A study of neonatal morbidity and mortality in government general hospital, Srikakulam Andhra Pradesh, India

Background: Four million newborn babies die in the neonatal period, India 1.2 million neonatal deaths every year. India contributes for a quarter of global neonatal deaths and thus faces the biggest newborn health challenge of any country in the world. The aims of the study were done with the objective to conclude the morbidity and mortality pattern of neonates admitted to a neonatal intensive care unit (NICU).Methods: Hospital based prospective study was conducted at NICU Government Medical Collage, Srikakulam, Andhra Pradesh, India. Neonates from admission to discharge flowed, LAMA or death collecting the data by using a predesigned standardized preform.Results: Neonates were admitted in the NICU during period April 2014 to March 2019. The data analysis for the morbidity showed that the neonatal jaundice (NNJ) were 765(10.57%) , septicemia were 1110 (15.34%), prematurity were 593 (8.19%), birth asphyxia were 963 (13.30%), respiratory distress syndrome (RDS) were 184 (2.54%),hypoxic ischemic encephalopathy (HIE) were 984 (8.46%), meconium aspiration syndrome (MAS)were 612 (8.46%),transient tachypnea of neonate (TTN) were 634 (8.76%), low birth weight (LBW) were 418 (5.77%), intra uterine growth retardation (IUGR) were 179 (2.47%), congenital anomalies were 131 (1.81%), meningitis were 83 (1.15%), seizure disorder were 49 (0.68%) and others. The disease wise mortality among the neonates admitted to NICU was studied and were found that prematurity 212 (35.75%), septicemia were 74 (6.67%), birth asphyxia were 91 (21.70%), meconium aspiration syndrome were 70 (11.44%) and respiratory distress syndrome were 66 (35.87%), low birth weight were 102 (24.40%) congenital anomalies were 31 (23.66%) the top major contributors to the neonatal mortality.Conclusions: The commonest causes of admission were neonatal jaundice (NNJ), sepsis, prematurity, meconium aspiration syndrome, birth asphyxia, low birth weight, congenital anomalies. The most common cause of case fatality was prematurity, meconium aspiration syndrome, birth asphyxia, low birth weight, congenital anomalies in NICU in a tertiary care teaching hospital, government medical college, Srikakulam, Andhra Pradesh, India.

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An Analysis of Five years Neonatal Mortality in NICU of a Tertiary Care Hospital of Rawalpindi 2014-2019

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i4.1394 ◽

2020 ◽

Vol 24 (4) ◽

pp. 328-333

Author(s):

Rai Muhammad Asghar ◽

Muddasir Sharif ◽

Khalid Saheel ◽

Rai Rijjal Ashraf ◽

Abid Hussain

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Neonatal Mortality ◽

Neonatal Jaundice ◽

Tertiary Care ◽

Birth Asphyxia ◽

Meconium Aspiration Syndrome ◽

Care Hospital ◽

Female Ratio ◽

Meconium Aspiration

Objective: This study was done to find out the main causes and magnitude of neonatal mortality in the neonatal intensive care unit (NICU) of Benazir Bhutto Hospital, Rawalpindi over a period of five years.Material and Methods: A hospital-based cross-sectional study was done from June 2014 to July 2019. The registration book of admitted neonates was reviewed by using a checklist to collect data. Data was analyzed in SPSS 24 for descriptive and bi-variate analysis applying the chi-square test and presented in text, frequencies, tables, and percentages.Results: The study assessed a total of 24,459 neonates admitted to the NICU at Benazir Bhutto Hospital over a span of five years (June 2014 to July 2019). The mean birth weight was 2432 grams ± 740 g (range: Between 800 and 6000 g). Male neonates accounted for 59.8% with male to female ratio of 1.5:1. 67.5% male neonates and 32.5% female neonates expired. Overall 19,832 neonates (81.1%) were discharged, while 4636 (18.9%) died, making a Neonatal Mortality Rate of 18.9% (189 per 1000 admissions). 86.21% of these deaths were early neonatal that occurred in the first week of life. The causes of death were pre-maturity/ low birth weight (LBW), suspected sepsis, birth asphyxia, neonatal jaundice, and meconium aspiration syndrome, accounting for 32%, 31%, 30%, 4%, and 3% respectively.Conclusion: In our NICU the neonatal mortality is high with prematurity/low birth weight (LBW), birth asphyxia (BA), neonatal jaundice (NNJ), and meconium aspiration syndrome (MAS) accounting for most of the deaths. These deaths are largely preventable with better antenatal, perinatal, and neonatal care.

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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

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180529 ◽

2018 ◽

Vol 5 (2) ◽

pp. 427 ◽

Cited By ~ 1

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.

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Morbidity and mortality of low birth weight babies in early neonatal period in a rural area teaching hospital, Telangana, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192759 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1582

Author(s):

Jayalakshmi Pabbati ◽

Preethi Subramanian ◽

Mahesh Renikuntla

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Respiratory Distress ◽

Gestational Age ◽

Neonatal Period ◽

Birth Asphyxia ◽

Morbidity And Mortality ◽

Neonatal Deaths ◽

Early Neonatal Period ◽

Preterm Babies

Background: A baby’s weight at birth is a strong indicator of newborn health and nutrition. Low birth weight (LBW) babies are more susceptible to morbidities and mortality in early neonatal period than normal birth weight (NBW) babies. Among neonatal deaths, 80% occurs in LBW / preterm babies and 75% of total neonatal deaths occur in early neonatal period. The present study was undertaken to know the incidence and early neonatal outcome of LBW babies in rural area.Methods: Prospective observational study was conducted in babies born with <2.5 kg (LBW) birth weight.Results: The incidence of LBW babies was 25.07% with almost an equal contribution from preterm (50.46%) and Term Intra Uterine Growth Restricted (IUGR) (49.53%) babies. The most common morbidity found in LBW babies was Jaundice (40.09%) followed by respiratory distress (18.16%), sepsis (8.72%) and apnea (4.48%). Preterm-LBW babies had more morbidities in terms of apnea (100%), birth asphyxia (88.88%), respiratory distress (87.01%%), sepsis (80.55%) and jaundice (67.64%). Early neonatal mortality was 21.22 per 1000 live births. Mortality was 100% for babies <1 kg in birth weight, 16% in 1-1.499 kg group and 0.75% in 1.5-2.499 kg group in early neonatal period. According to gestational age, mortality in preterm-LBW babies was 88.88% and 11.11% in Term IUGR-LBW babies. The most common cause of death in LBW babies was birth asphyxia (44.44%) followed by hyaline membrane disease (HMD) (33.33%).Conclusions: The present study revealed that preterm babies contributed 50% to incidence of LBW babies. Morbidity and mortality in LBW babies were inversely related to birth weight and gestational age.

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Infection remains a leading cause of neonatal mortality among infants delivered at a tertiary hospital in Karachi, Pakistan

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3569 ◽

2014 ◽

Vol 8 (11) ◽

pp. 1470-1475 ◽

Cited By ~ 3

Author(s):

Muhammad Ayaz Mustufa ◽

Razia Korejo ◽

Anjum Shahid ◽

Sadia Nasim

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Neonatal Mortality ◽

Distress Syndrome ◽

Very Low Birth Weight ◽

Neonatal Period ◽

Healthcare Facility ◽

Normal Birth Weight ◽

Neonatal Deaths ◽

Normal Birth

Introduction: The current cohort study was conducted to determine the frequency and compare the mortality rate with associated characteristics among low birth weight and normal birth weight infants during the neonatal period at a tertiary healthcare facility, Karachi. Methodology: Close-ended structured questionnaires were used to collect information from the parents of 500 registered neonates at the time of birth. Follow-ups by phone on the 28th day of life were done to determine the mortality among low birth weight and normal birth weight babies during the neonatal period. Results: The neonatal mortality rate ranged from as low as 2.4% in the normal birth weight and 16.4% in the low birth weight categories to as high as 96% in the very low birth weight category. Respiratory distress syndrome (24.2%) and sepsis (18.2%) were reported as the leading causes of neonatal deaths. The babies’ lengths of stay ranged from 2 to 24 hours, and around 90% of neonatal deaths were reported in the first seven days of life. More than 6% of neonates died at home, and 7.6% of the deceased babies did not visit any healthcare facility or doctor before their death. In the 12–15 hours before their deaths, 13.6% of the deceased babies had been unattended. Around 90% of the deceased babies were referred from a doctor or healthcare facility. Conclusions: The present estimates of neonatal mortality are very high among low birth weight and very low birth weight categories. Infectious diseases, including respiratory distress syndrome (24.2%) and sepsis (18.2%), were leading causes of neonatal deaths.

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Postnatal causes and severity of persistent pulmonary Hypertension of Newborn

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.5.2218 ◽

2021 ◽

Vol 37 (5) ◽

Author(s):

Muhammad Sohail Arshad ◽

Mudasser Adnan ◽

Hafiz Muhammad Anwar-ul-Haq ◽

Arif Zulqarnain

Keyword(s):

Pulmonary Hypertension ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Gestational Age ◽

Distress Syndrome ◽

Birth Asphyxia ◽

Meconium Aspiration Syndrome ◽

Persistent Pulmonary Hypertension ◽

High Morbidity ◽

Meconium Aspiration

Background & Objective: Persistent pulmonary hypertension of the newborn (PPHN) is described as severe respiratory failure along with hypoxaemia. PPHN is known to be linked with high morbidity and mortality around the world. This study was planned to determine the postnatal causes and assess the severity of persistent pulmonary hypertension of newborn in babies presenting to the Children’s Hospital, Multan. Methods: This observational study was conducted at the Department of Paediatric Cardiology, The Children Hospital &Institute of Child Health, Multan, Pakistan from July to December 2019. A total of 122 confirmed cases of PPHN admitted having gestational age above 34 weeks were enrolled. Demographic data of the newborns was recorded along with maternal medical history, pregnancy status and postnatal causes of PPHN. Severity of PPHN was also recorded. Results: Out of a total of 122 cases of PPHN, 81 (66.3%) were male. Majority, 78 (64.0%) had gestational age above 37 weeks. Mode of delivery as cesarean section was noted in 70 (57.4%). Meconium aspiration syndrome 52 (42.6%), birth asphyxia 48 (39.3%), respiratory distress syndrome 23 (18.8%) and sepsis 33 (27.0%) were found to be the commonest causes of PPHN. Severe PPHN was found to be the most frequent, noted among 63 (51.6%) while Moderate PPHN was observed in 40 (32.8%) and Mild PPHN in 19 (15.6%). Morality was noted among 26 (21.3%) of cases. Conclusion: Meconium aspiration syndrome, birth asphyxia and respiratory distress syndrome were the commonest postnatal causes of PPHN. Severe PPHN was found to be the most frequent form of PPHN. doi: https://doi.org/10.12669/pjms.37.5.2218 How to cite this:Arshad MS, Adnan M, Anwar-ul-Haq HM, Zulqarnain A. Postnatal causes and severity of persistent pulmonary Hypertension of Newborn. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.2218 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Clinical profile of meconium aspiration syndrome in relation to birth weight and gestational age

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180981 ◽

2018 ◽

Vol 5 (3) ◽

pp. 726

Author(s):

Ravi Garg ◽

Rupesh Masand ◽

Chaman Ram Verma ◽

Girdhari Lal Sharma ◽

Suman Ankit Yadav

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Gestational Age ◽

Birth Asphyxia ◽

Meconium Aspiration Syndrome ◽

P Value ◽

Maternal Risk Factors ◽

Meconium Aspiration ◽

Maternal Risk ◽

The Mean

Background: Meconium aspiration syndrome (MAS) is commonly encountered entity in neonates delivered in rural health centres.Methods: A prospective observational study was conducted in 50 consecutive cases of MAS who were admitted in Level III NICU of the Department of Pediatrics of a tertiary care teaching hospital located 50 kms from Jaipur city amidst rural surroundings from 1st January 2016 to 31st July 2017. Appropriate statistical analysis was carried out using Medcalc statistical software (version 16.4).Results: Out of 3585 deliveries, prevalence of MSAF and MAS was 14% and 8.5% respectively. The M:F ratio of study subjects was 1.2:1.The maternal risk factors significantly associated with MAS were maternal anemia (p value-<0.001), maternal age >30 (p value-0.025) and unbooked pregnancies (p value-0.032). The mean birth weight was 2734±499gms. Majority of cases of MAS were seen in babies with birth weight between 2.5-3.5 kg (n=30, 60%).The mean gestational age was 38.6±2.4 weeks. 30 (60%) babies were delivered after completing 37-<40 weeks of gestation and 9 (18%) babies were of 40-<42 weeks of gestation. The common complications observed were exaggerated physiological hyperbilirubinemia (75%), birth asphyxia (50%) and septicaemia (27.08%). The commonest cause of mortality was birth asphyxia (57.14%) and pneumonia (42.8%).Conclusions: MAS is a cause of concern for the attending obstetrician and pediatrician as it is associated with life threatening complications and mortality. Efforts need to be invested in promotion of institutional antenatal care and institutional deliveries so that maternal risk factors can be identified and managed effectively, especially in rural areas.

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A prospective observational study of morbidity and mortality profile of neonates admitted in neonatal intensive care unit of secondary care centre in central Maharashtra, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182536 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1403

Author(s):

Hemant Adikane ◽

Kishor Surwase ◽

Vishal Pawar ◽

Kalidas Chaudhari

Keyword(s):

Intensive Care ◽

Birth Weight ◽

Low Birth Weight ◽

Observational Study ◽

Neonatal Intensive Care ◽

Birth Asphyxia ◽

Admission Rate ◽

Study Data ◽

Neonatal Deaths ◽

Low Birth Weight Babies

Background: Globally, 2.6 (2.5-2.8) million newborns died in 2016-i.e. nearly 7,000 every day. Neonatal deaths accounted for 46 % of all under-five deaths, increasing from 41 % in 2000. Five countries accounted for half of all newborn deaths including India. NFHS 4 data suggests that neonatal mortality rate (NMR) declined to 30 deaths per 1,000 live births.Methods: Present observational study was conducted at district hospital, Parbhani. Study period was Jan 2017 to Dec 2017. All the admitted babies to NICU were included into study. Data was collected by interview method using a predesigned, semi-structured questionnaire. Various morbidities and reasons for mortality were included.Results: There were total 2471 admission during year of 2017. There was slightly higher admission rate for Males 1432 (57.95%) than females 1039 (42.05%). Pre-term admissions were 501 (20.28%). Majority of admissions were due to low birth weight 1170 (47.35%).Conclusions: In the year of 2017, total 2472 NICU admissions took place. Out of these, 126 (5.09%) died. Respiratory distress syndrome, low birth weight, birth asphyxia were accounting for mortalities. The neonatal jaundice, preterm and low birth weight babies had significantly high mortality even with standard intensive care.

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TO STUDY THE CLINICAL PROFILE OF MECONIUM ASPIRATION SYNDROME (MAS) IN NEONATES IN RELATION TO BIRTH WEIGHT, GESTATIONALAGE AND THEIR IMMEDIATE OUTCOME

10.36106/ijsr/9726593 ◽

2021 ◽

pp. 1-4

Author(s):

Mithilesh Kumar ◽

R. K. Sinha ◽

Debarshi Jana

Keyword(s):

Birth Weight ◽

Respiratory Distress ◽

Gestational Age ◽

Apgar Score ◽

Birth Asphyxia ◽

Meconium Aspiration Syndrome ◽

Clinical Profile ◽

Term Infants ◽

Cross Sectional ◽

Meconium Aspiration

Study the clinical profile of meconium aspiration syndrome (MAS) in neonates, in relation to birth weight, gestational age and their immediate outcome. Prospective observational cross sectional study. All preterm, term and post term infants, appropriate for gestational age with birth weight, delivered normally or by caesarean section or forceps, fulfilling all the inclusion criteria for MAS who were admitted to NICU, during the 9 months from January 2020 to September 2020 were included in the study. Over nine months' period, 574 neonates were admitted in NICU under that 312 neonates were in respiratory distress, out of which78 neonates were suffered with MAS. A detailed antenatal and natal history was elicited. Complications during delivery and details of resuscitation at birth, was done wherever required. Endo-tracheal intubation was done and bag and tube ventilation was given wherever needed. In MAS neonates, APGAR score at 1 minute and 5 minutes and gestational age was assessed with New Ballard’s score. A detailed clinical examination was carried out and respiratory distress was monitored by using Downes score system. Score > 6 was taken as an indication for assisted ventilation. 574 babies were admitted to NICU during the study period and out of them 312 were with respiratory distress. During the study period 78 (25%) babies had MAS. Conservative management was given to 59 cases (75.64%) and only 19 cases (24.36%) needed artificial ventilation, where indication was birth asphyxia, acute respiratory failure or other complications like pneumothorax. Out of 19 ventilated babies, 15 babies died and 4 babies survived and were discharged in good health. Conclusions: 1.Increased incidence of meconium aspiration syndrome was associated with increase in the gestational age (more in term and post term neonate, birth weight > 2.5kgs, 2. Highest mortality was associated with thick meconium and with low APGAR score at 5 minutes.

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Causes of Preterm and Low Birth Weight Neonatal Mortality in a Rural Community in Kenya: Evidence From Verbal and Social Autopsy

10.21203/rs.3.rs-76613/v1 ◽

2020 ◽

Author(s):

Beatrice Olack ◽

Nicole Santos ◽

Mary Inziani ◽

Vincent Moshi ◽

Polycarp Oyoo ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Neonatal Mortality ◽

Distress Syndrome ◽

Neonatal Period ◽

Preterm Neonates ◽

Neonatal Deaths ◽

Social Autopsy

Abstract BackgroundUnder-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study.MethodsThis was a cross sectional study whereby Verbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10). ResultsBetween January 2017 to December 2018, 3175 babies were born preterm or LBW, and 162 (5.1%) died in the first 28 days of life in 17 participating health facilities in the PTBI-K project. VASA was conducted among 88 (53.7%) neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 hours of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths. ConclusionDeaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced intrapartum and immediate postpartum care interventions targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.

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Causes of preterm and low birth weight neonatal mortality in a rural community in Kenya: evidence from verbal and social autopsy

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04012-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Beatrice Olack ◽

Nicole Santos ◽

Mary Inziani ◽

Vincent Moshi ◽

Polycarp Oyoo ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Neonatal Mortality ◽

Distress Syndrome ◽

Neonatal Period ◽

Preterm Neonates ◽

Neonatal Deaths ◽

Social Autopsy

Abstract Background Under-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study. Methods Verbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10). Results Between January 2017 to December 2018, 3175 babies were born preterm or LBW, and 164 (5.1%) died in the first 28 days of life. VASA was conducted among 88 (53.7%) of the neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 h of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths. Conclusion Deaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced implementation of existing facility-based intrapartum and immediate postpartum care interventions, targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.

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