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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
11.
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
12.
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
13.
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
14.
Neonatology ; 114(4): 315-322, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30025408

RESUMO

BACKGROUND: Perinatal anemia may cause perinatal asphyxia. Its pathophysiology and neurodevelopmental effects are theoretically different from other causes of perinatal asphyxia. OBJECTIVE: The study aimed to determine whether perinatal anemia results in different short-term and long-term outcomes than other causes of perinatal asphyxia treated with therapeutic hypothermia. METHODS: We retrospectively included infants with moderate to severe hypoxic-ischemic encephalopathy, born between May 2009 and October 2015. During follow-up, we assessed cognitive and motor development at 2-3 years of age, using the Bayley Scales of Infant and Toddler Development, third edition (BSID-III). Neurodevelopmental outcome (NDO) was classified as abnormal in case of cerebral palsy with Gross Motor Function Classification System ≥III and/or a BSID-III composite score < 85. Outcomes of infants with perinatal anemia (initial hemoglobin < 7 mmol/L) were compared to infants born with perinatal asphyxia due to other causes. RESULTS: In total, 111 infants were included of whom 30 infants (27%) died during the neonatal period. Infants with anemia (n = 23) had a higher mortality risk, OR 3.33, 95% CI 1.27-8.72, p = 0.01. None of the surviving infants with anemia (n = 12) had an abnormal NDO, in contrast to 26/69 (38%) with neurodevelopmental impairments, particularly motor problems, in the non-anemic group, p < 0.01. CONCLUSIONS: Perinatal anemia causing moderate to severe perinatal asphyxia is associated with a higher risk for neonatal mortality. All survivors with perinatal anemia, however, showed a normal NDO in contrast to children who were born asphyxiated due to other causes. The underlying pathophysiological mechanism for the favorable NDO in the perinatal anemia group needs further elucidation.


Assuntos
Anemia Neonatal/fisiopatologia , Asfixia Neonatal/fisiopatologia , Desenvolvimento Infantil , Deficiências do Desenvolvimento/etiologia , Anemia Neonatal/mortalidade , Asfixia Neonatal/mortalidade , Asfixia Neonatal/terapia , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Feminino , Humanos , Hipotermia Induzida , Lactente , Recém-Nascido , Masculino , Parto , Análise de Regressão , Estudos Retrospectivos
15.
Rev Gaucha Enferm ; 39: e20170084, 2018 Jul 23.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30043942

RESUMO

OBJECTIVE: To describe the epidemiological characteristics of perinatal deaths through the actions of the Unified Health System. METHODS: This is a descriptive study of temporal analysis with a population of perinatal deaths of mothers residing in Recife, Brazil, from 2010 to 2014. A list was used to classify the preventable diseases and the variables were analysed using Epi lnfo™ version 7. RESULTS: The perinatal deaths totalled 1,756 (1,019 foetal and 737 neonatal premature) with a reduction of neonatal deaths (-15.8%) and an increase of foetal deaths (12.1%) in the study period. The main causes of death were foetus and newborn affected by the mother´s condition and asphyxia/hypoxia at birth. CONCLUSIONS: Most deaths were avoidable, especially in the group of appropriate care to mothers during pregnancy. Faults in the care provided to women at birth explain the percentage of deaths caused by asphyxia/hypoxia. The reduction of preventable perinatal mortality is associated with the increased access and quality of care, which ensures health promotion, disease prevention, treatment and specific and timely care.


Assuntos
Programas Nacionais de Saúde , Morte Perinatal/prevenção & controle , Mortalidade Perinatal , Adulto , Asfixia Neonatal/mortalidade , Brasil/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Escolaridade , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Serviços de Saúde Materno-Infantil , Mortalidade Perinatal/tendências , Gravidez , Cuidado Pré-Natal , Natimorto/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
17.
Resuscitation ; 129: 1-5, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29802862

RESUMO

BACKGROUND: Birth asphyxia, defined as 5-minute Apgar score <7 in apneic newborns, is a major cause of newborn mortality. Heart rate (HR) response to ventilation is considered an important indicator of effective resuscitation. OBJECTIVES: To describe the relationship between initial HR in apneic newborns, HR responses to ventilation and 24-h survival or death. METHODS: In a Tanzanian hospital, data on all newborns ≥34 weeks gestational age resuscitated between June 2013-January 2017 were recorded using self-inflating bags containing sensors measuring ventilation parameters and expired CO2, dry-electrode electrocardiography sensors, and trained observers. RESULTS: 757 newborns of gestational age 38 ±â€¯2 weeks and birthweight 3131 ±â€¯594 g were included; 706 survived and 51 died. Fetal HR abnormalities (abnormal, undetectable or not assessed) increased the risk of death almost 2-fold (RR = 1.77; CI: 1.07, 2.96, p = 0.027). For every beat/min increase in first detected HR after birth the risk of death was reduced by 2% (RR = 0.98; CI: 0.97, 0.99, p < 0.001). A decrease in HR to <100 beats/minute when ventilation was paused increased the risk of death almost 2-fold (RR = 1.76; CI: 0.96, 3.20, p = 0.066). An initial rapid increase in HR to >100 beats/min in response to treatment reduced the risk of dying by 75% (RR = 0.25; CI: 0.14, 0.44, p < 0.001). A 1% increase in expired CO2 was associated with 28% reduced risk of death (RR = 0.72; CI: 0.62,0.85, p < 0.001). CONCLUSIONS: The risk of death in apneic newborns can be predicted by the fetal HR (absent or abnormal), initial newborn HR (bradycardia), and the HR response to ventilation. These findings stress the importance of reliable fetal HR monitoring during labor and providing effective ventilation following birth to enhance survival.


Assuntos
Asfixia Neonatal/terapia , Respiração com Pressão Positiva/métodos , Ressuscitação/métodos , Asfixia Neonatal/mortalidade , Peso ao Nascer , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , População Rural , Taxa de Sobrevida/tendências , Tanzânia/epidemiologia , Fatores de Tempo , Resultado do Tratamento
18.
J Neonatal Perinatal Med ; 11(2): 173-178, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29843267

RESUMO

BACKGROUND: Advances in treating the injured neonatal brain have given rise to neuro-intensive care services for newborns. This study assessed the impact of one such service in a cohort of newborns treated with therapeutic hypothermia. METHODS: Our newborn neuro-intensive care service was started in November 2012. From January 2008 to October 2016, a cohort of 158 newborns was treated with therapeutic hypothermia, 29 before and 129 after the inception of the service. This study compared the outcomes of newborns treated by the service with those of newborns treated before. Multivariate regression analysis associating length-of-stay and treatment pre- or post-service was adjusted for five-minute Apgar score, time-to-target temperature, seizures, and mortality. RESULTS: The neuro-intensive care service was also associated with a decrease in mortality (17% before service to 5.4% with the service, p = 0.03), though this association is likely multifactorial and reflects the application of therapeutic hypothermia to a wider variety of patients. However, the service was independently associated with decreased length-of-stay (mean 22 pre-service to 13 days with the service, p < 0.0005.)CONCLUSIONS:The service educated referring hospitals in recognizing therapeutic hypothermia candidates, which increased the number of treated newborns, and created a number of procedures to streamline the delivery of treatment. While the increasing number and variety of patients treated could spuriously reduce length-of-stay, length-of-stay was still significantly reduced after adjustment, providing evidence that neuro-intensive care services for newborns can improve hospital outcomes.


Assuntos
Asfixia Neonatal/terapia , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/terapia , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Convulsões/terapia , Índice de Apgar , Asfixia Neonatal/mortalidade , Regulação da Temperatura Corporal , Feminino , Humanos , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Neuroproteção/fisiologia , Convulsões/mortalidade
19.
BMC Pediatr ; 18(1): 167, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-29764391

RESUMO

BACKGROUND: About three - quarters of all neonatal deaths occur during the first week of life, with over half of these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy referral hospital. METHODS: Direct observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were computed and chi - square tests were used to test associations between the newborn outcome at 1 h and the NR processes for the observed newborns. Logistic regression models assessed the relationship between the survival status at 1 h versus the NR processes and newborn characteristics. RESULTS: Nurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations. Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation. However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance. About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08-7.76), keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22-8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12-0.96) and gestation age (P = 0.007, OR = 1.38, CI = 1.10-1.75) were associated with newborn outcome at 1 h. CONCLUSIONS: Mentorship and regular cost - effective NR trainings with focus on maintaining the warm chain during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs providing NR.


Assuntos
Asfixia Neonatal/terapia , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Gerais/normas , Tocologia , Recursos Humanos de Enfermagem no Hospital , Avaliação de Resultados da Assistência ao Paciente , Ressuscitação/métodos , Adulto , Asfixia Neonatal/mortalidade , Lista de Checagem , Protocolos Clínicos , Estudos Transversais , Humanos , Recém-Nascido , Capacitação em Serviço , Quênia , Corpo Clínico Hospitalar/educação , Pessoa de Meia-Idade , Tocologia/educação , Recursos Humanos de Enfermagem no Hospital/educação , Respiração Artificial/métodos , Adulto Jovem
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