Investigation of possible causes of increase in Hungarian infant mortality in 2019 / A hazai csecsemohalandóságban 2019-ben tapasztalt emelkedés lehetséges okainak vizsgálata.

Összefoglaló. Bevezetés: Magyarországon a csecsemohalandóság 2014 óta folyamatosan javult, azonban 2019-ben az elozo évi adathoz képest 11%-kal magasabb érték mutatkozott. Célkituzés: A vizsgálat célja a 2019. évi kedvezotlenebb csecsemohalálozási mutató lehetséges összetevoinek feltárása. Módszer: A 2018. és 2019. évi csecsemohalálozási adatokat hasonlítottuk össze a csecsemo kora, a halál oka és a gyógyintézeti, illetve nem gyógyintézeti elhalálozás szerint. A vizsgálathoz a Központi Statisztikai Hivatal adatait használtuk. A trendvizsgálatnál 2010-tol elemeztük az adatokat. A nem gyógyintézeti haláleseteket 10 évre összevonva járásonként térképesen ábrázoltuk. Eredmények: 2018-ban 304, 2019-ben 335 csecsemo halt meg Magyarországon, a csecsemohalálozási arányszám 3,4 ezrelékrol 3,8 ezrelékre emelkedett. A 2019. évi érték az elozo évtizedek trendjére illesztett görbe alapján megfelelt a várható értéknek. 2019-ben a 0-27 napos csecsemohalálozás alig változott a 2018. évihez képest, a 28-364 napos korban bekövetkezett halálesetek száma viszont növekedett. A vizsgált évben 59%-kal emelkedett a nem gyógyintézeti csecsemohalálozás. A 2019. évi csecsemohalálozás növekedéséért 74%-ban a nem gyógyintézeti esetek voltak felelosek. A nem gyógyintézeti halálozás dönto többsége késoi csecsemokorban következett be. A járásonkénti, 10 évre összevont, nem intézményben elhunyt csecsemok számában és 1000 élve születésre vonatkozó arányában ötszörös területi különbségek mutatkoztak. A halálokok közül a perinatalis szakban keletkezo bizonyos állapotok miatt meghalt csecsemok száma emelkedett a leginkább, a nem gyógyintézeti halálozás esetében pedig a hirtelen csecsemohalál szindrómában meghaltaké. Következtetés: 2019-ben kiugróan magas volt a nem gyógyintézeti, késoi csecsemohalálozás száma és részaránya, ezen esetek feltuno regionális halmozódást mutattak. A csecsemohalandóság csökkentésének hatásos eszköze lehetne a jövoben minden egyes csecsemohalál részletes szakmai értékelése. Orv Hetil. 2021; 162(1): 830-838. INTRODUCTION: In Hungary, infant mortality has been steadily declining since 2014, but in 2019 it increased by 11% compared to 2018. OBJECTIVE: The aim of our study is to explore the possible components of the above increase. METHOD: Ten-year trends of infant mortality were analized and compared by age, cause, place of deaths (hospital or non-hospital environment) and location, using Central Statistical Office data. RESULTS: There were 304 infant deaths in Hungary in 2018 and 335 in 2019. Infant mortality rate rose from 3.4‰ to 3.8‰, however, it was in line with the expected value based on the curve fitted to the trend of previous decades. In 2019, 0-27-day infant mortality basically did not change compared to 2018, while the number of deaths at 28-364 days of age increased. Non-hospital infant mortality increased by 59% in 2019 and these cases accounted for 74% of the total increase in infant mortality; the vast majority of these deaths occurred in late infancy. There were fivefold regional differences in the number of non-hospital infant deaths. Among the causes of death, the conditions related to the perinatal period and sudden infant death syndrome increased the most. CONCLUSION: In Hungary, the number and proportion of non-hospital infant mortality was remarkably high in 2019 compared to previous years. These cases showed a striking regional accumulation. An effective tool for reducing infant mortality could be an appropriate professional assessment of each infant death in the future. Orv Hetil. 2021; 162(21): 830-838.

Survival and early complications of preterm infants with birthweight less than 500 grams during a 10-year period in Hungary.

BACKGROUND: There are limited data available on the survival and early complications of preterm infants with less than 500 g birthweight. To estimate the outcomes for these infants, it is important for caregivers to be aware of perinatal factors that may affect survival. OBJECTIVES: We assessed the mortality and certain early complications of preterm infants born with less than 500 g in Hungary between 2006 and 2015. METHODS: We reviewed data of 486 infants from the database of the Hungarian Central Statistical Office and in parallel of 407 infants from the "NICU database." The study period was divided into two epochs: 2006-2010 and 2011-2015. RESULTS: The survival was 27.1% in the first epoch and 39.1% in the second epoch, and the incidence of early complications was slightly higher in the second epoch. In the surviving group (first and second epoch combined), gestational age (25.1 vs 23.7 weeks), birthweight (458 vs 447 g) antenatal steroid treatment (66.3% vs 52.3%), surfactant therapy (95.1% vs 84.3%), median Apgar scores (6 vs 3 and 8 vs 5 at 1 and 5 minutes, respectively) and proportion of caesarean delivery (89.3% versus 68.5%) were higher than in the non-surviving group (first and second epoch combined). The proportion of multiple births was lower in the surviving group (15.7% vs 33.4%). CONCLUSIONS: Survival of infants with less than 500 g improved between 2006-2010 and 2011-2015 in Hungary. The slightly higher occurrence of early complications might be associated with improving survival.

[Prevention of neonatal group B streptococcal sepsis in Hungary in 2012. Preliminary data of a nation-wide survey]. / A korai kezdetu újszülöttkori B csoportú Streptococcus-szepszis megelozésének helyzete Magyarországon 2012-ben. Egy országos felmérés adatai.

INTRODUCTION: At present, there is no obligatory guideline for the prevention of early-onset neonatal group B streptococcal disease in Hungary. AIM: The aim of the present study was to gain insight into the spontaneously developed preventive strategy of the domestic obstetric divisions and departments in Hungary. METHOD: Standardized questionnaire was sent out to each of the 71 obstetric divisions and departments in Hungary. RESULTS: Overall, 20 (27.4%) of the chairpersons replied, and thus, 39.9% of the total number of live births in Hungary were included in the study. Despite missing public health guidelines, each of the divisions and departments developed their own strategy to prevent neonatal group B streptococcal disease. In 95% of cases, bacterial culture of the lower vagina was the method of identifying pregnant women at risk. In 5% of the cases intrapartum antibiotic prophylaxis was based on risk assessment only. Of the departments using culture-based prophylaxis, 58% departments sampled women after completion of 36th gestational weeks. Antibiotic of choice was penicillin or ampicillin in 100% of cases. Of the study participants, 80% reported on multiple administration of colonized pregnant women after onset of labor or rupture of the membranes. CONCLUSIONS: The authors concluded that the rate of participation in the study was low. However, prevention of early-onset neonatal group B streptococcal infection is a priority of obstetric care in Hungary. Lack of a nation-wide public health policy did not prevent obstetric institutions in this country to develop their own prevention strategy. In the majority of cases and institutions, the policy is consistent with the widely accepted international standards.

Birth prevalence of neural tube defects: a population-based study in South-Eastern Hungary.

PURPOSE: Primary prevention by periconceptional folic acid supplementation can significantly reduce the risk of neural tube defects. EUROCAT, the European network of population-based registries for the epidemiologic surveillance of congenital anomalies, lacks sufficient data on the birth prevalence of neural tube defects in Hungary before and after the promotion of primary prevention by folic acid. Our aims were to compare the birth prevalence of neural tube defects (myelomeningocele, anencephaly and encephalocele) over two 12-year periods in South-Eastern Hungary. Further aims were to compare our data to those ones in other areas in Europe. METHODS: Data were collected from the databases of the Department of Hungarian Congenital Abnormality Registry. The total and live birth prevalence rate of neural tube defects were calculated and compared over 1980-1991 and 1994-2005. In addition, the trends in the total birth prevalence, the number of live births and terminations for and stillbirths with neural tube defects were analysed throughout the period of 1994-2005. RESULTS: A significant decline was found in the total and live birth prevalence of myelomeningocele, anencephaly and encephalocele over 1994-2005 compared to the period of 1980-1991. The total birth prevalence of neural tube defects, however, showed a trend of increase after 1994, with declining number of live births and increasing number of terminations for neural tube defects. CONCLUSION: Public health measures are warranted in order to replace termination of pregnancy with primary prevention in South-Eastern Hungary.