammaglobulin activity as well as by quantification of the concentration of total protein in serum. No differences in passive transfer or incidences of dystocia and diseases at weaning were observed between groups. Birth weight, method of feeding colostrum and dystocia were not correlated with PT in either group. Conclusions In this study, in vitro embryo production did not affect the health status, development, or passive transfer of immunity in Brahman calves.
Perlman, Jeffrey; Kjaer, Klaus
An important goal of obstetric anesthesia is to provide for the safety and comfort of the mother as well as to optimize physiologic outcomes for the neonate. Markers of neonatal physiologic outcome include cord umbilical artery pH and Apgar scores. Neonatal temperature has often been overlooked by anesthesiologists as an important physiologic outcome measure, but it may be significantly affected by operating room conditions and obstetric anesthesia technique at cesarean delivery. There is a dose-dependent increase in mortality with decreasing body temperature as well as an increased likelihood for more severe early respiratory distress. Multiple neonate-focused strategies have been shown to decrease the incidence of neonatal hypothermia. Because fetal temperature is affected by maternal temperature, strategies to mitigate maternal hypothermia at the time of delivery may also be important in preventing neonatal hypothermia. This focused review will examine the importance of neonatal temperature and discuss its relationship to maternal temperature as well as strategies for maintaining neonatal normothermia after delivery. PMID:27314693
Al-Matary, Abdulrahman; Hussain, Mushtaq; Nahari, Ahmed; Ali, Jaffar
Summary Background: Neonatal diabetes is a rare cause of hyperglycemia, affecting 1: 500,000 births, with persistent hyperglycemia occurring in the first months of life lasting more than 2 weeks and requiring insulin. This condition in infants less than 6 months of age is considered as permanent neonatal diabetes mellitus. Case Report: A rare case of permanent neonatal diabetes mellitus presented with intrauterine growth retardation (IUGR; birth weight: 1460 grams; female), hyperglycemia, gly...
Rabah M. Shawky
Conclusion: IEM represent a high percent (32.5% of neonates who had sepsis like symptoms, and when diagnosed, patients showed marked improvement after therapy. IEM should be considered in differential diagnosis of the sick neonates, and investigations, and management should be started rapidly to decrease morbidity, and mortality till nationwide screen for IEM is applied in Egypt.
Congress of the U.S., Washington, DC. Office of Technology Assessment.
After a brief introduction delineating the scope of the case study, chapter 1 summarizes findings and conclusions about the costs and effectiveness of neonatal intensive care in the United States. Chapter 2 inventories the national supply of neonatal intensive care units and describes recent trends in use and costs. Chapter 3 reviews mortality and…
... JR, Isemann B, Ward LP, et al. Current management of neonatal abstinence syndrome secondary to ... MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of ...
Sharma, Deepak; Choudhary, Mukesh; Lamba, Mamta; Shastri, Sweta
OBJECTIVE The objective of this study is to determine the correlation of Apgar score with asphyxial hepatic injury and neonatal mortality in moderately and severely asphyxiated newborns. MATERIAL AND METHODS This is a secondary analysis of our prospective observational case-controlled study. Sixteen neonates with severe birth asphyxia (five-minute Apgar ≤3) were compared with either 54 moderate asphyxia neonates (five-minute Apgar >3) or 30 normal neonates. Liver function tests were measured ...
Dilys M. Walker; Holme, Francesca; Zelek, Sarah T.; Olvera-García, Marisela; Montoya-Rodríguez, Airaín; Fritz, Jimena; Fahey, Jenifer; Lamadrid-Figueroa, Héctor; Cohen, Susanna; Kestler, Edgar
Background Despite expanding access to institutional birth in Guatemala, maternal mortality remains largely unchanged over the last ten years. Enhancing the quality of emergency obstetric and neonatal care is one important strategy to decrease mortality. An innovative, low-tech, simulation-based team training program (PRONTO) aims to optimize care provided during obstetric and neonatal emergencies in low-resource settings. Methods We conducted PRONTO simulation training between July 2012 and ...
Frost Chris; Jayanty Chitra; Figueiredo Ryan; Mukherjee Rohini; Mendiratta Tarana; Eble Alexander; Mann Vera; Boone Peter; Padmanabh M Reddy; Elbourne Diana
Abstract Background The trial aims to evaluate whether neonatal mortality can be reduced through systemic changes to the provision and promotion of healthcare. Neonatal mortality rates in India are high compared to other low income countries, and there is a wide variation of rates across regions. There is evidence that relatively inexpensive interventions may be able to prevent up to 75% of these deaths. One area with a particularly high rate is Mahabubnagar District in Andhra Pradesh, where ...