International Comparisons of Fetal and Neonatal Mortality Rates in High-Income Countries: Should Exclusion Thresholds Be Based on Birth Weight or Gestational Age?

Abstract Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight < 1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight < 1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

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Neonatal Mortality Risk Related to Birth Weight and Gestational Age in British Columbia

Journal of Obstetrics and Gynaecology Canada ◽

10.1016/s1701-2163(16)32507-5 ◽

2007 ◽

Vol 29 (7) ◽

pp. 568-574 ◽

Cited By ~ 2

Author(s):

William J. Kierans ◽

Lorne A. Verhulst ◽

Jemal Mohamed ◽

Leslie T. Foster

Keyword(s):

British Columbia ◽

Birth Weight ◽

Neonatal Mortality ◽

Gestational Age ◽

Mortality Risk

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Neonatal Mortality Risk for the Eighties: The Importance of Birth Weight/Gestational Age Groups

PEDIATRICS ◽

10.1542/peds.68.1.122 ◽

1981 ◽

Vol 68 (1) ◽

pp. 122-130

Author(s):

Alistair G. S. Philip ◽

George A. Little ◽

Denise R. Polivy ◽

Jerold F. Lucey

Keyword(s):

Intensive Care ◽

Birth Weight ◽

Data Base ◽

Neonatal Mortality ◽

New Hampshire ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Age Groups ◽

Therapeutic Interventions ◽

The Sixties

Since 1976 a computerized data base has been used to store information on babies admitted to two intensive care nurseries serving the Vermont/New Hampshire region. The data base now allows reporting "neonatal" mortality by birth weight/gestational age (BW/GA) groupings for 1976-1979. For all BW/GA groups, except the most immature infants, there has been marked improvement compared to data gathered in the sixties (ie, mortality has decreased). These data are probably applicable to most other centers providing neonatal intensive care. The use of BW/GA categories provides the most reliable way of objectively comparing statistics from one center to another. Differences between two centers were observed when birth weight specific rates were used, but were largely abolished by using BW/GA groups. Data gathered in this way will be increasingly important for comparisons between centers and across years and when evaluating the effectiveness of new therapeutic interventions.

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Hypoglycaemia in the Newborn

PRILOZI ◽

10.1515/prilozi-2017-0025 ◽

2017 ◽

Vol 38 (2) ◽

pp. 79-84

Author(s):

Orhideja Stomnaroska ◽

Elizabeta Petkovska ◽

Sanja Ivanovska ◽

Snezana Jancevska ◽

Dragan Danilovski

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Neonatal Mortality ◽

Gestational Age ◽

Apgar Score ◽

Significant Positive Correlation ◽

High Birth Weight ◽

Neonatal Hypoglycaemia ◽

Maternal Risk ◽

Positive Correlation

Abstract Aim: Severe neonatal hypoglycaemia (HG) leads to neurologic damage, mental retardation, epilepsy, impaired cardiac performance and muscle weakness. The aim was to assess the frequency and severity of HG in a population of newborns. Patients and methods: We investigated 739 patients with neonatal hypoglycaemia (HG) (M:F=370:369) born at the University Clinic for Gynaecology and Obstetritics in Skopje in the period 2014-2016 and treated at the neonatal intensive care unit (NICU). 1416 babies were treated in the same period in NICU, and HG was observed in 52.18%. The birth weight was dominated by children with low birth weight: very low birth weight (VLBW)(<1500g) 253 children, (34,23%), low birth weight (1500-2500g) 402 (54.39%), appropriate for gestational age (AGA) 78(10.55%), and high birth weight (>4000g) 6 babies (0.81%). The gestational age was also dominated by children with low gestational age: gestational week (GW) 20-25 four children (0.54%), 26-30 GW 133 babies (17.99%), 31-35 GW472 (63.87%), and 36-40 GW130 neonates (17.59 %). 241 mothers (32.61%) have had an infection during pregnancy, 82 preeclampsia or eclampsia (11.09%), 20 diabetes mellitus (2.70%), 78 placental situations (placenta previa, abruption) (10.55%). In this study 47 babies (6.35%) with HG and co-morbidities died. There was a significant positive correlation between HG birth weight (p<0.01), gestational age (p<0.05), and the lowest Apgar score (p<0.01). Neonatal deaths were significantly correlated with GA (р>0,01), co-morbidities of the mothers (р>0,05) but not with the birth weight (р>0,05). In contrast, a significant positive correlation was found between convulsions and body weight (р<0.05). The lowest Apgar score was positively correlated with the gestational age (0.01), but not with the birth weight (0.05). Conclusion: Low birth weight, low gestational age, maternal risk factors, hypoxic-ischemic encephalopathy and neonatal infections are associated with HG and are a significant factor in overall neonatal mortality. Those results indicate that diminishing the frequency of the neonatal HG and the rates of neonatal mortality requires complex interaction of prenatal and postnatal interventions.

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Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2003.07.025 ◽

2004 ◽

Vol 190 (1) ◽

pp. 170-174 ◽

Cited By ~ 64

Author(s):

Isaac Blickstein ◽

Louis G Keith

Keyword(s):

Birth Weight ◽

Neonatal Mortality ◽

Mortality Rates ◽

Discordant Twins

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Competing Risk Analysis of the Health Status of Neonates with Respiratory Distress Syndrome

Journal of Biostatistics and Epidemiology ◽

10.18502/jbe.v6i2.4878 ◽

2020 ◽

Author(s):

Zenaw Ayele ◽

Mekonnen Tadesse ◽

Zelalem Tazu

Keyword(s):

Prognostic Factors ◽

Birth Weight ◽

Health Status ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Neonatal Mortality ◽

Preterm Infants ◽

Gestational Age ◽

Distress Syndrome ◽

Competing Risk

Introduction: Respiratory distress syndrome (RDS) is not only the most common respiratory disorder in premature infants but also the main cause of neonatal mortality. Methods: Competing risk framework was used to examine and identify potential prognostic factors of the health status of preterm infants with respiratory distress syndrome. Preterm infants with RDS admitted to the neonatal intensive care units (NICUs) of selected hospitals in Ethiopia were followed for 28 days and only neonates with complete cases were included in the analysis. The Fine-Gray or sub-distribution hazard model was used to identify significant prognostic factors. Three outcome variables (death due to RDS, death due to other causes and discharged alive) were considered. Results: The Fine-Gray model fit results revealed that anemia, multiple pregnancies, birth-weight and gestational age were the prognostic factors significantly associated with the death of neonates due to Respiratory distress syndrome problem while Pneumonia, meningitis, anemia and gestational age of neonates were the significant prognostic factors for death of neonates due to other causes. Moreover, pneumonia, birth weight and gestational age were identified as the prognostic factors associated with neonates being discharged alive. Conclusion: Offering intensive and adequate treatments for neonates with lowest birth-weights and gestational age may be useful to reduce neonatal mortality and increase the incidence of being discharged alive.

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