Analysis of Causes of Neonatal Death in the United States with Specific Emphasis on Fatal Hyaline Membrane Disease

PEDIATRICS ◽  
1982 ◽  
Vol 70 (4) ◽  
pp. 570-575
Author(s):  
Robert H. Perelman ◽  
Philip M. Farrell
Keyword(s):  
Neonatal Mortality ◽  
Perinatal Asphyxia ◽  
Hyaline Membrane Disease ◽  
The United States ◽  
Mortality Statistics ◽  
Neonatal Deaths ◽  
Period 2 ◽  
National Mortality ◽  
Hyaline Membrane ◽  
Average Contribution

National mortality statistics for hyaline membrane disease (HMD) and the respiratory distress syndrome (RDS) and other major causalities were examined in this study for the years 1968 to 1978. A progressive reduction in total neonatal deaths began in 1971 such that only 56% as many newborn deaths occurred in 1978 as in 1968 (31,618 vs 66,456). In each of the 11 years surveyed, the majority of deaths occurred during the first four days of life, with more than half of the infants dying before 48 hours of age. HMD/RDS was the leading cause of death during nine of the 11 years analyzed, accounting for an average 19.5% of neonatal fatalities. Deaths associated with HMD/RDS increased for 1968 to 1971, plateaued, and progressively decreased in the ensuing years between 1974 and 1978. Thus, the percent of all neonatal deaths attributable to HMD/RDS increased from 14.7% in 1968 to a maximum of 21.3% in 1974, before declining to 17.5% in 1978. The average contribution of other major causes of death to overall neonatal mortality were: perinatal asphyxia, 13.4%; immaturity, 13.4%; and complications of pregnancy, 11.1%. These data indicate that: (1) despite the declining incidence of fatal HMD/RDS the disorder accounted for an increasing percent of total deaths through the later part of the 11-year period; (2) prevention and/or improved management of asphyxia made the most significant (29%) contribution to reduced neonatal mortality; (3) less change occurred in fatal complications of pregnancy, implying a continuing need for improved maternal/fetal care. Comparing national mortality statistics with those of Wisconsin suggests that further reduction in HMD/RDS death rates should be possible and could have a marked influence on national neonatal mortality statistics.

scholarly journals Neonatal outcome in new-borns admitted in NICU of tertiary care hospital in central India: a 5-year study

2018 ◽  
Vol 5 (4) ◽  
pp. 1364 ◽  
Author(s):  
Jyotsna Verma ◽  
Shweta Anand ◽  
Nawal Kapoor ◽  
Sharad Gedam ◽  
Umesh Patel
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Distress Syndrome ◽  
Perinatal Asphyxia ◽  
Hyaline Membrane Disease ◽  
Low Birth Weight Babies ◽  
Hyaline Membrane

Background: Neonatal mortality rate contributes significantly to under five mortality rates. Data obtained from pattern of admission and outcome may uncover various aspects and may contribute and help in managing resources, infrastructure, skilled hands for better outcome in future.Methods: This retrospective study was done on 1424 neonates who were admitted at LN Medical College and JK Hospital, Bhopal in neonatal intensive care unit (NICU) in the Department of Paediatrics from January 2013-December 2017.Results: 1424 newborns admitted within 24 hours of birth were included in the study. About 767 were male neonates, (Male: female1.16:1). The low birth weight babies were 54% in our study. Among the various causes of NICU admission, Respiratory distress was present in 555 (39%) of neonates, Respiratory distress syndrome (Hyaline membrane disease) being the most common cause of respiratory distress. Neonatal sepsis accounted for morbidity in 24% of neonates, with Klebsiella being the most common organism grown in the blood culture. The incidence of congenital anomalies was 2.5%. The neonatal mortality was found to be 11% in our study. Prematurity with Respiratory distress syndrome (Hyaline membrane disease) and perinatal asphyxia were the two most common causes of neonatal mortality in the study. Extremely low birth weight neonates had the highest case fatality rate in the study, which indicates the need to develop an efficient group of professionals in teaching hospitals who will provide highly specialized and focused care to this cohort of vulnerable neonates.Conclusions: Present study has shown respiratory distress, perinatal asphyxia, and sepsis as the predominant causes of neonatal morbidity. All three are preventable causes, and our health-care programs should be directed toward addressing the risk factors in the community responsible for the development of these three morbidities. The preterm and low birth weight babies had significantly high mortality even with standard intensive care; therefore, a strong and effective antenatal program with extensive coverage of all pregnant females specifically in outreach areas should be developed which will help in decreasing preterm deliveries and also lower the incidence of low birth weight babies.

Perverse Pluralism

PEDIATRICS ◽  
1977 ◽  
Vol 59 (4) ◽  
pp. 642-643
Author(s):  
Keyword(s):  
Hyaline Membrane Disease ◽  
The United States ◽  
Swine Flu ◽  
Focused Attention ◽  
Glucocorticoid Treatment ◽  
News Reports ◽  
Flu Vaccination ◽  
Hyaline Membrane ◽  
The Individual ◽  
Harmful Effects

Comments in two unrelated news reports recently focused attention on the issue of "acceptance" of medical innovations in the United States. A prominent authority opined1 (in reference to antepartum glucocorticoid treatment to prevent hyaline membrane disease), "...there is no way to answer every conceivable question about possible [harmful] effects in 10-50 years.... At what point do we, as physicians, make the decision that data are adequate to move from experimental to clinical use?" An apparent rejoinder2 appeared in comments on a completely different subject (the swine flu vaccination saga): "The experts say they are the only ones who can make the technical decisions and recommendations, but the emphasis on informed consent puts increased responsibility on the individual to accept or reject that advice....

scholarly journals Verbal autopsy of neonatal and infant deaths from Bhavnagar rural and comparison with recent data

2020 ◽  
Vol 8 (1) ◽  
pp. 351
Author(s):  
Rajesh B. Patel ◽  
Hinal A. Sinol ◽  
Sonal V. Jindal ◽  
Jayendra R. Gohil
Keyword(s):  
Verbal Autopsy ◽  
Vaginal Discharge ◽  
Neonatal Period ◽  
Perinatal Care ◽  
Neonatal Resuscitation ◽  
Birth Asphyxia ◽  
Hyaline Membrane Disease ◽  
Neonatal Deaths ◽  
Infant Deaths ◽  
Hyaline Membrane

Background: Infant deaths from Bhavnagar rural areas were studied by using a verbal autopsy tool.Methods: Community visit based retrospective study of Bhavnagar rural by WHO verbal autopsy questionnaire.Results: Of the 92 deaths analyzed, 59 % (early), 12% (late), and 29% were during the post neonatal period. Male deaths were 55 (60%). The most common immediate causes were infection (39%), birth asphyxia (23%), and hyaline membrane disease (15%). Underlying causes were: maternal illness with feeding problem (45%), prematurity (26%), meconium aspiration syndrome (9%), and congenital/genetic anomalies (10%). Infant and neonatal deaths were seen more with illiteracy of mother, age of mother (25-29 years), third parity, anemia, and vaginal discharge; and non-breastfed, low birth weight and preterm. Birth asphyxia and hyaline membrane disease were during early, and meningitis and pneumonia were after the neonatal period. Verbal autopsy was accurate in 18/23 (78%) of the facility-based deaths where the cause of death was available. Ethics approval was obtained.Conclusions: Reproductive health education to adolescent girls and mothers, regarding the treatment of fever, vaginal discharge; and breastfeeding counselling with vitamin B12 should be used as more infant deaths are associated with anemia of mother. Health workers should be skilled in neonatal resuscitation, prematurity management, and referral, after stabilization, identification of congenital anomaly, antenatal screening by USG, and neonatal metabolic screen. Recent 2018 data obtained from Bhavnagar District Health Authority shows that over a period of eight years, institutional deliveries have increased and home deliveries, early neonatal deaths, HMD, and septicemia have decreased. Perinatal care should be check-list based, monitored, and mentored.

scholarly journals Determinants of outcome in newborns with respiratory distress in Osogbo, Nigeria

2017 ◽  
Vol 5 (4) ◽  
pp. 1487 ◽  
Author(s):  
Olusegun J. Adebami ◽  
Victor I. Joel-Medewase ◽  
Efeturi Agelebe ◽  
Temitope O. Ayeni ◽  
Olamide V. Kayode ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Cardiopulmonary Arrest ◽  
Perinatal Asphyxia ◽  
Hyaline Membrane Disease ◽  
Descriptive Study ◽  
Inspiratory Stridor ◽  
Cross Sectional ◽  
Meconium Aspiration ◽  
Hyaline Membrane ◽  
Term Newborns

Background: Respiratory distress is one of the commonest presentations necessitating hospital admission in newborn unit. Regardless of the cause, if not recognized and managed quickly, respiratory distress can escalate to apnoea, respiratory failure, cardiopulmonary arrest and death.Methods: A cross-sectional and descriptive study of newborns with respiratory distress admitted into the SCBU of LAUTECH Teaching Hospital, Osogbo, Nigeria. Respiratory distress was diagnosed by grunting, inspiratory stridor, nasal flaring and tachypnea (more than 60 breaths per minute), retractions in the intercostal, subcostal, or supracostal spaces and cyanosis. At admission, every neonate had a complete physical examination.Results: Of 625 babies admitted, 384 (61.4%) were males while 241 (38.6%) were females and 164 (26.2%) had respiratory distress. Respiratory distress was commoner among the preterms than term newborns. c2 = 44.7, p = 0.001. Leading causes of respiratory distress among the preterms were hyaline membrane disease, septicaemia, while among the term babies were perinatal asphyxia, transient tachypnoea of newborn and meconium aspiration. Sixty (36.6%) of the 164 babies with respiratory distress died. While 40.2% of the preterms died mainly from causes like hyaline membrane disease and septicaemia, 31.3% of term babies died from causes like perinatal asphyxia and meconium aspiration. Mortality from hyaline membrane disease was 46.9%, while perinatal asphyxia and meconium aspiration accounted for 38.9% and 40.0% respectively.Conclusions: Respiratory distress is therefore, a very common neonatal problem and it causes death of more than third of those affected. Emphasis should be geared towards reduction of preterm delivery, control of asphyxia and neonatal sepsis in order to reduce neonatal mortality in our environment.

RETROLENTAL FIBROPLASIA: THE PEDIATRICIAN'S DILEMMA

PEDIATRICS ◽  
1971 ◽  
Vol 48 (4) ◽  
pp. 509-510
Author(s):  
A. Patz ◽  
V. Everett Kinsey
Keyword(s):  
Premature Infants ◽  
Oxygen Therapy ◽  
Hyaline Membrane Disease ◽  
The United States ◽  
Cooperative Study ◽  
Retrolental Fibroplasia ◽  
The World ◽  
Hyaline Membrane ◽  
Short Span ◽  
General Restriction

Retrolental fibroplasia (RLF), which was unknown prior to the early 1940's, was first identified in premature infants by Terry in 1942.1 Within the short span of approximately 10 years, RLF had become one of the major causes of blindness in children throughout the world. The incrimination of oxygen in the early 1950's was demonstrated conclusively in a cooperative study performed in the United States in 1953-54 and published in 1956.2 The results of this study led to the general restriction of oxygen therapy, and the incidence of RLF subsequently decreased dramatically. Avery and Oppenheimer3 in 1960 first reported that the mortality from hyaline membrane disease had increased in their nursery during the period of rigid curtailment of oxygen to prevent RLF.

Racial and Environmental Influences on Fetal Lung Maturation

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 790-795
Author(s):  
Samuel Ross ◽  
Richard L. Naeye
Keyword(s):  
South African ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
The United States ◽  
African Women ◽  
The South ◽  
Lung Maturation ◽  
The Us ◽  
Hyaline Membrane ◽  
Fetal Lung Maturation

Claims that fetal lung maturation is more rapid in blacks than in whites were investigated. Histologic measurements of lung maturation and the frequency of hyaline membrane disease were compared in four groups of neonates: 490 South African blacks, 841 Ethiopians, 767 US blacks, and 560 US whites. Lungs matured much more rapidly in the Ethiopian and more slowly in the South African than in the US fetuses. The rate of maturation was about the same in US blacks and whites. Hyaline membrane disease was more frequent in the South Africans and less frequent in the Ethiopians than in either US group. Environmental factors in the mother may explain some of these differences. Lungs matured more rapidly in the fetuses of cigarette smokers than in fetuses of nonsmokers. Half of the US mothers but almost none of the South African mothers smoked during pregnancy. The rate of lung maturation had an inverse correlation with maternal body weights. The South African women were heavier and the Ethiopians lighter than women in the United States.

scholarly journals Neonatal mortality in a district hospital setup

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Asim Khurshid ◽  
Junaid Rashid
Keyword(s):  
Neonatal Mortality ◽  
Cause Of Death ◽  
Neonatal Sepsis ◽  
District Hospital ◽  
Birth Asphyxia ◽  
Hyaline Membrane Disease ◽  
Meconium Aspiration Syndrome ◽  
The Third ◽  
Hyaline Membrane ◽  
Causes And Risk Factors

Objective: To evaluate the causes and risk factors of neonatal mortality, in a non-tertiary district hospital nursery. Study Design: Descriptive study. Place and duration of study: This study was carried out in the Neonatal Unit of Social Security Hospital Muzuffar Garh, Pakistan from 1st May 2004 to 30th April 2005. Patients and methods: All newborns admitted in the nursery during study period were counted and the expired ones were evaluated in detail for the cause of death. Results: A total of 410 neonates were admitted during study period, 53.65% were male and 46.35 females. 47.22% were admitted within 1st 24 hours of their life, and 61.66% within 72 hours of birth. 56.66% of the expired neonates were low birth weight. Neonatal sepsis being the commonest cause of death (44%), 35% being of EOS and 65% cases of LOS. 2"d commonest cause of neonatal death was birth asphyxia (22%) and the third commonest cause was prematurity (19%) with its complications. Other causes of neonatal mortality were neonatal jau ndice (2.77%), meconium aspiration syndrome (1.66%), hyaline membrane `disease (6.66%), neural tube defects (1.11%) and congenital heart disease (1.66%). Many babies had more than one of the above said causes. Conclusion: Neonatal sepsis, birth asphyxia and prematurity are the major killers in nurseries.

scholarly journals Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mandira D. Kawakami ◽  
Adriana Sanudo ◽  
Mônica L. P. Teixeira ◽  
Solange Andreoni ◽  
Josiane Q. X. de Castro ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Gestational Age ◽  
Perinatal Asphyxia ◽  
Population Based ◽  
Sao Paulo ◽  
São Paulo ◽  
Middle Income ◽  
Neonatal Deaths ◽  
Paulo State ◽  
São Paulo State

Abstract Background It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. Methods Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. Results Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks. Conclusions There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.

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