Neonatal Mortality: Effects of Selective Pediatric Interventions

PEDIATRICS ◽  
1985 ◽  
Vol 75 (1) ◽  
pp. 51-57
Author(s):  
Adekunle H. Dawodu ◽  
Charles E. Effiong
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Mortality ◽  
Current Knowledge ◽  
Perinatal Asphyxia ◽  
Birth Asphyxia ◽  
Case Fatality ◽  
Therapeutic Interventions ◽  
Low Birth Weight Infants ◽  
College Hospital

A previous prospective study of neonatal mortality in babies receiving special care at the University College Hospital, Ibadan, revealed that respiratory failure associated with prematurity, perinatal asphyxia, sepsis, and congenital malformations were the major causes of high neonatal mortality. To improve survival, selective measures were taken to improve care of low-birth-weight infants and prevent or treat intrapartum and postnatal hypoxia, metabolic acidosis, hypoglycemia, and hypothermia. A change in the initial antibiotic management of suspected septicemia to the use of cloxacillin and an aminoglycoside was also introduced, based on the current knowledge of etiologic agents and their antimicrobial sensitivities. In the 5-year period (1976 to 1980), the neonatal mortality in babies weighing 2,500 g and more at birth dropped significantly from 1.2% to 0.7% (P < .02). The case fatality rates from birth asphyxia and neonatal sepsis dropped by 48% and 32%, respectively. Despite therapeutic interventions, however, the neonatal mortality in babies with birth weight of 1,000 g or less, 1,001 to 1,500 g, 1,501 to 2,000 g, and 2,001 to 2,499 g remained unchanged at about 82%, 25%, 9%, and 3%, respectively. These results suggest that early identification of infants at risk of developing birth asphyxia or neonatal septicemia and institution of prompt and appropriate management could produce a significant reduction in mortality in infants of normal birth weight. Survival of low-birth-weight infants requires additional high technical, financial, and manpower resources, which most centers in developing countries cannot afford at the present time. Therefore, efforts are probably better concentrated on decreasing the incidence of low birth weight.

scholarly journals Neonatal Mortality in Yogyakarta Rural Areas

2019 ◽  
Vol 28 (5-6) ◽  
pp. 97-104 ◽  
Author(s):  
Achmad Surjono
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Mortality ◽  
Rural Areas ◽  
Traditional Birth Attendant ◽  
Birth Asphyxia ◽  
Health Service Delivery ◽  
Traditional Birth Attendants ◽  
Low Birth Weight Infants ◽  
Birth Attendants

The outcome of neonatal care was studied in three subdistricts rural areas in Yogyakarta Province with a total population of 112075 people. For data collection all pregnancies and deliveries between May 1983 -April 1984 were registered and visited twice during pregnancy, on delivery, 5 days and one month afterwards by trained health cadres. There were 1819 singleton liveborn infants with a neonatal mortality rate of 25.3 o/oo, in which 82.6% of the deaths occurred in the early neonatal period. An amount of 91.5% of the women delivered in their own house and 83.9% were assisted by a traditional birth attendant either trained or untrained. There was still 27.1% of pregnancies which never got any antenatal care. The coverage of tetanus immunization was 75.2% with 1.1 o/oo incidence of tetanus. The incidence of low birth weight infants was 8.1%, of which 19. 7% died before one month of age, I representing 63% of neonatal mortality. The causes of neonatal deaths were as follows: birth asphyxia and hypoxia 56.5%, prematurity/low birth weight 13%, infection/sepsis 13%, diarrhea 8. 7%, tetanus neonatorum 4.4% and others/unknown 4.4%. In rural areas, traditional birth attendants play a key role on assisting labour and taking care of the mothers as well as their newborns up to one month of age. Improvement of health service delivery at all levels of the health care system which includes the traditional birth attendants is needed especially concerning resuscitation of the newborns and the problems of low birthweights.

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.

scholarly journals A profile on the spectrum of neonatal mortality and morbidity pattern of extramural neonates in the Specialised Neonatal Care Unit (SNCU) in a tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 427 ◽  
Author(s):  
Anuradha D. ◽  
Rajesh Kumar S. ◽  
Aravind M. A. ◽  
Jayakumar M. ◽  
J. Ganesh J.
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Low Birthweight ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Care Hospital ◽  
Neonatal Deaths

Background: Every year, nearly four million newborn babies die in the first month of life. India carries the single largest share (around 25-30%) of neonatal deaths in the world. Neonatal deaths constitute two thirds of infant deaths in India. 45% of the deaths occur within the first two days of life. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively at the appropriate time. It was further estimated that health facility-based interventions can reduce neonatal mortality by 23-50% in different settings. Facility-based newborn care, thus, has a significant potential for improving the survival of newborns in India. This research has been planned with an aim to study the profile of pattern of admissions in a SNCU and their outcomes following admission and management in the unit.Methods: All babies referred for neonatal problems (less than 28 days) and admitted in NICU will be included. Both term and preterm babies will be considered. The criteria for admission includes various causes like low birth weight, preterm, birth asphyxia, respiratory distress, hyperbilirubinemia, congenital anomalies, risk factors (maternal, neonatal, prenatal), infections and outcome will be analysed.Results: Among the 2927 admissions term babies and boys outnumbered. The common causes for admission were birth asphyxia, respiratory distress, low birthweight and preterm. Most babies had an uncomplicated stay. The mortality in the extramural neonates was due to neonatal sepsis, extreme preterm and congenital malformations.Conclusions: Intensive and interventional management, along with good neonatal monitoring and care can reduce the mortality and improve the survival of low birth weight babies and other treatable problems. Thus, a combined effort of management by pediatricians, nursing care, neonatal intensive care unit can improve the survival rates of neonates.

PREMATURITY AND CP: A COMMON CAUSE?

PEDIATRICS ◽  
1994 ◽  
Vol 93 (1) ◽  
pp. A72-A72
Keyword(s):  
Cerebral Palsy ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Perinatal Asphyxia ◽  
Perinatal Care ◽  
Developed Countries ◽  
Low Birth Weight Infants ◽  
Common Cause ◽  
Improvement In Survival

. . .cerebral palsy rates in infants with birth weights under 1500 g increased from 12.1 to 64.9 [per 1000 births]. These results, which are similar to those found in other developed countries, suggest that improved perinatal care, including increased use of interventions to prevent perinatal asphyxia, has improved neonatal survival but not the rate of cerebral palsy. In low-birth-weight infants the rising cerebral palsy rate has paralleled the improvement in survival; one explanation for this finding is that low birth weight and cerebral palsy both result from an insult that occurs well before birth.

MID-ARM CIRCUMFERENCE AT BIRTH AS PREDICTOR OF LOW BIRTH WEIGHT AND NEONATAL MORTALITY

2000 ◽  
Vol 32 (4) ◽  
pp. 487-493 ◽  
Author(s):  
FARID UDDIN AHMED ◽  
ENAMUL KARIM ◽  
SYEDA NURJAHAN BHUIYAN
Keyword(s):  
Developing Countries ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Mortality ◽  
Neonatal Outcome ◽  
College Hospital ◽  
Medical Practitioners ◽  
Neonatal Deaths ◽  
Medical College ◽  
Arm Circumference

In Bangladesh, like other developing countries, most births occur at home or in the community, so logistic problems and taboos prevent the weighing of every newborn child. This study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight. A total of 1676 live births at the Chittagong Medical College Hospital constituted the study sample, and this showed a high correlation between mid-arm circumference and birth weight (r=0.792, p<0·000). A mid-arm circumference of <9·0 cm had the best sensitivity and specificity for identifying newborns with a birth weight of less than 2500 g. These neonates were followed up to record neonatal deaths. Neonatal mortality showed an inverse relation with mid-arm circumference. A mid-arm circumference of <9·0 cm and a birth weight of <2500 g were equally useful in predicting neonatal outcome. Mid-arm circumference is a simple, quick and reliable indicator for predicting low birth weight and neonatal outcome, and can be easily measured by medical practitioners and traditional birth attendants (TBAs) in the community of developing countries like Bangladesh.

Newborn Intensive Care and Neonatal Mortality in Low-Birth-Weight Infants

1982 ◽  
Vol 307 (3) ◽  
pp. 149-155 ◽  
Author(s):  
Nigel Paneth ◽  
John L. Kiely ◽  
Sylvan Wallenstein ◽  
Michele Marcus ◽  
Jean Pakter ◽  
...  
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Mortality ◽  
Low Birth Weight Infants ◽  
Newborn Intensive Care

scholarly journals Trends in Neonatal Mortality at a Tertiary Level Teaching Hospital

2013 ◽  
Vol 33 (3) ◽  
pp. 213-217
Author(s):  
Srijana Basnet ◽  
Laxman Shrestha
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Teaching Hospital ◽  
Distress Syndrome ◽  
Linear Trend ◽  
Perinatal Asphyxia ◽  
Live Births

Introduction: Neonatal services at Tribhuvan University Teaching hospital (TUTH) was essentially up to level II till year 2008 and upgraded to level III care in later years. A 4 years retrospective study was carried out at TUTH, Kathmandu, Nepal to determine any change in the trend of neonatal mortality after the improvement in its services. Materials and Methods: Labor room record book, neonatal record book, perinatal audit data and neonatal record charts were used to collect the data. Results: During the study period, there were total of 15063 live births. The neonatal mortality ranges from 9.46 to 14.88 per 1000 live births per year. There was no significant fall in trend of neonatal mortality (x2 for linear trend=1.40, p=0.23). There was also no significant fall in trend in perinatal mortality rates over this period (x2 for linear trend=1.92, p=0.16).The number of neonates referred to other hospitals has been significantly reduced by 61%.(x2 for linear trend=33.18, p<0.001). Majority of the neonatal deaths (72%) occurred within first 7 days of life and more than a third (39%) died within the first 24 hours of life. Respiratory distress syndrome, perinatal asphyxia and neonatal sepsis were three major causes of death. Deaths due to respiratory distress and perinatal asphyxia has not changed significantly over the years (p=0.4 and 0.25 respectively). Incidence of low birth weight ranges from 10.8 – 16.1% of total live births. 63% of neonatal mortality occurred in low birth weight babies. This trend has not changed in over the years (x2=1.03, p=0.31). Conclusion: With the improvement in the services, though neonatal mortality remained unchanged, referral rates and mortality due to respiratory distress syndrome of prematurity has decreased. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8957   J. Nepal Paediatr. Soc. 2013;33(3):213-217

scholarly journals Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study

2020 ◽  
Author(s):  
Jihyun Noh ◽  
Chae Young Kim ◽  
Euiseok Jung ◽  
Joo Hoon Lee ◽  
Young-Seo Park ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Birth Weight ◽  
Mortality Rate ◽  
Low Birth Weight ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Asphyxia ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants

Abstract Background: Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI). This study aimed to evaluate the clinical characteristics and outcomes of ELBW infants with AKI treated with PD.Methods: In this retrospective cohort study, the medical records of ELBW infants with AKI, who underwent PD from January 2008 to February 2018, were reviewed. A PD catheter (7.5–9.0 Fr) or central venous catheter (4 Fr) was used for the peritoneal access. Treatment with PD solutions (2.5 or 4.25%) was started at 10 mL/kg, which was increased to 20–30 mL/kg for 60–120 min/cycle continuing for 24 hours.Results: Twelve ELBW infants (seven male and five female infants) were treated, and their mean gestational age and birth weight were 27.2 (±3.3) weeks and 706.5 (±220.5) g, respectively. Two patients had severe perinatal asphyxia (5-min Apgar score ≤ 3). The most important indication for starting PD was AKI due to sepsis. The average duration of PD was 9.4 (± 7.7) days. The potassium levels in the ELBW infants with hyperkalemia decreased from 6.8 to 5.0 mg/mL after 9.3 (± 4.4) days. The most common complication of PD was mechanical dysfunction of the catheters, such as dialysate leakage (75 %). Two patients were successful weaned off PD. The mortality rate of the infants treated with PD was 91.7 %.Conclusions: The mortality rate of ELBW infants with AKI treated with PD is quite high because their organ system is not completely developed. Therefore, the use of PD should be carefully considered for the treatment of ELBW infants with AKI in terms of decisions regarding resuscitation.

scholarly journals Effect of Peritoneal Dialysis on Extremely Low Birth Weight Infants: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Jihyun Noh ◽  
Chae Young Kim ◽  
Euiseok Jung ◽  
Joo Hoon Lee ◽  
Young-Seo Park ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Birth Weight ◽  
Mortality Rate ◽  
Low Birth Weight ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Asphyxia ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants

Abstract Background: Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI). This study aimed to evaluate the clinical characteristics and outcomes of ELBW infants with AKI treated with PD.Methods: In this retrospective cohort study, the medical records of ELBW infants with AKI, who underwent PD from January 2008 to February 2018, were reviewed. A PD catheter (7.5–9.0 Fr) or central venous catheter (4 Fr) was used for the peritoneal access. Treatment with PD solutions (2.5 or 4.25%) was started at 10 mL/kg, which was increased to 20–30 mL/kg for 60–120 min/cycle continuing for 24 hours.Results: Twelve ELBW infants (seven male and five female infants) were treated, and their mean gestational age and birth weight were 27.2 (±3.3) weeks and 706.5 (±220.5) g, respectively. There were two patients who had severe perinatal asphyxia (5-min Apgar score ≤3). The most important indication for starting PD was AKI due to sepsis. The average duration of PD was 9.4 (±7.7) days. The potassium levels in the ELBW infants with hyperkalemia decreased from 6.8 to 5.0 mg/mL after 9.3 (±4.4) days. The most common complication of PD was mechanical dysfunction of the catheters, such as dialysate leakage (75%). Two patients were successful weaned off PD. The mortality rate of the infants treated with PD was 91.7%.Conclusions: The mortality rate of ELBW infants with AKI treated with PD is quite high because their organ system is not completely developed. Therefore, the use of PD should be carefully considered for the treatment of ELBW infants with AKI.

Favorable Results of Neonatal Intensive Care for Very Low-Birth-Weight Infants

PEDIATRICS ◽  
1982 ◽  
Vol 69 (5) ◽  
pp. 621-625
Author(s):  
Ronald S. Cohen ◽  
David K. Stevenson ◽  
Natalie Malachowski ◽  
Ronald L. Ariagno ◽  
Keith J. Kimble ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Mortality ◽  
Very Low Birth Weight ◽  
Ventilatory Support ◽  
University Hospital ◽  
High Risk Infant ◽  
Low Birth Weight Infants

From 1961 to 1976, 229 infants with birth weights ranging from 751 to 1,000 gm were admitted to the Stanford University Hospital Intensive Care Nursery. The overall neonatal mortality for these infants was 63% (144/229), and there were ten late deaths. Before 1967, no infant in this group who required mechanical ventilation survived; therafter, 30% (34/114) of the ventilated patients survived. Of the 75 long-term survivors 60 participated in a high-risk infant follow-up program; these included 23 infants who had received mechanical ventilation. The mean birth weight of these infants was 928 ± 67 (SD) gm. Seventeen children (28%) had significant morbidity: seven (12%) with severe handicaps and ten (17%) with moderate handicaps. During this same period, seven infants weighing less than 750 gm at birth were also observed. The three infants who had not required ventilatory support thrived; the other four infants had required respirators and were significantly handicapped. More recently, neonatal mortality for infants with birth weights from 751 to 1,000 gm has improved: for 1977 to 1980, it was 28% (33/118). Furthermore, neonatal mortality for ventilated infants in this weight group was 27% (26/95). These data indicate an improved prognosis for very low-birth-weight infants, even with ventilatory support.

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