Decline in Perinatal Mortality in the United States, 2017–2019

This report presents trends in perinatal mortality, as well as its components, late fetal and early neonatal mortality, for 2017 through 2019. Also shown are perinatal mortality trends by mother’s age, race and Hispanic origin, and state for 2017–2019.

Antenatal Care Predicts Neonatal Mortality in Eastern Africa: A Systematic Review and Meta-analysis of Observational Studies

Background Sub-Saharan African countries, especially the Eastern region, present the dismal picture of neonatal mortality (NM) in the globe. The majority of these deaths could be avoided if effective health measures are provided throughout pregnancy and childbirth. Although antenatal care (ANC) is assumed as one of the viable interventions that contribute to neonatal survival, the effect of ANC on NM was not systematically analyzed in Eastern Africa. Thus, the study aimed to determine the pooled effect of ANC on NM in Eastern Africa. Methods PubMed, EMBASE, CINAHL, and HINARI databases were searched using appropriate keywords from January 1, 1990 to February 12, 2021. Independent authors selected eligible articles and extracted data. The risk of a bias assessment tool for nonrandomized studies was used to assess the quality of the study. Comprehensive meta-analysis version 2 was used for meta-analysis. The random-effect model was employed, and the outcome is expressed as a risk ratio with 95% confidence interval (CI). Results In total, 1149 studies were identified through database search, and only 27 studies were included in the meta-analysis. Having at least 1 ANC visit during pregnancy reduced the risk of neonatal death by 42% compared to their counterparts (RR = 0.58, 95% CI [0.47, 0.71]). The pooled prevalence of NM was 8.5% (95% CI [7.3, 9.6]), with NM rate of 46.3/1000 live births. Conclusion The study indicated that NM might be decreased even with a single ANC visit when compared to no visits. Scaling up ANC services through ANC promotion and tackling service-related barriers could potentially reduce NM in Eastern Africa.

Assessment of neonatal mortalities and stillbirths data quality in Offinso North District of Ghana

Background: Stillbirths and neonatal deaths when poorly documented or collated, negatively affect the quality of decision and interventions. This study sought to assess the quality of routine neonatal mortalities and stillbirth records in health facilities and propose interventions to improve the data quality gaps. Method: Descriptive cross-sectional study was employed. This study was carried out at three (3) purposively selected health facilities in Offinso North district. Stillbirths and neonatal deaths recorded in registers from 2015 to 2017, were recounted and compared with monthly aggregated data and District Health Information Management System 2 (DHIMS 2) data using a self-developed Excel Data Quality Assessment Tool (DQS). An observational checklist was used to collect primary data on completeness and availability. Accuracy ratio (verification factor), discrepancy rate, percentage availability and completeness of stillbirths and neonatal mortality data were computed using the DQS tool. Findings: The results showed high discrepancy rate of stillbirth data recorded in registers compared with monthly aggregated reports (12.5%), and monthly aggregated reports compared with DHIMS 2 (13.5%). Neonatal mortalities data were under-reported in monthly aggregated reports, but over-reported in DHIMS 2. Overall data completeness was about 84.6%, but only 68.5% of submitted reports were supervised by facility in-charges. Delivery and admission registers availability were 100% and 83.3% respectively. Conclusion: Quality of stillbirths and neonatal mortality data in the district is generally encouraging, but are not reliable for decision-making. Routine data quality audit is needed to reduce high discrepancies in stillbirth and neonatal mortality data in the district.

Survival and mortality of preterm neonates in a neonatal intensive care unit in Northern Ethiopia: a retrospective cohort study

The purpose of this study was to assess the predictors of preterm neonatal survival in a neonatal intensive care unit (NICU). A cohort study was conducted retrospectively on 1017 preterm neonates using medical records from January 2014 through December 2018. The Kaplan–Meier model was used to estimate mean survival time and cumulative survival probability. Furthermore, Multivariable Cox regression analysis was run to identify predictors of preterm neonatal mortality using an adjusted hazard ratio (AHR) at P < 0.05 and 95% confidence interval (CI). During the follow-up period in the NICU, the mean survival time of the preterm neonates was 47 (95% CI (43.19–48.95)) days. Compound presentation (AHR = 2.29, 95% CI (1.23–4.24)), perinatal asphyxia (AHR = 2.83, 95% CI (1.75–4.58)), respiratory distress syndrome (AHR = 3.01, 95% CI (1.80–5.01)), 1-min APGAR score (AHR = 0.78, 95% CI (0.62–0.98)), and birth weight (AHR = 0.32, 95% CI (0.17–0.58)) were found to be significant predictors of time to preterm neonatal mortality. In conclusion, the survival probability of preterm neonates showed a considerable decrement in the first week of life. Fetal presentation, gestational age, birth weight, 1-min APGAR score, perinatal asphyxia and respiratory distress syndrome found as independent predictors of preterm neonatal mortality.

Association of Antenatal Corticosteroid Administration-to-delivery Interval With Neonatal Respiratory Distress Syndrome and Respiratory Support in Preterm Infants

Background: Administration of antenatal corticosteroids (ACS) is an effective strategy for the management of preterm infants, which can improve neonatal respiratory distress syndrome (NRDS) and attenuate the risk of neonatal mortality. However, many preterm infants do not expose to a complete course of ACS administration, and the effects of different ACS-to-delivery intervals on NRDS and respiratory support remain unclear.we explore the relationships of ACS administration-to-birth intervals with NRDS and respiratory support in preterm infants in this study.Methods: In this retrospective cohort study, the preterm infants born between 240/7 and 316/7 wk of gestation were recruited from Jan 2015 to Jul 2021. All participants were categorized based on the time interval from the first ACS dose to delivery: <24 h, 1-2 d, 2-7 d, and more >7 d. Multivariable logistic regression analysis was conducted to examine the relationships between ACS-to-birth interval and primary or secondary outcome, while adjusting for potential confounders.Results: Of the 706 eligible neonates, 264, 83, 292 and 67 received ACS-to-delivery intervals of <24 h, 1-2 d, 2-7 d and >7 d, respectively. After adjusting these confounding factors, multivariable logistic analysis showed a significant increased risk of NRDS (aOR: 1.8, 95% CI: 1.2-2.7), neonatal mortality (aOR: 2.8, 95% CI: 1.1-6.8), the need for surfactant use (aOR: 2.7, 95% CI: 1.7-4.4), endotracheal intubation in delivery room (aOR: 1.9, 95% CI: 1.0-3.7), mechanical ventilation (aOR: 1.9, 95% CI: 1.1-3.4) in the ACS-to-delivery interval of <24 h group when compared with the ACS-to-birth interval of 2-7 d group. Similar findings were observed in the subgroup analysis of the ACS interval of <6 h and 6-12 h groups (incidence of death and surfactant use), but no obvious differences were found in the ACS intervals of 12-24 h, 1-2 d and >7 d groups compared with the ACS-to-birth interval of 2-7 d group.Conclusions: Neonatal outcomes such as NRDS, neonatal mortality, the need for surfactant use, intubation in delivery room, mechanical ventilation are at a higher risk when the neonates exposed to ACS interval for less than 12 h before delivery.

Modeling Air Pollution Health Risk for Environmental Management of an Internationally Important Site: The Salt Range (Kallar Kahar), Pakistan

This study aimed to assess the health effects of emissions released by cement industries and allied activities, such as mining and transportation, in the salt range area of district Chakwal, Pakistan. DISPER was used to estimate dispersion and contribution of source emission by cement industries and allied activities to surface accumulation of selected pollutants (PM2.5, PM10, NOx, and O3). To assess the long-term effects of pollutants on human health within the radius of 500 m to 3 km, Air Q+ software was used, which was designed by the World Health Organization (WHO). One-year average monitoring data of selected pollutants, coordinates, health data, and population data were used as input data for the model. Data was collected on lung cancer mortality among different age groups (25+ and 30+), infant post-neonatal mortality, mortality due to respiratory disease, and all-cause mortality due to PM2.5 and NO2. Results showed that PM2.5 with the year-long concentration of 27.3 ug/m3 contributes a 9.9% attributable proportion (AP) to lung cancer mortality in adults aged 25+, and 13.8% AP in adults age 30+. Baseline incidence is 44.25% per 100,000 population. PM10 with the year-long concentration of 57.4 ug/m3 contributes 16.96% AP to infant post-neonatal mortality and baseline incidence is 53.86% per 1000 live births in the country. NO2 with the year-long concentration of 14.33 ug/m3 contributes 1.73% AP to all-cause mortality. Results obtained by a simulated 10% reduction in pollutant concentration showed that proper mitigation measures for reduction of pollutants’ concentration should be applied to decrease the rate of mortalities and morbidities. Furthermore, the study showed that PM2.5 and PM10 are significantly impacting the human health in the nearby villages, even after mitigation measures were taken by the selected cement industries. The study provides a roadmap to policymakers and stakeholders for environmental and health risk management in the area.

Survival analysis of neonatal mortality in Ghana using three population-based surveys

Background Neonatal mortality in many low-and middle-income countries (LMICs) remains high despite global efforts at addressing this challenge. Tackling neonatal death in LMICs is further complicated by lack of reliable data from individual countries in the region to inform effective context specific interventions. This study investigates the probability of neonatal survival and socio-demographic risk factors of neonatal mortality in Ghana. Methods Pooled data from three population-based surveys (N = 12,148) were analysed using multivariable Cox Proportional Hazards regression models. Results The risk of dying within the first 28 days of life was highest in the first week of life (early neonatal period), it then decreases sharply around the middle of the second week of life and remains low over the late neonatal period. Adjusted hazard ratios (HRs) showed that: rural residency (HR = 1.80, 95% CI: 1.15-2.75); birth order 2-3 (HR = 1.63, 95% CI: 1.10-2.42); birth order ≥7 (HR = 1.89, 95% CI: 1.07-3.33) increased the risk of neonatal death. Additionally, children born to women who were obese had higher risk of neonatal death (HR = 1.69, CI: 1.12-2.56) compared with those of women with optimal weight. Disparities in the risk of neonatal death by geographical regions were also found. Conclusion The risk of neonatal mortality is highest during the first week of life and it is socio-demographically patterned. The findings emphasise the need to tackle socio-demographic risk factors of neonatal mortality in order to achieve the Sustainable Development Goal 3, which is aimed at reducing neonatal mortality to 12 per 1000 live births by the year 2030.

Assessing neo-natal mortality trends in Pakistan: an insight using equity lens

Background Almost 2.5 million neonates died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of 5 years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across several dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation. Methods The study was done using raw data from the last three Pakistan Demographic & Health Surveys (2017–18, 2012–13 and 2006–07). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24. Results The situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist. Conclusions Presentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.

FACTORES DE RIESGO ASOCIADOS A LA MORTALIDAD Y PESO AL NACER DE PACIENTES NEONATOS, CASO DE ESTUDIO: HOSPITAL PEDIÁTRICO BACA ORTIZ

Introducción: El peso al nacer es uno de los principales indicadores pronóstico de mortalidad neonatal, en el que influyen factores asociados con la madre, el neonato, y también con las características socioeconómicas del núcleo familiar. Los factores de riesgo implican comorbilidades al momento del nacimiento, por lo que, la intervención adecuada y el oportuno acceso a los servicios de salud constituyen elementos primordiales para la reducción de la mortalidad neonatal. Objetivo: establecer los factores de riesgo asociados a la mortalidad y peso al nacer de pacientes neonatos, de la Unidad de Cuidados Intensivos Neonatales del Hospital Pediátrico Baca Ortiz. Métodos: Se realizó una investigación de diseño observacional, transversal de tipo descriptivo que con una muestra de 204 recién nacidos ingresados en la Unidad de Cuidados Intensivos Neonatales del Hospital Pediátrico Baca Ortiz en la ciudad de Quito, Ecuador, durante el año 2019. Resultados: El peso al nacimiento tiene una asociación lineal negativa significativa con la mortalidad neonatal, siendo los neonatos de género masculino los más susceptibles a fallecer. También, existe mayor frecuencia de mortalidad neonatal en las madres que residen en el área urbana de la sierra ecuatoriana. Conclusiones: El peso al nacer es una variable de gran influencia en la salud y supervivencia infantil, debido a que los datos epidemiológicos muestran que un niño que nace con un peso por debajo de los límites normales tiene un mayor riesgo de fallecer, en comparación con los niños nacidos con un peso dentro del rango considerado normal. Palabras clave: Mortalidad infantil, factores de riesgo, recién nacido de bajo peso, enfermería neonatal, mortalidad neonatal. Abstract Introduction: Birth weight is one of the main prognostic indicators of neonatal mortality, which is influenced by factors associated with the mother, the neonate, and the socioeconomic characteristics of the family. Moreover, the risk factors imply comorbidities at birth. Therefore, adequate intervention and timely access to health services constitute essential elements to reduce neonatal mortality. Objective: establish the risk factors associated with mortality and birth weight of neonatal patients, from the Neonatal Intensive Care Unit of the Baca Ortiz Pediatric Hospital. Methods: An observational, cross-sectional, descriptive research was carried out with a sample of 204 newborns admitted to the Neonatal Intensive Care Unit of the Baca Ortiz Pediatric Hospital in the city of Quito, Ecuador, during the year 2019. Results: The birth weight shows a significant negative linear association with neonatal mortality, where the male infants are the most susceptible to death. Furthermore, there is a higher frequency of neonatal mortality in mothers who live in the urban area of ​​the Ecuadorian highlands. Conclusions: The birth weight is a highly influential variable for child health and survival since epidemiological data show that a newborn with a weight below the range considered normal, has a higher risk of death as compared to children with a normal weight. Keywords: Infant mortality, risk factors, low birth weight, neonatal nursing, neonatal mortality.