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1.
Afr J Paediatr Surg ; 20(1): 46-50, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36722569

RESUMO

Context: Gastroschisis is a common abdominal wall defect faced by paediatric surgeons worldwide. Early gastroschisis detection, access to improved neonatal intensive care, parenteral nutrition and surgical techniques have led to a reported improvement in mortality of between 4% and 8% in high-income countries. In low to middle income countries, such as in Southern Africa, however, there is as much as 84% mortality among patients with gastroschisis. This is thought to be due to factors such as lack of antenatal screening, access to neonatal intensive care services and parenteral nutrition. Aims: The purpose of this study was to calculate the prevalence of gastroschisis and report on its neonatal mortality in the Eastern Cape Province of South Africa. Settings and Design: A retrospective observational study on all neonates with gastroschisis, presenting to a tertiary facility offering paediatric surgical services within the Eastern Cape Province from 1 January 2016 to 31 December 2018. Subjects and Methods: A convenience sampling method was used in retrieving patient files for the study period. Statistical analysis used: Stata version 13. Results: Thirty-seven neonates were included in the study. The prevalence of gastroschisis ranged from 0.07% to 0.18% throughout the 3-year study. The majority (81%) of the neonates were outborn and delivered by mode of caesarean section. Nearly 60% (n = 22) were female. 54% (n = 20) of neonates died within the neonatal period. Conclusions: The majority of the neonates in this study were outborn and female. Although their mortality rate was higher than reported in high-income countries, it was much improved from what is reported in the low to middle income countries.


Assuntos
Gastrosquise , Gravidez , Recém-Nascido , Criança , Feminino , Humanos , Masculino , Gastrosquise/epidemiologia , Gastrosquise/cirurgia , Prevalência , Cesárea , Mortalidade Infantil , Nutrição Parenteral
2.
JAMA Netw Open ; 6(1): e2250593, 2023 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-36656583

RESUMO

Importance: Active postnatal care has been associated with center differences in survival among periviable infants. Regional differences in outcomes among periviable infants in the US may be associated with differences in active postnatal care. Objective: To determine if regions with higher rates of active postnatal care will have higher gestational age-specific survival rates among periviable infants. Design, Setting, and Participants: This cohort study included live births from 22 to 25 weeks' gestation weighing 400 to 999 g in the US Centers for Disease Control and Prevention (CDC) WONDER 2017 to 2020 (expanded) database. Infants with congenital anomalies were excluded. Active postnatal care was defined using the CDC definition of abnormal conditions of newborn as presence of any of the following: neonatal intensive care unit (NICU) admission, surfactant, assisted ventilation, antibiotics, and seizures. Data were analyzed from August to November 2022. Main Outcomes and Measures: Regional gestational age-specific survival rates were compared with rates of active postnatal care in the 10 US Health and Human Services regions using Kendall τ test. Results: We included 41 707 periviable infants, of whom 32 674 (78%) were singletons and 19 467 (46.7%) were female. Among those studied 34 983 (83.9%) had evidence of active care, and 26 009 (62.6%) survived. Regional rates of active postnatal care were positively correlated with regional survival rates at 22 weeks' gestation (rτ[8] = 0.56; r2 = 0.31; P = .03) but the correlation was not significant at 23 weeks' gestation (rτ[8] = 0.47; r2 = 0.22; P = .07). There was no correlation between active care and survival at 24 or 25 weeks' gestation. Regional rates of both NICU admission and assisted ventilation following delivery were positively correlated with regional rates of survival at 22 weeks' gestation (both P < .05). Regional rates of antenatal corticosteroids exposure were also positively correlated with regional rates of survival at 22 weeks' gestation (rτ[8] = 0.60; r2 = 0.36; P = .02). Conclusions and Relevance: In this cohort study of 41 707 periviable infants, regional differences in rates of active postnatal care, neonatal intensive care unit admission, provision of assisted ventilation and antenatal corticosteroid exposure were moderately correlated with survival at 22 weeks' gestation. Further studies focused on individual-level factors associated with active periviable care are warranted.


Assuntos
Terapia Intensiva Neonatal , Cuidado Pós-Natal , Recém-Nascido , Lactente , Humanos , Feminino , Gravidez , Masculino , Estudos de Coortes , Idade Gestacional , Mortalidade Infantil , Corticosteroides
3.
BMC Pediatr ; 23(1): 31, 2023 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658521

RESUMO

BACKGROUND: Sudden Unexpected Infant Deaths (SUID) can occur between 1 month and 1 year of age and are inequitably distributed with a greater burden in populations with numerous health disparities. Modifying the infant sleep environment to promote safe sleep is the most effective risk reduction strategy to reduce SUID. The provision of baby boxes with a mattress and infant supplies has been part of a larger anti-poverty social justice maternity package for decades in Finland. While infant mortality rates have generally improved after the maternity package was introduced, little is known about whether the provision of the baby box increased safe sleep practices. The purpose of the study was to evaluate whether the provision of a Finnish-style baby box reinforced safe infant sleep practice in the home in a low-resource community in Ecuador. METHODS: In this longitudinal randomized controlled trial all participants received the same safe sleep education in their third trimester of pregnancy (n = 100). This was followed by randomization into two groups; the control received a diaper bag and newborn gifts, and the intervention group received a baby box and the same gifts at each timepoint. Four infant sleep practices (room sharing, bed sharing/co-sleeping, position, and soft items in the sleep environment) were assessed at 1 month and 1 months post-delivery during a home visit where safe sleep education was also reinforced with both groups. RESULTS: Those in the baby box group were 2.5 times more likely to report safe sleep practices compared with mothers in the diaper bag group at 1 month (odds ratio [OR] = 2.45 and 95% confidence interval [CI]: 1.03-5.86; χ2 = 4.1, p = .043). The group difference was also present at 6-months post-birth: those in the baby box group were 2.9 times more likely to report safe sleep practices compared with those in the diaper bag group (OR = 2.86 and 95% CI: 1.16-7.05; χ2 = 5.2, p = .022). CONCLUSIONS: While not all participants used the box regularly, the mothers who received the box were more likely to practice safe sleep at 1 month and 6 months. This suggests the baby box may have served as an important prompt towards safer infant sleep practice. TRIAL REGISTRATION: (Clinical Trial Registry, per clinicaltrials.gov : not applicable under 42 CFR 11.22(b) as the study Facility Location was not in the United States (took place in Ecuador), does not involve FDA IND or IDE, and does not involve a drug, biological or device product that is manufactured in and exported from the US for study in another country. The University of San Francisco Quito, Research Ethics Committee in Human Beings approved the study, #2017- 127 M. The University of Kentucky Office of Research Integrity also approved the study, IRB # 42965).


Assuntos
Morte Súbita do Lactente , Lactente , Recém-Nascido , Criança , Humanos , Feminino , Estados Unidos , Gravidez , Equador , Morte Súbita do Lactente/prevenção & controle , Mães , Sono , Mortalidade Infantil , Cuidado do Lactente
4.
Med J Malaysia ; 78(1): 25-31, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36715187

RESUMO

INTRODUCTION: The under-five mortality (U5M) trend in Malaysia significantly declined from 30.0 per 1000 live births (1980) to 8.0 per 1000 live births (2004), and the trend plateaued over the next two decades. Stillbirths and neonatal deaths were the major contributors to U5M. Scarce literature addressing factors associated with preventable U5M in Malaysia. The objective of this study was to describe preventable stillbirths and neonatal mortality, the associated factors and recommendation for improvement. MATERIALS AND METHODS: The U5M surveillance data from 2015 to 2017 was retrieved for Malaysian cases of stillbirths and neonatal deaths with multiple pregnancies as exclusion. Stillbirth and neonatal death cases were analysed descriptively for socio-demographic and clinical characteristics. Logistic regressions were performed to identify the associated factors. RESULTS: There were 15,444 cases selected for analysis, of which 55% of stillbirths and 45% of neonatal deaths. There were 21% of preventable deaths (U5M) and the major contributing causes of preventable stillbirths and neonatal deaths were classified as perinatal death (82.5%), infectious and parasitic diseases (4.1%) and congenital malformations (3.5%). The birth weight (aOR 6.03, 95% CI: 4.14-8.79), hypertensive mother (aOR 1.88, 95% CI: 1.66-2.12) and instrumental delivery (aOR 1.64, 95% CI: 1.16-2.31) were significantly associated with preventable stillbirths and neonatal deaths. Higher household income (>RM3000 per month) was noted as a protective factor (aOR 0.79, 95% CI:0.69,0.89). Mothers with ethnicities other thanBumiputera, single mothers and housewives were identified as the group of mothers with higher odds of poor perinatal services. Among the 3242 cases of preventable stillbirths and neonatal deaths with a complete documented level of adequacy and quality of healthcare, the most frequently identified factors were due to insufficient antenatal care (ANC) (20.4%), non-compliance with medical advice (12.3%) and unsuitable place of delivery (8.6%). CONCLUSION: Increasing trend of preventable stillbirths and neonatal deaths was noted over 3 years (2015-2017), and one-fifth was related to insufficient ANC service-related factors. Remedial measures in improving the quality of ANC services with an emphasis on the targeted high-risk maternal socio-demographic group (other Bumiputera, older antenatal mothers, nonmarried, poor family income neglected family) and enhancing ANC competency skills among the healthcare provider through adequate training are required to decrease preventable stillbirths and neonatal deaths in Malaysia.


Assuntos
Morte Perinatal , Natimorto , Recém-Nascido , Gravidez , Feminino , Humanos , Natimorto/epidemiologia , Morte Perinatal/etiologia , Morte Perinatal/prevenção & controle , Malásia/epidemiologia , Mortalidade Infantil , Mães
5.
BMC Pediatr ; 23(1): 26, 2023 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-36647037

RESUMO

BACKGROUND: Sub-Saharan African countries are a high-burden region of neonatal mortality and showed slow progress in its reduction. In developing countries, as long as the current trend of mortality persists, achieving a sustainable development target for neonatal mortality would be challenging. The aim of this study was to detect significant geographic areas and identify community and individual-level predictors of neonatal mortality in Ethiopia to draw attention to a policy. METHODS: A weighted total sample of 24,136 mothers from the 2019 mini-Ethiopian demographic and health survey data were included in the analysis. Global Moran's I statistics was run to check the clustering of neonatal mortality and then kriging interpolation was done to predict the magnitude of neonatal mortality in Ethiopia. In addition, SaTScan analysis was also executed to identify hot spot clusters of neonatal mortality. Finally, a multilevel mixed-effect logistic regression model was used to identify community and individual-level predictors of early neonatal and neonatal mortality. RESULTS: The lifetime early neonatal and neonatal mortality among mothers in Ethiopia was 5.08 (95% CI: 4.13-6.03) and 6.54 (5.55, 7.52) per 1000 births respectively. Neonatal mortality was spatially clustered in the country and the SaTScan analysis identified significant hotspot areas of neonatal mortality in the Amhara and Afar regions and some areas of the Somali and Oromia regions. Its predicted magnitude was > 8 per 1000 births in wide areas of the Amhara and Benishangul regions. A multilevel mixed-effect logistics regression analysis identified that a lower level of maternal education, being a twin neonate, and being a male neonate were predictors of both early neonatal and neonatal mortality. Whereas, the younger age of mothers predicted neonatal mortality. CONCLUSIONS: Neonatal mortality in Ethiopia is geographically clustered and sociodemographic and obstetric factors played a significant role. Policy direction should focus on evidence-based practices like midwives-led community and facility-based continuum of care from preconception to postnatal periods to possibly reduce neonatal mortality.


Assuntos
Mortalidade Infantil , Mães , Gravidez , Feminino , Recém-Nascido , Humanos , Masculino , Inquéritos Epidemiológicos , Análise Multinível , Etiópia/epidemiologia , Análise Espacial
6.
BMC Public Health ; 23(1): 32, 2023 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604673

RESUMO

BACKGROUND: There is still a gap in knowledge of the impact that child marriage could have on the mortality and morbidity of children in Afghanistan. This study used the data from the latest Afghanistan demographic health survey conducted in 2015 (ADHS) to address this gap and advance the current knowledge. METHODS: A secondary analysis of the 2015 ADHS, including the births in the past 5 years to ever-married women aged 15-24 years old, was carried out. Logistic regression analyses were employed to examine the association of child marriage (< 18y) with morbidities (diarrhea, acute respiratory infection, and fever in the last 2 weeks), mortality (neonatal, infant, child), and size at birth among the children under 5 born to women aged 15-24 years, before and after adjusting for the effect of sociodemographic and structural inequalities. RESULTS: Approximately two-thirds of births in the past 5 years belong to 15-24 years old mothers who married at ages < 18. The majority of them were born to mothers residing in rural areas (75.67%) with no education (51.68%) from poor households (39.39%). As compared to the births to women married at ages ≥ 18, there was a significantly higher likelihood of neonatal mortality among births to women married at ages < 18 (crude OR = 2.30, 95% CI: 1.52-3.49 & adjusted OR = 1.94, 95% CI: 1.25-3.01) and higher infant mortality among the births to the women married at ages ≤ 14y (crude OR = 1.94, 95% CI: 1.06-3.53). However, it disappeared for neonatal mortality after adjustment for adequacy of antenatal care (ANC) and infant mortality after adjustment for sociodemographic inequalities. CONCLUSION: Although the births to women married as a child (< 18) were more likely to die at an early age, this association disappeared after adjustment for the adequacy of ANC. Given the unavoidable practice of child marriage in Afghanistan, this finding emphasizes the importance of providing adequate ANC for young brides to prevent child mortality. In addition, strong global advocacy is required to empower and support young Afghan women in negotiating their reproductive and maternity rights with their partners by reducing social and gender-based inequalities.


Assuntos
Mortalidade Infantil , Casamento , Lactente , Recém-Nascido , Feminino , Criança , Humanos , Gravidez , Pré-Escolar , Adolescente , Adulto Jovem , Adulto , Afeganistão/epidemiologia , Mortalidade da Criança , Morbidade
7.
Trials ; 24(1): 5, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36597115

RESUMO

BACKGROUND: Mass drug administration (MDA) of azithromycin (AZI) has been shown to reduce under-5 mortality in some but not all sub-Saharan African settings. A large-scale cluster-randomized trial conducted in Malawi, Niger, and Tanzania suggested that the effect differs by country, may be stronger in infants, and may be concentrated within the first 3 months after treatment. Another study found no effect when azithromycin was given concomitantly with seasonal malaria chemoprevention (SMC). Given the observed heterogeneity and possible effect modification by other co-interventions, further trials are needed to determine the efficacy in additional settings and to determine the most effective treatment regimen. METHODS: LAKANA stands for Large-scale Assessment of the Key health-promoting Activities of two New mass drug administration regimens with Azithromycin. The LAKANA trial is designed to address the mortality and health impacts of 4 or 2 annual rounds of azithromycin MDA delivered to 1-11-month-old (29-364 days) infants, in a high-mortality and malaria holoendemic Malian setting where there is a national SMC program. Participating villages (clusters) are randomly allocated in a ratio of 3:2:4 to three groups: placebo (control):4-dose AZI:2-dose AZI. The primary outcome measured is mortality. Antimicrobial resistance (AMR) will be monitored closely before, during, and after the intervention and both among those receiving and those not receiving MDA with the study drugs. Other outcomes, from a subset of villages, comprise efficacy outcomes related to morbidity, growth and nutritional status, outcomes related to the mechanism of azithromycin activity through measures of malaria parasitemia and inflammation, safety outcomes (AMR, adverse and serious adverse events), and outcomes related to the implementation of the intervention documenting feasibility, acceptability, and economic aspects. The enrolment commenced in October 2020 and is planned to be completed by the end of 2022. The expected date of study completion is December 2024. DISCUSSION: If LAKANA provides evidence in support of a positive mortality benefit resulting from azithromycin MDA, it will significantly contribute to the options for successfully promoting child survival in Mali, and elsewhere in sub-Saharan Africa. TRIAL REGISTRATION: ClinicalTrials.gov NCT04424511. Registered on 11 June 2020.


Assuntos
Azitromicina , Administração Massiva de Medicamentos , Humanos , Lactente , Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Mortalidade Infantil , Malária/prevenção & controle , Mali/epidemiologia , Administração Massiva de Medicamentos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Sci Rep ; 13(1): 1114, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670231

RESUMO

Early neonatal mortality occurs when a newborn dies within the first seven days of life. Despite interventions, neonatal mortality remains public health problem over time in Ethiopia (33 per 1000 live births). Determinants varies on level of neonatal mortality. The study's goal was to determine magnitude of early newborn death, as well as its determinants and causes in Newborn Intensive Care Unit of Referral hospital in Ethiopia's Somali region. Health facility based retrospective study review was conducted between May 2019 to May 2021 in Shiek Hassan Yabare Referral Hospital of Jigjiga University of Ethiopia. All neonates admitted at neonatal intensive care unit (NICU) with complete data and get registered using the new NICU registration book from May 2019 to May 2021 were included. Kobo toolkit was used for data collection and analyzed in SPSS 20. The magnitude of early neonatal mortality rate was defined as death between 0 and 7 days. Logistic regression model was used to estimate maternal and neonatal characteristics as a determinant variables on neonatal mortality. The statistical significance was considered at P-value < 0.05. The magnitude of early neonatal mortality rate of Ethiopia's Somali region is estimated to be 130 per 1000 live births-that is say 130 newborn couldn't celebrate their seventh day in every 1000 live births. Hypothermia, prematurity, maternal death at birth and shorter length of stay in NICU were increasing the chance of neonatal mortality at early stage while neonatal resuscitation had shown protective effect against neonatal mortality. Similarly birth asphyxia, preterm, sepsis, and congenital abnormalities were major causes of admission and death in the NICU. The magnitude of early neonatal mortality is considerable and most of the determinants are preventable. Enhancing quality of intra-partum and NICU care including infection prevention, managing hypothermia and neonatal resuscitation as per the national standard within the first golden hour is key.


Assuntos
Hipotermia , Morte Perinatal , Feminino , Recém-Nascido , Humanos , Lactente , Estudos Retrospectivos , Etiópia/epidemiologia , Somália/epidemiologia , Ressuscitação , Mortalidade Infantil , Hospitais , Unidades de Terapia Intensiva Neonatal
9.
BMC Public Health ; 23(1): 87, 2023 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-36631798

RESUMO

BACKGROUND: Ending preventable deaths of newborns and children under five by 2030 is among the United Nations Sustainable Development Goals. This study aimed to describe infant mortality rate due to preventable causes in Rio Grande do Sul (RS), the Southernmost state in Brazil. With 11,329,605 inhabitants and 141,568 live births in 2017, RS was the fifth most populous state in the country. METHOD: An ecological and cross-sectional statewide study, with data extracted from records of the Mortality Information System, Death Certificates, and Live Birth Certificates for the year 2017. Preventability was estimated by applying the List of Causes of Deaths Preventable through Intervention of SUS (acronym for Sistema Unico de Saude - Brazilian Unified Health System) Intervention. Rates of preventable infant mortality (PIMR), preventable early neonatal mortality (PENMR), preventable late neonatal mortality (PLNMR), and preventable post-neonatal mortality (PPNMR) per 1000 live births (LB) were quantified. Incidence ratios, according to contextual characteristics (human development index of the health region and of the municipality; Gini index of the municipality), maternal characteristics at the time of delivery (age, education, self-reported skin color, presence of a partner, number of antenatal care consultations, and type of delivery), and characteristics of the child at the time of birth (gestational age, weight, and pregnancy type) were calculated. RESULTS: In 2017, there were 141,568 live births and 1425 deaths of infants younger than 1 year old, of which 1119 were preventable (PIMR = 7.9:1000 LB). The PENMR, PLNMR, and PPNMR were 4.1:1000 LB; 1.5:1000 LB; and 2.3:1000 LB, respectively. More than 60% of deaths in the first week and 57.5% in the late neonatal period could be reduced through adequate care of the woman during pregnancy. The most frequent preventable neonatal causes were related to prematurity, mainly acute respiratory syndrome, and non-specified bacterial septicemia. In the post-neonatal period, 31.8% of deaths could be prevented through adequate diagnostic and treatment. CONCLUSIONS: The strategies needed to reduce preventable infant deaths should preferably focus on preventing prematurity, through adequate care of the woman during pregnancy.


Assuntos
Mortalidade Infantil , Recém-Nascido Prematuro , Criança , Lactente , Recém-Nascido , Humanos , Gravidez , Feminino , Estudos Transversais , Brasil/epidemiologia , Morte do Lactente/prevenção & controle , Causas de Morte
10.
Gynecol Obstet Fertil Senol ; 51(2): 123-128, 2023 Feb.
Artigo em Francês | MEDLINE | ID: mdl-36539075

RESUMO

OBJECTIVES: To compare the mortality of monochorionic-monoamniotic (MCMA) and monochorionic-biamniotic (MCBA) twin pregnancies, from 14weeks of gestation to 28th day of life, before and after exclusion of major congenital malformations. METHODS: We conducted a retrospective cohort study in two level 3 maternity units of the Hospices civils de Lyon (France) including all patients with a monochorionic twin pregnancy between January 2013 and December 2020. We excluded TRAP sequences and conjoined twins. RESULTS: A total of 38 MCMA and 658 MCBA pregnancies were included. We showed an increase in overall mortality in the MCMA group compared to the MCBA group (31.6% versus 16.4%, P=0.03) even after exclusion of major congenital malformations (20.3% versus 9.5%, P=0.01). The main cause of mortality found in the MCMA group was the occurrence of unexpected IUGR. CONCLUSIONS: MCMA pregnancies have a higher foetal and neonatal mortality rate than MCBA pregnancies even after exclusion of congenital malformations related to the occurrence of unexpected MFIU.


Assuntos
Gravidez de Gêmeos , Gêmeos Monozigóticos , Feminino , Humanos , Recém-Nascido , Gravidez , Mortalidade Infantil , Cuidado Pré-Natal , Estudos Retrospectivos
11.
Health Res Policy Syst ; 20(1): 141, 2022 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-36578090

RESUMO

The WHO ACTION-I trial, the largest placebo-controlled trial on antenatal corticosteroids (ACS) efficacy and safety to date, reaffirmed the benefits of ACS on mortality reduction among early preterm newborns in low-income settings. We discuss here lessons learned from ACTION-I trial that are relevant to a strategy for ACS implementation to optimize impact. Key elements included (i) gestational age dating by ultrasound (ii) application of appropriate selection criteria by trained obstetric physicians to identify women with a likelihood of preterm birth for ACS administration; and (iii) provision of a minimum package of care for preterm newborns in facilities. This strategy accurately identified a large proportion of women who eventually gave birth preterm, and resulted in a 16% reduction in neonatal mortality from ACS use. Policy-makers, programme managers and clinicians are encouraged to consider this implementation strategy to effectively scale and harness the benefits of ACS in saving preterm newborn lives.


Assuntos
Nascimento Prematuro , Recém-Nascido , Gravidez , Feminino , Humanos , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal , Corticosteroides/uso terapêutico , Mortalidade Infantil , Organização Mundial da Saúde
12.
Rev. urug. enferm ; 17(2): 1-14, dic. 2022.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1391902

RESUMO

Objetivo: Avaliar as características das internações de recém-nascidos em uma unidade de terapia intensiva neonatal do extremo sul do Brasil durante um curto período de tempo. Método: Estudo observacional, com 85 neonatos, por dados secundários de pacientes internados na Unidade de Terapia Intensiva Neonatal, nos meses de maio de 2020 a outubro de 2020. Resultados: A prevalência das internações foi do sexo masculino, com diagnóstico de prematuridade, que pesavam entre 1500g e 2499g, não receberam leite materno na primeira hora de vida, receberam visitas dos pais, colo e leite materno durante a internação. As mães tinham mais de 6 consultas de pré-natal e os bebês nasceram de cesárea. Conclusão: O atendimento prestado de forma holística, baseado na ciência e maneira humanizada aos recém-nascidos e aos pais, pode reduzir a mortalidade infantil, trazer maior segurança aos pais e confi ança na equipe assistencial, além de evitar complicações futuras no desenvolvimento infantil.


Objetivo: Evaluar las características de las hospitalizaciones de recién nacidos en una unidad de cuidados intensivos neonatales en el extremo sur de Brasil durante un corto período de tiempo. Método: Estudio observacional, con 85 neonatos, con base en datos secundarios de pacientes hospitalizados en la Unidad de Cuidados Intensivos Neonatales, de mayo de 2020 a octubre de 2020. Resultados: La prevalencia de hospitalizaciones fue del sexo masculino, con diagnóstico de prematuridad, que pesaron entre 1500g y 2499g, no recibió leche materna en la primera hora de vida, recibió visitas de los padres, regazo y leche materna durante la hospitalización. Las madres tuvieron más de 6 consultas prenatales y los bebés nacieron por cesárea. Conclusión: La atención brindada de forma holística, basada en la ciencia y de forma humanizada a los recién nacidos y a los padres, puede reducir la mortalidad infantil, brindar mayor seguridad a los padres y confi anza en el equipo de atención, además de prevenir futuras complicaciones en el desarrollo del niño.


Objective: To evaluate the characteristics of hospitalizations of newborns in a neonatal intensive care unit in the extreme south of Brazil during a short period of time. Method: Observational study, with 85 neonates, based on secondary data from patients hospitalized in the Neonatal Intensive Care Unit, from May 2020 to October 2020. Results: The prevalence of hospitalizations was male, with a diagnosis of prematurity, who weighed between 1500g and 2499g, did not receive breast milk in the fi rst hour of life, received visits from parents, lap and breast milk during hospitalization. The mothers had more than 6 prenatal consultations and the babies were born by cesarean section. Conclusion: The care provided in a holistic way, based on science and in a humanized way to newborns and parents, can reduce infant mortality, bring greater security to parents and confidence in the care team, in addition to preventing future complications in child development.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Criança , Adolescente , Adulto , Adulto Jovem , Qualidade da Assistência à Saúde , Unidades de Terapia Intensiva Neonatal , COVID-19/epidemiologia , Hospitalização , Fatores Socioeconômicos , Fatores de Tempo , Brasil/epidemiologia , Mortalidade Infantil , Estudos Retrospectivos , Estudos Longitudinais , Humanização da Assistência , Saúde Holística
13.
PLoS One ; 17(12): e0279622, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36584129

RESUMO

INTRODUCTION: Neonatal sepsis can be either early (<7 Days) or late-onset ≥7days) neonatal sepsis depending on the day of the occurrence. Despite the decrement in early onset neonatal sepsis, there is still an increment in late-onset neonatal sepsis. Ethiopian demography and health survey report showed an increment in neonatal mortality in 2019/20. OBJECTIVE: The objective of this study was to assess the determinants of late-onset neonatal sepsis among neonates admitted to the neonatal intensive care unit at Arba-Minch general hospital, southern Ethiopia. METHODS: An institution based study was conducted from March 1, 2021, to June 30, 2021 in Arba-Minch general hospital. Cases were neonates diagnosed with late-onset neonatal sepsis with their index mother chart and controls were neonates admitted with other diagnoses at the same period. Cases and controls were selected consecutively. Data extraction tool and interview which was developed by reviewing different kinds of literature was used to collect data. Data were entered by using Epi data version 3.1software and transformed to Statistical Package for Social Sciences version 25 software for analysis. The binary logistic regression model was used to assess determinants and variables with a p-value <0.2 were transformed to multivariable logistic regression then, a p-value < 0.05 with 95% confidence interval were used to declare significant association with the outcome variable. RESULT: A total of 180 subjects (60 cases and 120 controls) were included in this study. The mean age of neonates was 12.1 days with standard deviations of 4.3. Multivariable logistic regression analysis showed that; history of either sexually transmitted disease /urinary tract infection [AOR = 9.4; 95%CI(3.1-28.5)], being preterm (gestational age of <37 weeks) [AOR = 4.9; 95%CI (1.7-13.7)], use of endotracheal intubation/mechanical intubation [AOR = 8.3; 95%CI (1.8-26.4)]and either mixed types of infant feeding option or formula feeding before admission [AOR = 12.7; 95%CI(3.7-42.8)]were significantly associated with late-onset neonatal sepsis. CONCLUSION AND RECOMMENDATIONS: This study revealed that antenatal, intrapartum and postpartum factors have shown an association with late-onset neonatal sepsis. It is recommended to strengthen counseling and advice to mothers with specific risk factors of late-onset neonatal sepsis.


Assuntos
Hospitais Gerais , Sepse Neonatal , Lactente , Recém-Nascido , Humanos , Feminino , Gravidez , Etiópia/epidemiologia , Sepse Neonatal/epidemiologia , Unidades de Terapia Intensiva Neonatal , Mortalidade Infantil
14.
Rev Peru Med Exp Salud Publica ; 39(2): 178-184, 2022.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-36477318

RESUMO

OBJECTIVE: This study aimed to analyze inequality in the neonatal mortality rate (NMR) between departments in Peru, generated by poverty and education, in the years 2011 and 2019. MATERIALS AND METHODS: Ecological study based on the analysis of social inequalities in health, recommended by the World Health Organization. The health indicator was the NMR. Poverty, measured as the existence of at least one unmet basic need per department, and education, average years of study of women of childbearing age per department, were selected to stratify equity. We calculated the absolute inequality gap (AG), the relative inequality gap (RG) and the health concentration index (HCI). RESULTS: A higher NMR was found in departments with greater poverty and less education. In the NMR generated by poverty, the AG decreased from 8.13 to 2.24 between 2011-2019 and the RG from 2.08 to 1.31. The AG of the NMR according to education dropped from 4.50 to 2.31 and the RG from 1.62 to 1.28. The HCI registered values close to zero and with a decreasing trend; in 2019 it was 0.07 for poverty and 0.06 for education. CONCLUSIONS: There is inequality in neonatal mortality between departments in Peru according to poverty and education, which decreased between 2011 and 2019 mainly in the poor or less educated population. The Ministry of Health should continue to reduce neonatal mortality by promoting interventions with a greater population focus.


OBJETIVO: El objetivo de este estudio fue analizar la desigualdad en la TMN entre departamentos del Perú, generada por la pobreza y educación, en los años 2011 y 2019. MATERIALES Y MÉTODOS: Estudio ecológico basado en el análisis de desigualdades sociales en salud recomendada por la Organización Mundial de la Salud. El indicador de salud fue la TMN y como estratificadores de equidad se seleccionaron a la pobreza, medida como la existencia de al menos una necesidad básica insatisfecha por departamento, y a la educación, promedio de años de estudio de las mujeres en edad fértil por departamento. Se calculó la desigualdad absoluta (BA), relativa (BR) y el índice de concentración de salud (ICS). RESULTADOS: Se encontró mayor TMN en departamentos con mayor pobreza y menor educación. En la TMN generada por la pobreza la BA se redujo de 8,13 a 2,24 entre 2011-2019 y la BR de 2,08 a 1,31. La BA de la TMN según educación pasó de 4,50 a 2,31 y la BR de 1,62 a 1,28. El ICS registró valores cercanos a cero y con tendencia a la reducción; en el 2019 fue 0,07 para la pobreza y 0,06 para la educación. CONCLUSIONES: Existe desigualdad en la mortalidad neonatal entre departamentos del Perú según pobreza y la educación, habiéndose reducido entre el 2011 y 2019 principalmente en la población pobre o menos educada. El Ministerio de Salud debe continuar reduciendo la mortalidad neonatal impulsando intervenciones con mayor enfoque poblacional.


Assuntos
Mortalidade Infantil , Recém-Nascido , Feminino , Humanos , Peru/epidemiologia
15.
Rev Bras Epidemiol ; 25: e220038, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-36478211

RESUMO

OBJECTIVE: To analyze the causes of age-specific neonatal deaths and death-associated factors in the 2021 state of Rio de Janeiro birth cohort. METHODS: Retrospective cohort of live births (LB) followed up to 27 days of delivery (<24hs, 1-6 and 7-27 days). Data obtained from the Information Systems on Live Births (2021) and Mortality (2021/2022). We described the distributions of maternal and newborn characteristics and causes of death. We used multinomial regression models with hierarchical levels of determination of neonatal death. RESULTS: Of the 179,837 LB, 274 died within 24 hours, 447 within 1-6 days and 324 within 7-27 days. The neonatal mortality rate was 5.8‰ LB (CI 95%: 5.5-6.2). Neonatal survivors and deaths were heterogeneous according to the analyzed characteristics, except for the reproductive history (p<0,05). 78% of causes of death were avoidable. Causes reducible by adequate care for pregnant women (<24 hours and 1-6 days) and newborns (7-27 days) predominated. Low schooling showed a significant association for deaths between 7-27 days (ORajusted=1.3); mixed race, for deaths between 1-6 days (ORajusted=1.3), and black color for both age groups (1-6 days: ORajusted=1.5 and 7-27 days: ORajusted=1.8). Health care and biological factors of LB (intermediate and proximal levels) remained strongly associated with neonatal death, regardless of age. CONCLUSION: Causes of death, factors associated with neonatal death, and strength of association differed according to death-specific age. Preventive actions for neonatal death should consider sociodemographic vulnerabilities and intensify adequate prenatal and perinatal care.


Assuntos
Morte Perinatal , Recém-Nascido , Gravidez , Feminino , Humanos , Coorte de Nascimento , Estudos Retrospectivos , Brasil/epidemiologia , Mortalidade Infantil , Fatores Etários
16.
PLoS One ; 17(12): e0267999, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36584102

RESUMO

BACKGROUND: Neonatal mortality is the probability of dying during the first 28 days of life. Of approximately 5 million children who die in the first year of life in the world, about 3 million are within their first 28 days of birth. In Ethiopia, the neonatal mortality rate is high about 37 per 1000 live births, and the factors are not well documented. Then, this study aimed to determine the key factors that have a significant influence on neonatal mortality. METHODS: A total of 5753 neonatal mortality-related data were obtained from Ethiopia Mini Demographic and Health Survey (2019) data. A frequency distribution to summarize the overall data and Binary Logistic Regression to identify the subset of significant risk factors for neonatal mortality were applied to analyze the data. RESULTS: An estimated 36 per 1000 live children had died before the first 28 days, with the highest in the Benishangul Gumuz region (15.9%) and the lowest in Addis Ababa (2.4%). From the Binary logistic regression analysis, the odds ratio and 95% CI of age 25-34 (OR = 0.263, 95% CI: 0.106-0.653), Afar (OR = 0.384, 95% CI: 0.167-0.884), SNNPR (OR = 0.265, 95% CI: 0.098-0.720), Addis Ababa (OR = 5.741, 95% CI: 1.115-29.566), Urban (OR = 0.253, 95% CI: 0.090, 0.709), toilet facility (OR = 0.603, 95% CI: 0.404-0.900), single birth (OR = 0.261, 95% CI: 0.138-0.495), poorest (OR = 10.573, 95% CI: 2.166-51.615), poorer (OR = 19.573, 95% CI: 4.171-91.848), never breastfed (OR = 35.939, 95% CI: 25.193-51.268), public health delivery (OR = 0.302, 95% CI: 0.106-0.859), private health facility (OR = 0.269, 95% CI: 0.095-0.760). CONCLUSION: All regional states of Ethiopia, specially Benishangul Gumuz, and the Somali region must take remedial actions on public health policy, design strategies to improve facilities, and improve the capacities of stakeholders living in their region toward those major factors affecting neonatal mortality in the country.


Assuntos
Aleitamento Materno , Mortalidade Infantil , Gravidez , Recém-Nascido , Feminino , Criança , Humanos , Adulto , Etiópia/epidemiologia , Razão de Chances , Morte , Fatores de Risco
17.
PLoS One ; 17(12): e0279451, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36542646

RESUMO

INTRODUCTION: Birth asphyxia is one of the leading causes of early neonatal mortality, which causes an estimated 900,000 deaths annually. Therefore, assessing the survival status and predictors of mortality among asphyxiated neonates will be highly helpful to policymakers in designing, implementing, and evaluating programs to achieve the sustainable development goal of reducing neonatal mortality as low as 12/1,000 live births by 2030. METHODS: A facility-based retrospective cohort study was conducted among 378 asphyxiated neonates admitted to the NICU of Dessie Comprehensive Specialized Hospital from January, 2017 -December, 2019. The data were collected from eligible records by using a structured data extraction tool from March 30 -April 21, 2020. The data were cleaned manually and entered into Epi-data version 7.1.2.0, and STATA version 16 was used for the analysis. Bivariate and Multivariate Cox proportional hazard regression analysis were performed, and significant predictors were identified using 95% confidence interval and p-value <0.05. RESULT: A total of 378 neonates were followed for 2298 neonatal days, ranging from 1 to 28 days. The mortality incidence rate was 5.3/100 person-days-of observation (95% CI: 4.41, 6.29), and 32% (95% CI: 27.6%, 36.8%) of the study subjects died. Admission weight (AHR: 1.72; 95% CI: 1.09, 2.72), seizure (AHR: 1.52; 95% CI: 1.02, 2.27), neonates who received resuscitation (AHR: 2.11; 95% CI: 1.18, 3.80), and stage of asphyxia (moderate (AHR: 3.50; 95% CI: 1.55, 8.36), and severe (AHR: 11.55; 95% CI: 4.73, 28.25)) were significant predictors of neonatal mortality among asphyxiated neonates. CONCLUSION: The magnitude of neonatal mortality among asphyxiated neonates in the study area was high. Admission weight, seizure, resuscitation, and stage of asphyxia were significant predictors of mortality among neonates with asphyxia. Therefore, special attention should be given to asphyxiated neonates with low admission weight and those who had seizure. Additionally, the timing, quality, and effectiveness of resuscitation might need further assessment and evaluation.


Assuntos
Asfixia , Doenças do Recém-Nascido , Recém-Nascido , Feminino , Humanos , Etiópia/epidemiologia , Estudos Retrospectivos , Unidades de Terapia Intensiva Neonatal , Mortalidade Infantil , Hospitais , Convulsões
19.
Front Public Health ; 10: 999514, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36579062

RESUMO

Objectives: Unambiguously, Nigeria is off-track in achieving the health-related SDGs. Consequentially, this study aligns with SDG 3 which calls for "good health and wellbeing for people by ensuring healthy lives and promoting wellbeing for all at all ages". This article examines the combined effect of health expenditure and other key macro-economic factors on health indices such as maternal and newborn and child mortality in Nigeria. Contrary to existing literature, we formulated a model that predicts the level of macro-economic determinants needed to achieve the SDG targets for maternal and newborn and child mortality in Nigeria by 2030. Methodology: The study used Autoregressive Distributed Lag (ARDL), which is usually used for large T models. The study period spans from 1995 to 2020. Results: We found a significant negative relationship between health outcomes and macro-economic determinants namely, household consumption, total health expenditure, and gross fixed capital while we determined a significant positive relationship between health outcomes and unemployment. Our findings are further supported by out-of-sample forecast results suggesting a reduction in unemployment to 1.84 percent and an increase in health expenditure, gross fixed capital, household consumption, control of corruption to 1,818.87 billon (naira), 94.46 billion (naira), 3.2 percent, and -4.2 percent respectively to achieve SDG health targets in Nigeria by 2030. Policy implication: The outcome of this result will give the Nigerian government and stakeholders a deeper understanding of the workings of the macro-economic factors, concerning health performance and will help position Nigeria, and other SSA countries by extension, toward reducing maternal mortality to 70 per 100,000 and newborn and child mortality to 25 per 1,000 births by 2030. The African leaders should consider passing into law the need for improvement in macro-economic factors for better health in Africa. We also recommend that the Nigerian government should steadily increase health expenditure to reach and move beyond the forecast level for improvement in maternal and infant mortality, given the present low and unimpressive funding for the health sector in the country.


Assuntos
Mortalidade Infantil , Desenvolvimento Sustentável , Recém-Nascido , Criança , Humanos , Lactente , Nigéria , Mortalidade da Criança , Família
20.
BMC Pregnancy Childbirth ; 22(1): 981, 2022 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-36585673

RESUMO

BACKGROUND: Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions. METHODS: This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes. RESULTS: Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference. CONCLUSIONS: Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe. TRIAL REGISTRATION: The trial is registered with ClinicalTrials.gov, number NCT01824940.


Assuntos
Nascimento Prematuro , Natimorto , Lactente , Criança , Recém-Nascido , Feminino , Gravidez , Humanos , Natimorto/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Zimbábue/epidemiologia , Mortalidade Infantil , Instituições de Assistência Ambulatorial
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