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1.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32778541

RESUMO

CONTEXT: Helping Babies Breathe (HBB) is a well-established neonatal resuscitation program designed to reduce newborn mortality in low-resource settings. OBJECTIVES: In this literature review, we aim to identify challenges, knowledge gaps, and successes associated with each stage of HBB programming. DATA SOURCES: Databases used in the systematic search included Medline, POPLINE, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, African Index Medicus, Cochrane, and Index Medicus. STUDY SELECTION: All articles related to HBB, in any language, were included. Article quality was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation framework. DATA EXTRACTION: Data were extracted if related to HBB, including its implementation, acquisition and retention of HBB knowledge and skills, changes in provider behavior and clinical care, or the impact on newborn outcomes. RESULTS: Ninety-four articles met inclusion criteria. Barriers to HBB implementation include staff turnover and limited time or focus on training and practice. Researchers of several studies found HBB cost-effective. Posttraining decline in knowledge and skills can be prevented with low-dose high-frequency refresher trainings, on-the-job practice, or similar interventions. Impact of HBB training on provider clinical practices varies. Although not universal, researchers in multiple studies have shown a significant association of decreased perinatal mortality with HBB implementation. LIMITATIONS: In addition to not conducting a gray literature search, articles relating only to Essential Care for Every Baby or Essential Care for Small Babies were not included in this review. CONCLUSIONS: Key challenges and requirements for success associated with each stage of HBB programming were identified. Despite challenges in obtaining neonatal mortality data, the program is widely believed to improve neonatal outcomes in resource-limited settings.


Assuntos
Asfixia Neonatal/mortalidade , Asfixia Neonatal/terapia , Competência Clínica , Mortalidade Infantil , Ressuscitação/educação , Ressuscitação/métodos , Asfixia Neonatal/diagnóstico , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido
2.
J Ayub Med Coll Abbottabad ; 32(2): 189-193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32583992

RESUMO

BACKGROUND: Blood gases can provide information about the perinatal, natal and postnatal condition of newborn. Severity of metabolic acidosis has deleterious effect on the outcome of babies. When the cord blood gases are not available the arterial blood gases are used for interpreting the status of newborn. The purpose of study was to determine the relationship between severity of metabolic acidosis at admission with the stage of hypoxic ischemic encephalopathy, and its outcome in asphyxiated neonates. METHODS: This was descriptive cross-sectional study of 384 neonates born at ≥35 weeks to <42 weeks from June to December 2018, admitted in Neonatology department of the Children's hospital & the Institute of Child Health, Lahore within first 6 hours of birth. The neonates with history of delayed cry at birth and arterial pH ≤7.30 and base deficit ≥10 were included in the study. The pH and base deficit of babies was analyzed in relation to the stage of HIE, duration of stay and death or discharge of the babies using SPSS-20. The p-value was calculated using chi-square test. RESULTS: Total of 470 neonates were eligible. Eighty-four neonates were excluded. Finally, 384 neonates were included and analyzed for the outcome variables. With severe metabolic acidosis pH <7.01, all the babies developed HIEII/III. Majority (82.1%) of the babies expired and 27.9% had prolonged hospital stay. CONCLUSIONS: Increasing severity of metabolic acidosis at admission increases the likelihood of adverse outcome in asphyxiated neonates.


Assuntos
Acidose , Asfixia Neonatal , Acidose/epidemiologia , Acidose/etiologia , Acidose/mortalidade , Acidose/terapia , Asfixia Neonatal/complicações , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/mortalidade , Asfixia Neonatal/terapia , Estudos Transversais , Humanos , Recém-Nascido , Admissão do Paciente , Resultado do Tratamento
3.
PLoS One ; 15(5): e0232406, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365073

RESUMO

BACKGROUND: High global neonatal deaths have triggered efforts to improve facility-based care. However, the outcomes achievable at different levels of care are unclear. This study compared morbidity and mortality patterns of newborns admitted to a regional and a district hospital in Ghana to determine outcome, risk and modifiable factors associated with mortality. OBJECTIVE: This study compared morbidity and mortality patterns of newborns admitted to a regional and a district hospital in Ghana to determine outcome, risk and modifiable factors associated with mortality. METHODS: A cross-sectional study involving a records-review over one year at the Upper West Regional Hospital, and three years at St Joseph's District Hospital, Jirapa was carried out. Age, sex, gestational age, weight, duration of admission, diagnosis, among others were examined. The data were analysed and statistical inference made. RESULTS: Altogether, 2004 newborns were examined, comprising 1,241(62%) from St Joseph's District Hospital and 763(38%) from Upper West Regional Hospital. The proportion of neonatal deaths was similar, 8.94% (St Joseph's District Hospital) and 8.91% (Upper West Regional Hospital). Prematurity, neonatal sepsis, birth asphyxia, low birth weight, neonatal jaundice and pneumonia contributed the most to mortality and suspected infections including malaria accounted for almost half (45.5%). Mortality was significantly associated with duration of stay of 48 hours, being premature, and being younger than 3 days. CONCLUSION: Majority of the mortality among the neonates admitted was due to preventable causes. Better stabilization and further studies on the epidemiology of sepsis, prematurity, low birth weight, including the contribution of malaria to these and outcome of transferred neonates are needed.


Assuntos
Hospitalização , Mortalidade Infantil , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/mortalidade , Estudos Transversais , Feminino , Gana/epidemiologia , Mortalidade Hospitalar , Hospitais de Distrito , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Sepse Neonatal/epidemiologia , Sepse Neonatal/mortalidade , Admissão do Paciente
4.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 64-68, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31092676

RESUMO

OBJECTIVE: Apgar scores of zero at 10 min strongly predict mortality and morbidity in infants. However, recent data reported improved outcomes among infants with Apgar scores of zero at 10 min. We aimed to review the mortality rate and neurodevelopmental outcomes of infants with Apgar scores of zero at 10 min in Japan. DESIGN: Observational study. PATIENTS: Twenty-eight of 768 infants registered in the Baby Cooling Registry of Japan between 2012 and 2016, at >34 weeks' gestation, with Apgar scores of zero at 10 min who were treated with therapeutic hypothermia. INTERVENTIONS: We investigated the time of first heartbeat detection in infants with favourable outcomes and who had neurodevelopmental impairments or died. MAIN OUTCOME MEASURES: Clinical characteristics, mortality rate and neurodevelopmental outcomes at 18-22 months of age were evaluated. RESULTS: Nine (32%) of the 28 infants died before 18 months of age; 16 (57%) survived, but with severe disabilities and 3 (11%) survived without moderate-to-severe disabilities. At 20 min after birth, 14 of 27 infants (52%) did not have a first heartbeat, 13 of them died or had severe disabilities and one infant, who had the first heartbeat at 20 min, survived without disability. CONCLUSION: Our study adds to the recent evidence that neurodevelopmental outcomes among infants with Apgar scores of zero at 10 min may not be uniformly poor. However, in our study, all infants with their first heartbeat after 20 min of age died or had severe disabilities.


Assuntos
Índice de Apgar , Asfixia Neonatal/mortalidade , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/mortalidade , Transtornos do Neurodesenvolvimento/epidemiologia , Asfixia Neonatal/terapia , Reanimação Cardiopulmonar , Seguimentos , Gastrostomia/estatística & dados numéricos , Humanos , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Intubação Intratraqueal , Japão/epidemiologia , Testes Neuropsicológicos , Sistema de Registros , Respiração Artificial/estatística & dados numéricos , Traqueostomia/estatística & dados numéricos , Escala de Memória de Wechsler
5.
PLoS One ; 14(12): e0226891, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860643

RESUMO

BACKGROUND: Birth asphyxia is a leading cause of infant morbidity and mortality in developing nations, such as Ethiopia. Though Ethiopia has made considerable achievement in the reduction of under-five mortality rate, the neonatal mortality burden has not experienced the same reduction, which may be attributed to birth asphyxia. Thus, this study attempts to assess the prevalence and associated factors of birth asphyxia among newborns in public hospitals in the northeastern Amhara region, Ethiopia. METHODS: An institution-based cross-sectional study was conducted on 357 births from 1st April to 2nd May 2018. The sample size was proportionally allocated to randomly selected three public hospitals namely, Dessie referral hospital, Debre Berhan referral hospital, and Woldia general hospital. The allocation was made by taking the average number of deliveries given in each hospital six months before the data collection period. Using the delivery registration of hospitals a systematic random sampling technique was used to get all study participants. The diagnosis of birth asphyxia was confirmed based on the physician's diagnosis of an APGAR score < 7 in the 1st and 5th minutes of birth. A pretested and structured questionnaire was used to collect data. Variables with p-values < 0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis. A statistical significant level was declared at a p-value of <0.05. RESULTS: The prevalence of birth asphyxia was found to occur 22.6% of the time [95% CI 19.2% - 26.4%] in the first minute of birth. In the multivariable logistic regression being primipara [AOR = 3.77: 95% CI 1.86, 7.65], presented with complicated labor [AOR = 3.45: 95% CI 1.58, 7.49], premature rupture of membrane [AOR = 3.85: 95% CI 1.76, 8.44) and having blood-stained amniotic fluid at birth [AOR = 5.02: 95% CI 1.69, 14.87] were the independent predictors of birth asphyxia. CONCLUSION: The study revealed that birth asphyxia is a common newborn complication in the Amhara region. Integrated mitigation measure to reduce neonatal mortality in the Amahar region should give due attention to primipara women and for these high-risk pregnancies in order for the region to achieve national and global commitment to have sustainable change in women and neonatal health.


Assuntos
Asfixia Neonatal/epidemiologia , Hospitais Públicos , Parto , Adulto , Líquido Amniótico , Asfixia Neonatal/mortalidade , Estudos Transversais , Países em Desenvolvimento , Etiópia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais , Humanos , Recém-Nascido , Modelos Logísticos , Complicações do Trabalho de Parto , Paridade , Gravidez , Prevalência , Fatores de Risco , Adulto Jovem
6.
BMC Health Serv Res ; 19(1): 552, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391044

RESUMO

BACKGROUND: Ethiopia is one of five countries that account for half of the world's 2.6 million newborn deaths. A quarter of neonatal deaths in Ethiopia are caused by birth asphyxia. Understanding different dimensions of the quality of care for newborns with breathing difficulties can lead to improving service provision environments and practice. We describe facility readiness to treat newborns with breathing difficulties, the extent to which newborn resuscitation is provided, and by modeling the survival of newborns with difficulties breathing, we identify key factors that suggest how mortality from asphyxia can be reduced. METHODS: We carried out a secondary analysis of the 2016 Ethiopia Emergency Obstetric and Newborn Care Assessment that included 3804 facilities providing childbirth services and 2433 chart reviews of babies born with difficulties breathing. We used descriptive statistics to assess health facilities' readiness to treat these newborns and a binary logistic regression to identify factors associated with survival. RESULTS: Over one-quarter of facilities did not have small-sized masks (size 0 or 1) to complete the resuscitation kits. Among the 2190 cases with known survival status, 49% died before discharge, and among 1035 cases with better data quality, 29% died. The odds of surviving birth asphyxia after resuscitation increased eightfold compared to newborns not resuscitated. Other predictors for survival were the availability of a newborn corner, born at term or post-term, normal birth weight (≥2500 g) and delivered by cesarean or assisted vaginal delivery. CONCLUSION: The survival status of newborns with birth asphyxia was low, particularly in the primary care facilities that lacked the required resuscitation pack. Newborns born in a facility with better data quality were more likely to survive than those born in facilities with poor data quality. Equipping health centers/clinics with resuscitation packs and reducing the incidence of preterm and low birth weight babies should improve survival rates.


Assuntos
Asfixia Neonatal/mortalidade , Asfixia Neonatal/terapia , Ressuscitação/mortalidade , Estudos Transversais , Parto Obstétrico/métodos , Etiópia/epidemiologia , Feminino , Instalações de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Recém-Nascido , Gravidez , Ressuscitação/métodos
7.
J Perinatol ; 39(12): 1627-1634, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31434996

RESUMO

OBJECTIVE: We aimed to investigate the clinical course and outcome of newborns with ductal-dependent congenital heart disease (CHD) who suffered from perinatal asphyxia. STUDY DESIGN: Clinical data of 504 patients with ductal-dependent CHD and perinatal asphyxia were retrospectively analyzed over a 10-year period (2005-2014). RESULT: Perinatal asphyxia was diagnosed in 17 (3.4%) patients, comprising two nonoverlapping groups: Five infants with intrauterine acidosis (umbilical artery pH < 7.0), and 12 infants with persistent or deteriorating postnatal depression (Apgar score <6 at 10 min of life). Preoperative (41.7%, p < 0.001) and overall mortality (50.0%, p = 0.001) were increased in infants with asphyxia caused by persistent or deteriorating postnatal depression. Apgar scores at 10 min were independently associated with preoperative (OR 0.479, 95% CI 0.342-0.672, p < 0.001) and overall death (OR 0.655, 95% CI 0.537-0.799, p < 0.001). CONCLUSIONS: Asphyxia caused by postnatally deteriorating depression rather than fetal acidosis is associated with high mortality.


Assuntos
Acidose/complicações , Asfixia Neonatal/etiologia , Cardiopatias Congênitas/complicações , Índice de Apgar , Asfixia Neonatal/mortalidade , Peso ao Nascer , Salas de Parto , Feminino , Sangue Fetal/química , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Masculino , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco
8.
Ann Glob Health ; 85(1)2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397983

RESUMO

Global new-born mortality has shown steady decline over the last two decades, but this decline has been slowest in Sub-Saharan Africa (SSA). Perinatal asphyxia (PA) is a major cause of new-born deaths in this region and as such SSA now contributes a disproportionate large percentage of global asphyxia-related deaths. In this paper, we examine regional challenges affecting primary, secondary and tertiary prevention of PA and proffers locally adaptable solutions to these identified challenges.


Assuntos
Asfixia Neonatal/mortalidade , Asfixia Neonatal/prevenção & controle , Prevenção Primária , Prevenção Secundária , Prevenção Terciária , África ao Sul do Saara/epidemiologia , Asfixia Neonatal/terapia , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Obstetrícia , Cuidado Pré-Natal
9.
Trials ; 20(1): 444, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324213

RESUMO

BACKGROUND: Intrapartum-related death is the third leading cause of under-5 mortality. Effective ventilation during neonatal resuscitation has the potential to reduce 40% of these deaths. Face-mask ventilation performed by midwives is globally the most common method of resuscitating neonates. It requires considerable operator skills and continuous training because of its complexity. The i-gel® is a cuffless supraglottic airway which is easy to insert and provides an efficient seal that prevents air leakage; it has the potential to enhance performance in neonatal resuscitation. A pilot study in Uganda demonstrated that midwives could safely resuscitate newborns with the i-gel® after a short training session. The aim of the present trial is to investigate whether the use of a cuffless supraglottic airway device compared with face-mask ventilation during neonatal resuscitation can reduce mortality and morbidity in asphyxiated neonates. METHODS: A randomized phase III open-label superiority controlled clinical trial will be conducted at Mulago Hospital, Kampala, Uganda, in asphyxiated neonates in the delivery units. Prior to the intervention, health staff performing resuscitation will receive training in accordance with the Helping Babies Breathe curriculum with a special module for training on supraglottic airway insertion. A total of 1150 to 1240 babies (depending on cluster size) that need positive pressure ventilation and that have an expected gestational age of more than 34 weeks and an expected birth weight of more than 2000 g will be ventilated by daily unmasked randomization with a supraglottic airway device (i-gel®) (intervention group) or with a face mask (control group). The primary outcome will be a composite outcome of 7-day mortality and admission to neonatal intensive care unit (NICU) with neonatal encephalopathy. DISCUSSION: Although indications for the beneficial effect of a supraglottic airway device in the context of neonatal resuscitation exist, so far no large studies powered to assess mortality and morbidity have been carried out. We hypothesize that effective ventilation will be easier to achieve with a supraglottic airway device than with a face mask, decreasing early neonatal mortality and brain injury from neonatal encephalopathy. The findings of this trial will be important for low and middle-resource settings where the majority of intrapartum-related events occur. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT03133572 . Registered April 28, 2017.


Assuntos
Asfixia Neonatal/terapia , Países em Desenvolvimento , Acesso aos Serviços de Saúde , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Respiração Artificial/instrumentação , Ressuscitação/instrumentação , Asfixia Neonatal/diagnóstico , Asfixia Neonatal/mortalidade , Ensaios Clínicos Fase III como Assunto , Países em Desenvolvimento/economia , Desenho de Equipamento , Estudos de Equivalência como Asunto , Acesso aos Serviços de Saúde/economia , Mortalidade Hospitalar , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/mortalidade , Respiração Artificial/efeitos adversos , Respiração Artificial/mortalidade , Ressuscitação/efeitos adversos , Ressuscitação/mortalidade , Fatores de Tempo , Resultado do Tratamento , Uganda
10.
S Afr Med J ; 109(7): 480-485, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266573

RESUMO

BACKGROUND: The Rapid Mortality Surveillance System has reported reductions in child mortality rates in recent years in South Africa (SA). In this article, we present information about levels of mortality and causes of death from the second SA National Burden of Disease Study (SA NBD) to inform the response required to reduce child mortality further. OBJECTIVES: To estimate trends in and causes of childhood mortality at national and provincial levels for the period 1997 - 2012, to highlight the importance of the SA NBD. METHODS: Numbers of registered child deaths were adjusted for under-reporting. Adjustments were made for the misclassification of AIDS deaths and the proportion of ill-defined natural causes. Non-natural causes were estimated using results from the National Injury Mortality Surveillance System for 2000 and the National Injury Mortality Survey for 2009. Six neonatal conditions and 11 other causes were consolidated from the SA NBD and the Child Health Epidemiological Reference Group lists of causes of death for the analysis. The NBD cause-fractions were compared with those from Statistics South Africa, the United Nations Children's Fund (UNICEF) and the Institute for Health Metrics and Evaluation (IHME). RESULTS: Under-5 mortality per 1 000 live births increased from 65 in 1997 to 79 in 2004 as a result of HIV/AIDS, before dropping to 40 by 2012. The neonatal mortality rate declined from 1997 to 2001, followed by small variations. The death rate from diarrhoeal diseases began to decrease in 2008 and the death rate from pneumonia from 2010. By 2012, neonatal deaths accounted for 27% of child deaths, with conditions associated with prematurity, birth asphyxia and severe infections being the main contributors. In 1997, KwaZulu-Natal, Free State, Mpumalanga and Eastern Cape provinces had the highest under-5 mortality, close to 80 per 1 000 live births. Mortality rates in North West were in the mid-range and then increased, placing this province in the highest group in the later years. The Western Cape had the lowest mortality rate, declining throughout the period apart from a slight increase in the early 2000s. CONCLUSIONS: The SA NBD identified the causes driving the trends, making it clear that prevention of mother-to-child transmission of HIV, the Expanded Programme on Immunisation and programmes aimed at preventing neonatal deaths need to be equitably implemented throughout the country to address persistent provincial inequalities in child deaths. The rapid reduction of childhood mortality since 2005 suggests that the 2030 Sustainable Development Goal target of 25 per 1 000 for under-5 mortality is achievable for SA. Comparison with alternative estimates highlights the need for cause-of-death data from civil registration to be adjusted using a burden-of-disease approach.


Assuntos
Causas de Morte/tendências , Mortalidade da Criança/tendências , Asfixia Neonatal/mortalidade , Criança , Pré-Escolar , Diarreia/mortalidade , Infecções por HIV/mortalidade , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Pneumonia/mortalidade , Vigilância da População , África do Sul/epidemiologia , Tuberculose/mortalidade , Ferimentos e Lesões/mortalidade
11.
Afr Health Sci ; 19(1): 1554-1562, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148983

RESUMO

Background: Birth asphyxia (BA) is a preventable cause of cerebral insults in newborns. It is associated with high morbidity and mortality. Of the 120 million babies born in third world countries annually, it is estimated that about 3.6 million will develop BA. Objectives: We aimed to determine the short term outcome and predictors of survival among birth asphyxiated babies using Apgar score. Methods: This study was carried out in the Newborn Unit of Enugu State University Teaching Hospital. In-hospital deliveries (Inborn) and those from other centers (Out-born) with one minute Apgar score ≤ 6 were included. Interviewer administered questionnaire was used to collect data from caregivers. Information sought included gestational age (GA), birth weight (BW), Apgar score, place of delivery and outcome. Data was analyzed using SPSS. Bivariate and multivariate logistic regressions were done. Results: Of the 150 neonates, 61.3% survived. Majority of the dead were out-born. The difference was statistically significant (p < 0.001). The inborn were about 1.2 times (AOR = 1.22; 95% CI: 1.06-1.78) more likely to survive BA. Among low birth weights (LBWs), 73.9% died, 23.7% of normal weights and 14.3% of macrosomics died. The difference was statistically significant (p < 0.001). The normal weights were about 2 (AOR = 2.23, 95% CI: 1.76-6.25) and the macrosomics about 5 times more likely to survive BA than LBWs. Regarding GA, 78.8%, 17.2% and 18.2% of the pre-terms, term and post-dates died respectively. The difference was statistically significant (p < 0.001). The term babies were about 11 (AOR = 11.27; 95% CI: 4.02-31-56) and post-dates about 9 (AOR = 8.79; 95% CI: 1.43-54.04) times more likely to survive BA than preterms. Other significant factors were degree of asphyxia (p = 0.003), and parental education (p < 0.001). Conclusion: BW, GA, degree of asphyxia, place of delivery and parental education all predicts survival among birth asphyxiated newborns.


Assuntos
Asfixia Neonatal/mortalidade , Parto Obstétrico/métodos , Índice de Apgar , Asfixia Neonatal/etiologia , Peso ao Nascer , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Nigéria/epidemiologia , Gravidez , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Centros de Atenção Terciária
12.
Medicine (Baltimore) ; 98(23): e15788, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169678

RESUMO

Data based on forensic autopsy in neonates and infants in China are rare in the literature. The purpose of this study is to evaluate the characteristics of fetal, neonatal, and infant death and to determine the main cause of death among them.A retrospective analysis of fetal and infant forensic autopsies referred to the Tongji Forensic Medical Center (TFMC) in Hubei, central China, during a 16-year period between January 1999 and December 2014, was performed.In this period, there were 1111 males and 543 females; the total male-to-female ratio (MFR) was 2.05:1. There were 173 fetal and infant autopsies conducted, comprised of 43 fetal, 84 neonatal (<28 days) and 46 infant (4 weeks to 1 year) cases. The annual case number ranged from 5 in 2004 to 18 in 2014 (annual mean of 10.8). MFR was 1.75:1. About 94% of these deaths (163/173) resulted from natural causes, 6 cases (3.5%) were accidental deaths, and 4 (2.3%) resulted from homicide (4 abandoned babies). Among fetuses, the most common causes of death were placental and umbilical cord pathologies (28%, 12/43), followed by intrapartum asphyxia resulting from amniotic fluid aspiration (AFA) or meconium aspiration syndrome (MAS) (18.6%, 8/43), congenital malformation (14%, 6/43), and intrapartum infection (9.3%, 4/43). A majority of neonatal deaths (66.7%, 56/84) died within 24 hours of birth. The main causes of neonatal death were asphyxia resulting from AFA, MAS, or hyaline membrane disease, and congenital malformation. The main causes of infant (1-12 months) death were infectious diseases, including pneumonia, meningitis, and viral brainstem encephalitis.This study was the 1st retrospective analysis of autopsies of fetal, neonatal, and infant death in TFMC and central China. We delineate the common causes of early demise among cases referred for autopsy, and report a male preponderance in this population. Our data observed that placental and/or umbilical cord pathology, asphyxia due to AFA, and/or MAS, and pneumonia were the leading causes of fetal, neonatal, and infant death, respectively. And it can inform clinical practitioners about the underlying causes of some of the most distressing cases in their practices.


Assuntos
Morte Fetal/etiologia , Doenças Fetais/mortalidade , Morte do Lactente/etiologia , Doenças do Recém-Nascido/mortalidade , Morte Perinatal/etiologia , Asfixia Neonatal/mortalidade , Autopsia , Causas de Morte , China , Feminino , Patologia Legal , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Aspiração de Mecônio/mortalidade , Pneumonia/mortalidade , Gravidez , Estudos Retrospectivos
13.
BMC Res Notes ; 12(1): 236, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014375

RESUMO

OBJECTIVES: The aim of this study was to describe potential factors contributing to neonatal mortality in Takeo, Cambodia through assessment of verbal autopsies collected following newborn deaths in the community. The mortality review was nested within a trial of a behavioral intervention to improve newborn survival, and was conducted after the close of the trial, within the study setting. The World Health Organization standardized definition of neonatal mortality was employed, and two pediatricians independently reviewed data collected from each event to assign a cause of death. RESULTS: Thirteen newborn deaths of infants born in health facilities participating in a community based, behavioral intervention were reported during February 2015-November 2016. Ten deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of deaths were attributed to asphyxia. The study highlights the continuing need to improve quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.


Assuntos
Asfixia Neonatal/mortalidade , Serviços de Saúde Comunitária/ética , Mortalidade Infantil/tendências , Sepse Neonatal/mortalidade , Autopsia/métodos , Camboja , Causas de Morte , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Natimorto
14.
BMC Pregnancy Childbirth ; 19(1): 83, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819143

RESUMO

BACKGROUND: The first one month of life; the neonatal period is the most risky time for child survival. In Ethiopia, neonatal mortality is unacceptably high, and the trend in reduction is slower as compared to infant and child mortality. The magnitude and associated factors of neonatal mortality in a tertiary care facility were not well documented. Therefore, the aim of this study was to determine neonatal mortality and predictors among neonates admitted to neonatal intensive care unit of Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia. METHODS: A retrospective cohort study design was done among neonates admitted to neonatal intensive care unit of a University Teaching and Referral Hospital from 2015 to 2017. Data were collected using data extraction checklist from the medical registry. The main outcome was the occurrence of death within the first four weeks. The survival time was calculated in days between the date of admission and the date of death. Kaplan-Meier survival was used to depict the pattern of death in 28 days and Cox-Proportional model was used to identify the predictors of the neonatal mortality. RESULTS: A total of 964 neonates which contributed to 5889 neonates-days were included in the study. There were 159 neonatal deaths during the follow-up time. Overall, the neonatal mortality incidence was 27 per 1000 neonates-days. Predictors of neonatal mortality were: multiple birth, mothers who did not attend antenatal care visits, neonates born by cesarean section, not initiated breast feeding within 1 h of birth, neonates resuscitated, hyaline membrane disease and perinatal asphyxia. CONCLUSION: Neonatal mortality at neonatal intensive care unit was high. Managing neonatal complications, initiating breast feeding within 1 h of birth, promoting antenatal care visits, improving quality of services and ensuring continuum of care are recommended to increase survival of neonates.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Mortalidade Infantil , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Asfixia Neonatal/mortalidade , Aleitamento Materno/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Doença da Membrana Hialina/mortalidade , Incidência , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Gravidez , Gravidez Múltipla/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Modelos de Riscos Proporcionais , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
15.
JNMA J Nepal Med Assoc ; 57(219): 287-292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32329449

RESUMO

INTRODUCTION: Perinatal asphyxia is one of the major causes of perinatal and early neonatal mortality in developing countries. The main objective of this study was to observe the prevalence of perinatal asphyxia in babies born at Kathmandu Medical College Teaching Hospital. METHODS: This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six month period (January to June 2019). All preterm, term and post term babies delivered at Kathmandu Medical College Teaching Hospital were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College (Ref.:2812201808). Convenient sampling method was applied. Data analysis was done in Statistical Package for Social Sciences (SPSS 18), point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: A total of 1284 babies delivered over six months period were enrolled in this study and 47 (3.66 %) babies were asphyxiated, at 95% Confidence Interval (2.64%-4.68%). The mean birth weight of asphyxiated babies was 2759.75±65 grams and gestational age was 37.57±2 weeks. Among asphyxiated babies, 15 (32%) babies were normal, 15 (32%) babies were in Hypoxic Ischemic Encephalopathy stage I, 14 (30%) were in stage II and 3 (6%) were in stage III. Twenty Three (49%) asphyxiated babies had antenatal risk factors and all 47 babies had intrapartum risk factors leading to asphyxia. CONCLUSIONS: Prevalence of perinatal asphyxia was lower compared to that of other similar tertiary care hospitals. Perinatal asphyxia remains a major cause of neonatal morbidity and mortality.


Assuntos
Asfixia Neonatal/epidemiologia , Idade Gestacional , Hipóxia-Isquemia Encefálica/epidemiologia , Asfixia Neonatal/mortalidade , Peso ao Nascer , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Nepal , Gravidez , Prevalência , Fatores de Risco , Centros de Atenção Terciária
16.
PLoS One ; 13(10): e0204410, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30312312

RESUMO

The major causes of newborn deaths in sub-Saharan Africa are well-known and countries are gradually implementing evidence-based interventions and strategies to reduce these deaths. Facility-based care provides the best outcome for sick and or small babies; however, little is known about the cost and burden of hospital-based neonatal services on parents in West Africa, the sub-region with the highest global neonatal death burden. To estimate the actual costs borne by parents of newborns hospitalised with birth-associated brain injury (perinatal asphyxia) and preterm/low birth weight, this study examined economic costs using micro-costing bottom-up approach in two referral hospitals operating under the nationwide social health insurance scheme in an urban setting in Ghana. We prospectively assessed the process of care and parental economic costs for 25 out of 159 cases of perinatal asphyxia and 33 out of 337 cases of preterm/low birth weight admitted to hospital on the day of birth over a 3 month period. Results showed that medical-related costs accounted for 66.1% (IQR 49% - 81%) of out-of-pocket payments irrespective of health insurance status. On average, families spent 8.1% and 9.1% of their annual income on acute care for preterm/LBW and perinatal asphyxia respectively. The mean out-of-pocket expenditure for preterm/LBW was $147.6 (median $101.8) and for perinatal asphyxia was $132.3 (median $124). The study revealed important gaps in the financing and organization of health service delivery that may impact the quality of care for hospitalised newborns. It also provides information for reviewing complementary health financing options for newborn services and further economic evaluations.


Assuntos
Asfixia Neonatal/economia , Asfixia Neonatal/terapia , Custos de Cuidados de Saúde , Gastos em Saúde , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Asfixia Neonatal/mortalidade , Estudos Transversais , Gana , Humanos , Recém-Nascido , Seguro Saúde , Tempo de Internação/economia , Estudos Longitudinais , Pais , Estudos Prospectivos , Fatores Socioeconômicos , População Urbana
17.
BMC Pregnancy Childbirth ; 18(1): 380, 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30236080

RESUMO

BACKGROUND: Late- and postterm pregnancy are associated with adverse perinatal outcomes, like perinatal death. We evaluated causes of death and substandard care factors (SSFs) in term and postterm perinatal death. METHODS: We used data from the Perinatal Audit Registry of the Netherlands (PARS). Women with a term perinatal death registered in PARS were stratified by gestational age into early-/full-term (37.0-40.6) and late-/postterm (≥41.0 weeks) death. Cause of death and SSFs ≥41 weeks were scored and classified by the local perinatal audit teams. RESULTS: During 2010-2012, 947/479,097 (0.21%) term deaths occurred, from which 707 cases (75%) were registered and could be used for analyses. Five hundred ninety-eight early-/full-term and 109 late-/postterm audited deaths were registered in the PARS database. Of all audited cases of perinatal death in the PARS database, 55.2% in the early-/fullterm group occurred antepartum compared to 42.2% in the late-/postterm group, while intrapartum death occurred in 7.2% in the early-/full-term group compared to 19.3% in the late-/postterm group in the audited cases from the PARS database. According to the local perinatal audit, the most relevant causes of perinatal death ≥41 weeks were antepartum asphyxia (7.3%), intrapartum asphyxia (9.2%), neonatal asphyxia (10.1%) and placental insufficiency (10.1%). In the group with perinatal death ≥41 weeks there was ≥1SSF identified in 68.8%. The most frequent SSFs concerned inadequate cardiotocography (CTG) evaluation and/or classification (10.1%), incomplete registration or documentation in medical files (4.6%) or inadequate action on decreased foetal movements (4.6%). CONCLUSIONS: In the Netherlands Perinatal Audit Registry, stillbirth occurred relatively less often antepartum and more often intrapartum in pregnancies ≥41 weeks compared to pregnancies at 37.0-40.6 weeks in the audited cases from the PARS database. Foetal, intrapartum and neonatal asphyxia were identified more frequently as cause of death in pregnancies ≥41 weeks. The most identified SSFs related to death in pregnancies ≥41 weeks concerned inadequate CTG monitoring (evaluation, classification, registration or documentation) and inadequate action on decreased foetal movements.


Assuntos
Asfixia Neonatal/mortalidade , Morte Perinatal/etiologia , Mortalidade Perinatal , Gravidez Prolongada , Natimorto/epidemiologia , Adulto , Causas de Morte , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Auditoria Médica , Países Baixos/epidemiologia , Gravidez , Sistema de Registros , Nascimento a Termo
18.
Rev. inf. cient ; 97(5): 1020-1030, sep.-oct. 2018.
Artigo em Espanhol | CUMED | ID: cum-74026

RESUMO

Introducción: el término asfixia perinatal es muy controvertido y su empleo requiere extremo cuidado por sus implicaciones éticas y legales. Las tres principales causas de muerte de recién nacidos en el mundo son las infecciones, la prematuridad y la asfixia perinatal, según datos de la OMS. Objetivo: realizar una actualización sobre los factores de riesgo maternos que influyen en la asfixia perinatal. Desarrollo: se revisaron fuentes nacionales e internacionales actuales sobre las diferentes causas de muerte asociadas a la asfixia neonatal; producidas por malformaciones congénitas, sepsis neonatal y la asfixia secundaria a afecciones placentarias y factores de riesgo. Conclusiones: Se propone posible plan de acción tanto para nivel primario como secundario(AU)


Introduction: the term perinatal asphyxia is very controversial and its use requires extreme care due to its ethical and legal implications. The three main causes of death of newborns in the world are infections, prematurity and perinatal asphyxia, according to WHO data. Objective: to update the maternal risk factors that influence perinatal asphyxia. Development: current national and international sources on the different causes of death associated with neonatal asphyxia were reviewed; produced by congenital malformations, neonatal sepsis and asphyxia secondary to placental conditions and risk factors. Conclusions: A possible action plan is proposed for both primary and secondary levels(AU)


Introdução: o termo asfixia perinatal é muito controverso e seu uso requer extremo cuidado devido às suas implicações éticas e legais. As três principais causas de morte de recém-nascidos no mundo são infecções, prematuridade e asfixia perinatal, segundo dados da OMS. Objetivo: atualizar os fatores de risco maternos que influenciam a asfixia perinatal. Desenvolvimento: foram revisadas as atuais fontes nacionais e internacionais sobre as diferentes causas de morte associadas à asfixia neonatal; produzido por malformações congênitas, sepse neonatal e asfixia secundária a condições placentárias e fatores de risco. Conclusões: Um plano de ação possível é proposto para os níveis primário e secundário(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Asfixia Neonatal/mortalidade , Fatores de Risco
19.
Neonatology ; 114(4): 341-347, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30130752

RESUMO

BACKGROUND: The so-called Thompson-score (TS) for newborns with hypoxic-ischemic encephalopathy (HIE) was developed before the introduction of controlled hypothermia as clinical routine. Information on the predictive value of TS in newborns undergoing therapeutic hypothermia to estimate long-term outcome is limited. OBJECTIVES: To determine the predictive value of TS to estimate long-term cognitive and neurological outcome in newborns with perinatal asphyxia treated with controlled hypothermia. METHODS: Thirty-six term newborns with HIE undergoing controlled hypothermia were followed using Wechsler Preschool and Primary Scale of intelligence III test and standardized neurological examination. The primary outcome was survival without cognitive impairment, defined as an IQ ≥85. Secondary outcomes were motor outcomes, survival without relevant neurological impairment, death and epilepsy. RESULTS: Follow-up was done in 33 out of 36 (91.6%) infants at 53 ± 12 months (mean ± SD). For all investigated parameters, a statistically significant relationship with peak TS was demonstrated. A one-point increase in peak TS indicated an OR (95% CI) of 1.5 (1.1-2.0, p = 0.006) for death or cognitive impairment, an OR (95% CI) of 2.2 (1.3-3.8, p = 0.004) for death or relevant neurologic impairment, an OR (95% CI) of 2.1 (1.3-3.5, p = 0.005) for death or epilepsy and an OR (95% CI) of 1.5 (1.1-2.1, p = 0.02) for death. Although the TS for newborns with adverse outcome (death or cognitive impairment) compared to normal outcome tended to be higher (13 [4-16] vs. 9 [0-13], d1; 15 [5-19] vs. 9 [1-14], d2; 14 [5-21] vs. 8 [2-15], d3; median [range]), there was a considerable overlap during the first 3 days of life between both groups. CONCLUSIONS: The TS seems to be a prognostic tool for predicting the long-term outcome in asphyxiated term newborns undergoing controlled hypothermia after the third day of life. A higher score appears to be significantly associated with an adverse outcome.


Assuntos
Asfixia Neonatal/diagnóstico , Asfixia Neonatal/terapia , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/diagnóstico , Hipóxia-Isquemia Encefálica/terapia , Asfixia Neonatal/mortalidade , Deficiências do Desenvolvimento/etiologia , Feminino , Humanos , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Modelos Logísticos , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
20.
J Neonatal Perinatal Med ; 11(2): 179-183, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29966208

RESUMO

BACKGROUND: Perinatal asphyxia is an important cause of morbidity and mortality in the neonatal period, accounting for 20-30% of neonatal mortality. A substantial proportion (estimated at 26%) of the 1 million annual intrapartum stillbirths result from asphyxia. Probably higher than the mortality is the plethora of morbidity associated with asphyxia, especially long term neuro-developmental problems including cerebral palsy.The real burden of perinatal asphyxia is difficult to establish because of paucity of information from the rural communities where the majority of neonatal morbidity and deaths occur. Extended Apgar scores and HIE grade have been identified as predictive tools in prognosticating asphyxia, however HIE staging require a certain level of medical expertise which is not widely available. AIM: To determine the incidence of asphyxia, the mortality rate and factors associated with mortality in Irrua Specialist Hospital. METHOD: It was a descriptive, retrospective study of neonates admitted into the special care baby unit (SCBU) between October 2013 and September 2014 with diagnosis of perinatal asphyxia. Data was obtained from babies' and mother's case notes. The outcome was classified as survived or died. RESULTS: Perinatal asphyxia accounted for 45 out of 347 (13%) of admissions within the review period. The mean gestational age and birth weight of the subjects were 39.2±2.2 weeks and 3020±520 grams respectively. The mortality rate was 31.1% and the factors significantly associated with mortality include lack of antenatal care and HIE stage III. CONCLUSION: The burden of perinatal asphyxia in Irrua Specialist Hospital is comparable to figures from similar settings in the developing world. Lack of antenatal care and HIE stage III are associated with mortality. Continuous efforts should be made to improve the uptake of antenatal care and high risk pregnancies should be delivered in centres with facilities for neonatal care.


Assuntos
Asfixia Neonatal/mortalidade , Natimorto , Adolescente , Adulto , Índice de Apgar , Peso ao Nascer , Escolaridade , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Mortalidade Infantil/tendências , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Idade Materna , Nigéria/epidemiologia , Estudos Retrospectivos , Fatores de Risco , População Rural , Adulto Jovem
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