Background:Preterm birth and neonatal mortality continue to pose significant public health challenges in Ghana.This study explores their temporal trends and associated determinants from 2008 to 2022.Methods:Birth reco...Background:Preterm birth and neonatal mortality continue to pose significant public health challenges in Ghana.This study explores their temporal trends and associated determinants from 2008 to 2022.Methods:Birth record data from the Ghana Demographic and Health Surveys(2008,2014,and 2022)were used to analyse trends and determinants in neonatal mortality and preterm birth aligned with World Health Organization antenatal care(ANC)guidelines using Pearson’s Chi-square test and multivariate logistic regression with statistical significance at P<0.05 and 95%confidence intervals(CI).Results:Preterm birth rate and neonatal mortality rate decreased from 13.0%to 9.1%and 27.6 to 23.7 per 1000 live births from 2008 to 2022 respectively.Lack of iron supplementation(odds ratio[OR]1.127,95%CI:1.047 to 1.967)a nutritional intervention maternal assessments(moderate/severe anaemia(OR 1.423,95%CI:1.178 to 2.051),preventive measures(Untreated malaria(OR 1.449,95%CI:1.104 to 2.411)or deworming(OR 1.267,95%CI:0.970 to 1.645)were associated with increased preterm birth risk.Attending<8 ANC visits raised the odds of preterm birth(OR 1.24,95%CI:1.03 to 1.257)and neonatal mortality(OR 1.583,95%CI:1.120 to 2.480).Conclusion:Despite reductions in preterm birth and neonatal mortality rates,substantial gaps in antenatal care remain.Strengthening the implementation of World Health Organization ANC guidelines is critical to reducing preterm birth and neonatal mortality in Ghana.展开更多
<strong>Background</strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:""><span style="font-family:Verdana;&quo...<strong>Background</strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Neonatal mortality remains a major public health problem in low income countries. The survival within the first 28 days of life remains a challenge in such countries. Many strategies have been implemented to reduce deaths in children under five especially in sub-Saharan Africa. Laquintinie Douala Hospital benefits from some of these measures including a perinatal network and an emergency voucher. We aimed to describe the main causes of neonatal deaths at Laquintinie Douala Hospital. </span><b><span style="font-family:Verdana;">Methods</span></b></span><b><span style="font-family:Verdana;">:</span></b><span style="font-family:""><span style="font-family:Verdana;"> We carried out a cross-sectional study including files of all deceased neonates in the neonatal unit during a 24 months period from January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2017 to De</span><span><span style="font-family:Verdana;">cember 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2018. Data collection included socio-demo</span></span><span style="font-family:Verdana;">graphic characteristics of the mothers and the newborns, clinical and therapeutic data and the evolution of the newborn. We used SPSS 20 software for data analysis with a </span><i><span style="font-family:Verdana;">p</span></i></span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">value less than 0.05. </span><b><span style="font-family:Verdana;">Results:</span></b></span><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">We included 270 files with an over</span><span style="font-family:""><span style="font-family:Verdana;">all mortality rate of 13.1% and a sex ratio of 1.2. The main causes of death included prem</span><span style="font-family:Verdana;">aturity (37.8%), neonatal infection (34.1%) and neonatal asph</span><span style="font-family:Verdana;">yxia (24.4%). The main factors associated with deaths included informal sector (</span><i><span style="font-family:Verdana;">OR </span></i><span style="font-family:Verdana;">= 5.49;95% </span><i><span style="font-family:Verdana;">CI </span></i><span style="font-family:Verdana;">0.86</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">34.77;</span><i><span style="font-family:Verdana;">p </span></i><span style="font-family:Verdana;">= 0.07) and a primary level of education for mothers, malaria during pregnancy (</span><i><span style="font-family:Verdana;">OR </span></i><span style="font-family:Verdana;">2.28;95% </span><i><span style="font-family:Verdana;">CI</span></i><span style="font-family:Verdana;">, 1.44</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">3.12;</span><i><span style="font-family:Verdana;">p</span></i></span><i><span style="font-family:""> </span></i><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.0001), very preterm babies (</span><i><span style="font-family:Verdana;">OR</span></i><span style="font-family:Verdana;"> 6.45;95%</span><i><span style="font-family:Verdana;"> CI </span></i><span style="font-family:Verdana;">4.68</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">- 8.89;</span><i><span style="font-family:Verdana;">p</span></i></span><i><span style="font-family:""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.001) and resuscitation (</span><i><span style="font-family:Verdana;">OR </span></i><span style="font-family:Verdana;">1.63;</span><i> </i><span style="font-family:Verdana;">95%</span><i><span style="font-family:Verdana;"> CI </span></i><span style="font-family:Verdana;">1.25</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">- 2.13;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.0001)</span></span><span style="font-family:Verdana;">.</span><i><span style="font-family:""> </span></i><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Neonatal mortality was lower than data in previous studies but remains high. This highlights </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">need </span><span style="font-family:Verdana;">for</span><span style="font-family:Verdana;"> caregiver training and improvement of antenatal visits in our setting.</span>展开更多
Introduction: Neonatal mortality represents a global health problem that has been at the core of programs developed by the World Health Organization (WHO) for more than 30 years. In our country, it represents a real s...Introduction: Neonatal mortality represents a global health problem that has been at the core of programs developed by the World Health Organization (WHO) for more than 30 years. In our country, it represents a real scourge and remains high despite the efforts made by the Ministry of Health. The goal of this study was to investigate the prevalence and causes of neonatal mortality at CHU-MEL of Cotonou in 2023. Material and Methods: This was a cross-sectional and descriptive study with retrospective data collection, carried out in the neonatology unit of the Mother and Child Teaching Hospital of Lagune (CHU-MEL) in Cotonou over a period of six months from January 1, 2023 to June 30, 2023. All neonates, premature or full-term, born alive and who died during hospitalization in the unit were included. Results: 211 cases of neonatal deaths were recorded among the 2884 neonates hospitalized in the unit during the study period, representing a hospital prevalence of 7.31%. Early neonatal mortality represented 81.5% of cases. The average age at admission was 4.6 days ± 5.3. The average weight of deceased neonates was 1609.08 ± 798.35 g. The most frequent reasons for hospitalization were represented by prematurity (60.66%) and respiratory distress (23.22%), respectively. Prematurity was the leading cause of neonatal mortality (41.7%), followed by neonatal infections (29.4%) and perinatal asphyxia (10.9%). Conclusion: The prevalence of neonatal mortality in the neonatology unit of CHU-MEL is high. Efforts to improve the quality of perinatal care departments must be intensified to reduce this prevalence.展开更多
Cox Proportional Hazard model is a popular statistical technique for exploring the relationship between the survival time of neonates and several explanatory variables. It provides an estimate of the study variables’...Cox Proportional Hazard model is a popular statistical technique for exploring the relationship between the survival time of neonates and several explanatory variables. It provides an estimate of the study variables’ effect on survival after adjustment for other explanatory variables, and allows us to estimate the hazard (or risk) of death of newborn in NICU of hospitals in River Nile State-Sudan for the period (2018-2020). Study Data represented (neonate gender, mode of delivery, birth type, neonate weight, resident type, gestational age, and survival time). Kaplan-Meier method is used to estimate survival and hazard function for survival times of newborns that have not completed their first month. Of 700 neonates in the study area, 25% of them died during 2018-2020. Variables of interest that had a significant effect on neonatal death by Cox Proportional Hazard Model analysis were neonate weight, resident type, and gestational age. In Cox Proportional Hazard Model analysis all the variables of interest had an effect on neonatal death, but the variables with a significant effect included, weight of neonate, resident type and gestational age.展开更多
This paper concerns the Log-rank test for comparing survival curves of neonatal mortality characteristic groups in River Nile State, Sudan. In this paper, log-rank test is used to compare two or more survival curves f...This paper concerns the Log-rank test for comparing survival curves of neonatal mortality characteristic groups in River Nile State, Sudan. In this paper, log-rank test is used to compare two or more survival curves for the characteristics of newborn associated with newborn death after using Kaplan-Meier methods to estimate and graph survival curves for the variable of interest as (sex of newborn, weight of newborn, gestational age, mode of delivery and resident type), at the hospital of River Nile state—Sudan, with a sample size 700 of newborn in which the admission to the Neonatal Intensive Care Unit (NICU) of those hospitals during the period 2018-2020. In term of risk of death for newborn we found that 25% of sample study for newborns who were born in River Nile State-Sudan died. In addition, we conclude that after the log-rank statistics and Kaplan-Meier methods were applied, gender does not affect the newborn’s risk of survival, while the risk of survival increases when the birth weight is greater than 4.35 kg and the gestational age is greater than 42 weeks. There is no difference in the probability of survival for newborns whether the delivery is normal or cesarean. However, newborns are significantly more likely to survive in urban areas than in rural areas.展开更多
Introduction: The birth of a baby is a moment of joy and celebration. However, the neonatal period is a very delicate phase of life. Neonatal mortality rates remain high in low-income countries. In Guinea, after 20 ye...Introduction: The birth of a baby is a moment of joy and celebration. However, the neonatal period is a very delicate phase of life. Neonatal mortality rates remain high in low-income countries. In Guinea, after 20 years, this rate has fallen from 34.2% in 1998 to 32% in 2018. Objective: To identify the main risk factors for neonatal mortality. Methods: This was an observational, analytical case-control study, lasting 6 months from January 1 to June 30, 2019, conducted at the Institut de Nutrition et de la Santé de l’Enfant (INSE) at Donka National Hospital. Results: We collected 242 cases and 242 controls, i.e. a total of 484 records. 748 patients were registered, with 32.35% deaths. 82.86% of deaths occurred in the early neonatal period. Statistical analysis revealed the main risk factors: prematurity (RQ 7.39 95% CI 3.27 - 16.61 p = 0.0000003), hypothermia (RQ 2.29 95% CI 1.51 - 3.46 p = 0.0001), acute fetal distress (RQ 2.13 95% CI 1.33 - 3.43 p = 0.0016), low birth weight (QR 1.91 95% CI 1.12 - 3.24 p = 0.016), home birth (QR 3.26 95% CI 1.25 - 8.46 p = 0.015). Conclusion: Neonatal mortality is a health problem in the INSE neonatology department. To reduce the mortality rate in this referral facility, it is essential to equip it and provide ongoing training for staff.展开更多
Objective:Integrated congenital heart disease(CHD)services were implemented in Beijing in 2022.This study analyzed prenatal diagnosis patterns and neonatal mortality data for duct-dependent CHDs before and after imple...Objective:Integrated congenital heart disease(CHD)services were implemented in Beijing in 2022.This study analyzed prenatal diagnosis patterns and neonatal mortality data for duct-dependent CHDs before and after implementation to provide insights for service optimization.Methods:We conducted a retrospective analysis of 487 cases of duct-dependent CHDs identified through the Beijing Birth Defects Monitoring System from January 2021 to December 2022.The study population included fetuses and infants from 13 weeks gestation to one year after birth.Cases underwent descriptive analysis focusing on disease occurrence,diagnostic timing,and mortality outcomes.Results:The prenatal diagnosis rate for ductdependent CHDs increased from 93.39%in 2021 to 93.91%in 2022,while delayed diagnosis rates decreased from 4.28%to 3.91%.Genetic diagnosis rates improved from 27.92%to 31.94%.Live birth rates following prenatal diagnosis increased substantially from 28.75%to 40.28%.Outcomes varied significantly by CHD subtypes,with complete transposition of the great arteries with intact ventricular septum achieving an 82.14%live birth rate,while hypoplastic left heart syndrome cases resulted in no live births.Notably,neonatal mortality decreased markedly from 7.23%to 3.03%.Conclusions:Beijing’s integrated service model for CHDs has effectively strengthened the connection between secondary and tertiary prevention strategies,reduced unnecessary pregnancy terminations,and improved neonatal survival outcomes.展开更多
Progress toward the fourth Sustainable Development Goal(SDG)-reducing child mortality under the age of five,to which all countries are committed-has been slow in several Central African countries in recent years.This ...Progress toward the fourth Sustainable Development Goal(SDG)-reducing child mortality under the age of five,to which all countries are committed-has been slow in several Central African countries in recent years.This study includes 2,886 observations from Burundi between 2019 and 2022.Early neonatal mortality(0-6 days)accounts for 50%of neonatal deaths in the country.Using survival analysis,I identified several key risk factors-notably malaria and fetal distress-as primary contributors to early neonatal mortality.Contrary to conventional wisdom,many of these health issues can be addressed with cost-effective,evidence-based interventions that do not require sophisticated skills or advanced technology,even in countries with high infant mortality rates.Improving maternal health through adequate nutrition during pregnancy,proper management of childbirth,and appropriate care of the newborn could prevent up to 32.9%of infant deaths.These findings strongly support the implementation of targeted prevention policies focused on the mother-child pair-including better monitoring of pregnancies,ensuring comprehensive vaccination coverage,and strengthening health infrastructure.展开更多
Background The most common cause of death among preterm infants in low-and middle-income countries is respiratory distress syndrome.The purpose of this review was to assess whether antenatal corticosteroids given to w...Background The most common cause of death among preterm infants in low-and middle-income countries is respiratory distress syndrome.The purpose of this review was to assess whether antenatal corticosteroids given to women at risk of preterm birth at≤34 weeks of gestation reduce rates of neonatal mortality and respiratory distress syndrome in low-and middle-income countries.Methods Two reviewers independently searched four databases including MEDLINE(through PubMed),CINAHL,Embase,and Cochrane Libraries.We did not apply any language or date restrictions.All publications up to April 2020 were included in this search.Results The search yielded 71 articles,10 of which were included in this review(3 randomized controlled trials,7 observa-tional studies,36,773 neonates).The majority of studies reported associations between exposure to antenatal corticosteroids and lower rates of neonatal mortality and respiratory distress syndrome.However,a few studies reported that antenatal corticosteroids were not associated with improved preterm birth outcomes.Conclusions Most of the studies in low-and middle-income countries showed that use of antenatal corticosteroids in hospitals with high levels of neonatal care was associated with lower rates of neonatal mortality and respiratory distress syndrome.However,the findings are inconclusive because some studies in low-resource settings reported that antenatal corticosteroids had no benefit in reducing rates of neonatal mortality or respiratory distress syndrome.Further research on the impact of antenatal corticosteroids in resource-limited settings in low-income countries is a priority.展开更多
Background The neonatal period is the most vulnerable period during childhood,with the risk of death being the highest even in developed countries/regions.Hong Kong’s neonatal mortality(1‰)is among the world’s lowe...Background The neonatal period is the most vulnerable period during childhood,with the risk of death being the highest even in developed countries/regions.Hong Kong’s neonatal mortality(1‰)is among the world’s lowest and has remained similar for 15 years.This study aimed to explore neonatal deaths in Hong Kong in detail and determine whether neonatal mortality is reducible at such a low level.Methods Live births in public hospitals in Hong Kong during 01 Jan 2006–31 Dec 2017 were included.Relevant data were extracted from the electronic medical records.Gestational age-specific mortality was calculated,and the trends were analyzed using the Cochran–Armitage trend test.Causes of death were summarized,and risk factors were identified in multivariate logistic regression analysis.Results In 490,034 live births,755 cases(1.54‰)died during the neonatal period,and 293(0.6‰)died during the post-neonatal period.The neonatal mortality remained similar overall(P=0.17)and among infants born at 24–29 weeks’gestation(P=0.4),while it decreased in those born at 23(P=0.04),30–36(P<0.001)and≥37(P<0.001)weeks’gestation.Neonates born at<27 weeks’gestation accounted for a significantly increased proportion among cases who died(27.6%to 51.9%),with hemorrhagic conditions(24%)being the leading cause of death.Congenital anomalies were the leading cause of death in neonates born≥27 weeks’gestation(52%),but its cause-specific mortality decreased(P=0.002,0.6‰to 0.41‰),with most of the decrease attributed to trisomy 13/18 and multiple anomalies.Conclusion Reduction of neonatal mortality in developed regions may heavily rely on improved quality of perinatal and neonatal care among extremely preterm infants.展开更多
Background:To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants(≤1500 g)born by cesarean with those by vaginal delivery.Methods:In this retrospective,case...Background:To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants(≤1500 g)born by cesarean with those by vaginal delivery.Methods:In this retrospective,case-control study,we evaluated neonatal mortality,medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight(VLBW)infants born between January 2005 and December 2010.Of the 710 infants,351 were born by the cesarean and 359/710 by vaginal route.Results:There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group[56/351(15.9%)vs.71/359(19.8%),P=0.20].VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route[221/351(63.0%)vs.178/359(49.6%),P<0.001].There were no differences in other neonatal morbidities,including intraventricular hemorrhage[126/351(35.9%)vs.134/359(37.3%),P=0.69],bronchopulmonary dysplasia[39/351(11%)vs.31/359(8.6%),P=0.38]and necrotising enterocolitis[40/351(11.4%)vs.32/359(8.9%),P=0.32]between the two groups.The incidence of poor neurodevelopment after cesarean delivery was similar to that after vaginal delivery[105/351(29.9)vs.104/359(29.0%),P=0.78].Conclusions:In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants.Moreover,the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants.The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.展开更多
High incidences of pre-weaning mortality continue to limit global sheep production,constituting a major economic and welfare concern.Despite significant advances in genetics,nutrition,and management,the proportion of ...High incidences of pre-weaning mortality continue to limit global sheep production,constituting a major economic and welfare concern.Despite significant advances in genetics,nutrition,and management,the proportion of lamb deaths has remained stable at 15–20%over the past four decades.There is mounting evidence that melatonin can improve outcomes in compromised ovine pregnancies via enhanced uterine bloodflow and neonatal neuroprotection.This review provides an overview of the major risk factors and underlying mechanisms involved in perinatal lamb mortality and discusses the potential of melatonin treatment as a remedial strategy.Supplementing pregnant ewes with melatonin enhances uterine bloodflow and fetal oxygenation,and potentially birthweight and neonatal thermogenic capacity.Melatonin freely crosses the ovine placenta and blood-brain barrier and provides neuroprotection to the fetal lamb during periods of chronic and acute hypoxia throughout gestation,with improved behavioural outcomes in hypoxic neonates.The current literature provides strong evidence that maternal melatonin treatment improves outcomes for lambs which experience compromised in utero development or prolonged parturition,though to date this has not been investigated in livestock production systems.As such there is a clear basis for continued research into the effects of maternal melatonin supplementation during gestation on pre-weaning survival under extensive production conditions.展开更多
Considering the severe impacts of genetic bottlenecks and small numbers of founders in populations of reintroduced animals, it is necessary to study inbreeding and its effect on fitness in species of conservation conc...Considering the severe impacts of genetic bottlenecks and small numbers of founders in populations of reintroduced animals, it is necessary to study inbreeding and its effect on fitness in species of conservation concern. Pere David＇s deer is one of few large mammal species extinct in the wild but safely preserved in captivity. Its specific background gives us the opportunity to study the relationships between heterozygosity and neonatal fitness in relocated populations. We employed five microsatellite loci to explore heterozygosity-fitness correlations in a population of Pere David＇s deer at the Beijing Milu Ecological Research Center. We observed associations between microsatellite-based variables sMLH, IR, MD^2 and HL, and two components of fitness ex- pressed early in life （birth weight and the neonatal mortality of 123 Pere David＇s deer calves born over six consecutive years）. We found that neonatal mortality was 19.1% - 7.6%, not higher than the 19% or 18% reported in other ungulates. The heterozygosity of calves was not associated with neonatal mortality, nor birth weight. Our study implies that low genetic variability of microsa- l：ellite loci has no overt effect on birth weight and neonatal mortality in reintroduced populations of P^re David＇s deer [Current Zoology 59 （2）： 249-256, 2013].展开更多
<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The neonatal mortality rate in the Central African Republic (CAR) is 42.3 pe...<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The neonatal mortality rate in the Central African Republic (CAR) is 42.3 per 1000 live births in 2017, indicating that CAR is with the highest number of newborn deaths. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> T</span></span><span style="font-family:Verdana;">he objective is t</span><span style="font-family:""><span style="font-family:Verdana;">o clarify the risk factors of neonatal deaths in this area. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> A case-control study with retrospective data collection. Targets were newborns >7 days, hospitalized and dead (cases), and newborns admitted after the respective case during the study period and discharged before the 7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> day of life. This study was carried out between 2016 and 2018 in the neonatal unit of the “Complexe Hospitalier Universitaire Pédiatrique de Bangui” (CHUPB), the only national hospital for newborns care in the CAR. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> We included 902 newborns, with 451 cases of early neonatal death and 451 controls. 4168 newborns were admitted to the neonatology unit with 621 early death cases;a lethality rate of 14.9%. Early neonatal deaths factors were: newborns with low birth weight (OR = 22.59;95% CI [15.93 - 32.04];</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">P < 0.001);mothers who did not attend antenatal care (OR = 5.54;95% CI [3.95 - 7.79];P < 0.001), home delivery (OR = 0.70;95% CI [0.03 - 0.15];P < 0.001);young maternal age <</span><span style="font-family:""> </span><span style="font-family:Verdana;">25 years (OR = 2.08;95% CI [1.58 - 2.73];P < 0.001);non-medical transport (OR = 2.14;95% CI [1.03 - 4.46];P = 0.03);origin from remote areas (OR = 5.25;95% CI [3.95 - 6.98];P < 0.001);isolated prematurity (P <</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.01);anoxo-ischemic encephalopathy (OR = 12.72;95% CI [6.54 - 34.73];P <</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.01);delivery by cesarean section (OR = 0.59;95% CI [0.41 - 0.84];P < 0.001);preterm delivery (OR = 29.36;95% CI [20.12 - 42.81];P < 0.001), and maternal lower education (OR = 5.65;95% CI [4.08 - 7.81];P < 0.001). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The early neonatal mortality rate remains high in this area. Controlling the factors mentioned above might lead to improving the survival of newborns.</span></span>展开更多
Aim: To identify the association between access to obstetric and neonatal hospital service and neonatal death rates. Method: Quantitative and retrospective research retrieved from Declaration of Live Newly-born Childr...Aim: To identify the association between access to obstetric and neonatal hospital service and neonatal death rates. Method: Quantitative and retrospective research retrieved from Declaration of Live Newly-born Children;Declaration of Death;Investigation Chart on Municipal Child Mortality, between 2000 and 2009, at the Nucleus of Information on Mortality Rates. The population studied comprised 537 neonatal deaths and mothers with residence in the municipality, and investigated by the work team of the Committee for the Investigation of Mother-Child Deaths. Data were analyzed in Epi Info 2002<sup></sup>? computer program and the Statistical Package for the Social Sciences<sup></sup>? was used. Chi-square Test and Fischer’s Exact Test were applied at p < 0.05. Results: 63.7% of 537 neonates were born in hospitals with maternities and neonatal intensive therapy unit;60.7% weighed ≤1.500 grams;76.7% had a pregnancy age of ≤36 weeks;73% died of asphyxia in the 1st minute and 73.5% died during the perinatal period. Throughout the ten years of analysis, access to hospital obstetric service without NITU reduced death rate from 25% in 2000 to 6.8% in 2009. There was a significant statistical association between place of delivery and maternal socio-demographic variables (maternal age bracket p = 0.028;schooling p = 0.000;family income p = 0.000);occupation p = 0.000) and neonatal variables (race/skin color p = 0.007;type of delivery p = 0.000;weight at birth p = 0.000;pregnancy age p = 0.000 and Apgar Score 1st minute p = 0.000 and Apgar Score 5th minute p = 0.007). Conclusion: Although the municipal government provides obstetric services and specialized neonatal care, this right is not extensive to all;gaps at different levels in mother-child care should be identified to reduce neonatal deaths.展开更多
Background & Objectives: Sustainable Development Goals (SDGs) are set up as a part of the Post Millennium Development Goals (MDGs). Then it becomes essential to review the achievement of the MDGs in India and less...Background & Objectives: Sustainable Development Goals (SDGs) are set up as a part of the Post Millennium Development Goals (MDGs). Then it becomes essential to review the achievement of the MDGs in India and lessons learned to incorporate into the SDGs. The present study reviews and predicts different components of under-five mortality rate beyond 2015 to assess the present situation and to determine the future possibilities of achieving the new targets for SDGs in India. Data and Methods: It uses available time series data on different components of U5MR from the India’s Sample Registration System (SRS). Autoregressive Integrated Moving Averages (ARIMA) model has been taken as the method of time series analysis to forecast the mortality rates beyond 2015. Results: There is a consistent pattern of faster decline in the under-five mortality compared with the neonatal mortality rate across all major states in India although neonatal mortality contributes largest share in under-five mortality. Again, share of neonatal death among under-five death is increasing steadily over the future projected years. This indicates very slow progress of reduction in neonatal mortality. Stimulating efforts with new intervention programmes will be needed to focus more on lowering neonatal mortality particularly in rural India.展开更多
<strong>Background</strong><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Neonatal sepsis is a global health problem...<strong>Background</strong><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Neonatal sepsis is a global health problem that mainly affects low- and middle-income countries. We have previously shown that early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We sought to determine the prevalence of neonatal sepsis, sepsis-related mortality, and bacterial species patterns in neonatal and young infant sepsis in this hospital.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods</span></b><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">A hospital-based study was conducted in the hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood samples from 96 babies clinically diagnosed with or at risk of sepsis were cultured using the BACTEC 9050<span style="white-space:nowrap;"><sup>®</sup> </span>machine. Clinical data including gravida, parity and antibiotic medication before delivery of mother and delivery type, gestation, birth weight and antibiotic medication status were collected for analysis. MALDI-TOF MS identified bacterial isolates, and their identities were confirmed via </span><i><span style="font-family:Verdana;">tuf</span></i><span style="font-family:Verdana;"> gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Blood cultures were positive in 28 of the babies, with 14 and 12 representing early-onset and late-onset neonatal sepsis, respectively, and two cases of unknown sepsis type. Of the bacterial species that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was the most prevalent isolate in 22 cases, followed by </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae </span></i><span style="font-family:Verdana;">in </span><span style="font-family:Verdana;">two and </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;">, </span><i><span style="font-family:Verdana;">Streptococcus agalactiae</span></i><span style="font-family:Verdana;">, the </span><i><span style="font-family:Verdana;">Acinetobacter</span><span> </span></i><span style="font-family:Verdana;">species</span><span style="font-family:Verdana;">, and </span><i><span style="font-family:Verdana;">Escherichia coli</span></i><span style="font-family:Verdana;"> in the rest (one each). Of the CoNS, </span><i><span style="font-family:Verdana;">S. haemolyticus</span></i><span style="font-family:Verdana;"> and </span><i><span style="font-family:Verdana;">S. epidermidis</span></i><span style="font-family:Verdana;"> were the most prevalent species, found in eight and six cases, respectively. Thirteen neonates died, of whom seven had positive blood cultures, and two were referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused by Gram-negative bacterial infection was higher than that caused by Gram-positive bacteria. </span><b><span style="font-family:Verdana;">Conclusions</span></b></span><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">These data suggest a significant burden of sepsis among neonates and young infants and are associated with substantial morbidity and mortality at the HTH. There is a need to investigate risk factors associated with the increased sepsis rate in this hospital to inform measures to reduce the neonatal sepsis rate.</span>展开更多
A number of evaluations of health education interventions in developing countries for the reduction of neonatal mortality have been reported. These interventions can be divided into two categories： those which includ...A number of evaluations of health education interventions in developing countries for the reduction of neonatal mortality have been reported. These interventions can be divided into two categories： those which include medical professionals and those without medical professionals. No systematic review has yet been performed that compares these two types of interventions. This study is an attempt to determine whether the inclusion of medical professionals in health education interventions more greatly decreases neonatal mortality in developing countries. Databases were searched for impact evaluation studies which： 1） had both experimental and control groups, 2） conducted both pre-tests and post-tests, 3） identified the intervention as a health education package, 4） were published in peer reviewed journals, 5） used neonatal mortality as an outcome measure, and 6） were undertaken in developing countries A total 14 studies were found that fit these criteria---eight of these studies included medical professionals in the intervention, and six studies were without medical professionals. To calculate the net effect of each intervention, both the difference-in-difference method and the use of log odds ratios were tested. Interventions involving medical professionals had significantly lower neonatal mortality rates than those without medical professionals. Interventions meant to decrease neonatal mortality in developing countries are recommended to involve medical professionals.展开更多
Introduction: Kangaroo mother care (KMC) or skin-to-skin contact help to prevent hypothermia, promote breastfeeding and baby-mother attachment. It’s an effective technique management of low-birth-weight (LBW) newborn...Introduction: Kangaroo mother care (KMC) or skin-to-skin contact help to prevent hypothermia, promote breastfeeding and baby-mother attachment. It’s an effective technique management of low-birth-weight (LBW) newborns. The objective of this study was to investigate the efficacy of KMC for LBW newborns admitted to the university health center of Cocody in Abidjan, Côte d’Ivoire. Population and Methods: This was a retrospective study focusing on a cohort of low birth weight newborns admitted in KMC unit during the period from September 2019 to July 2021 (23 months). We don’t include newborns whose records were incomplete or whose length of stay in kangaroo care had been less than 72 hours. We collected sociodemographic, maternal, obstetric, neonatal characteristics and KMC data (age/weight at inclusion, thermoregulation, feeding, growth evolution and complications). Results: We included 137 newborns with a mean gestational age of 31 SA. Mean birth weight was 1401 g. The majority of mothers worked in the informal sector (45%). The average length of stay in conventional care was 17 days. At inclusion in KMC, the mean weight was 1376 g (minimum 900 g). The most common complications were anemia (16.2%), weight loss (9.5%) and infection (2.9%). Only 13% of newborns received exclusive breast milk. The average daily weight gain was 25 g. Average discharge weight was 1570 g. The hypothermia rate was 17%. We notified 2 deaths (1.5%). Factors influencing regular weight gain of 25 g/day were mother’s marital status and length of stay in conventional care. Conclusion: In developing countries such as Côte d’Ivoire, KMC is a good alternative to conventional care.展开更多
Introduction: Antenatal care (ANC) contributes to the reduction of maternal and neonatal morbidity and mortality. The study aimed to investigate the determinants of the low proportion of pregnant women seen for first ...Introduction: Antenatal care (ANC) contributes to the reduction of maternal and neonatal morbidity and mortality. The study aimed to investigate the determinants of the low proportion of pregnant women seen for first antenatal care in the first trimester of pregnancy at the urban medical center of Koudougou, Burkina Faso. Materials and Methods: This was a cross-sectional study with data collection from June 08 to August 18, 2021. It involved a sample of 302 participants including 280 pregnant women and 22 maternity providers. Semi-structured individual interviews, non-participant observation, and a literature review were used. Results: Pregnant women age 20 and over, knowledge of the date of their last menstrual period, and knowledge of the antenatal care calendar were associated with coming into contact (1) with Antenatal care in the first trimester of pregnancy. In addition, there was a lack of availability of antenatal care services, inadequate reception of clients, and shortages of health products. Conclusion: There is a need to revisit strategies for communicating with women about ANC, reorganizing ANC services, and improving ANC services.展开更多
文摘Background:Preterm birth and neonatal mortality continue to pose significant public health challenges in Ghana.This study explores their temporal trends and associated determinants from 2008 to 2022.Methods:Birth record data from the Ghana Demographic and Health Surveys(2008,2014,and 2022)were used to analyse trends and determinants in neonatal mortality and preterm birth aligned with World Health Organization antenatal care(ANC)guidelines using Pearson’s Chi-square test and multivariate logistic regression with statistical significance at P<0.05 and 95%confidence intervals(CI).Results:Preterm birth rate and neonatal mortality rate decreased from 13.0%to 9.1%and 27.6 to 23.7 per 1000 live births from 2008 to 2022 respectively.Lack of iron supplementation(odds ratio[OR]1.127,95%CI:1.047 to 1.967)a nutritional intervention maternal assessments(moderate/severe anaemia(OR 1.423,95%CI:1.178 to 2.051),preventive measures(Untreated malaria(OR 1.449,95%CI:1.104 to 2.411)or deworming(OR 1.267,95%CI:0.970 to 1.645)were associated with increased preterm birth risk.Attending<8 ANC visits raised the odds of preterm birth(OR 1.24,95%CI:1.03 to 1.257)and neonatal mortality(OR 1.583,95%CI:1.120 to 2.480).Conclusion:Despite reductions in preterm birth and neonatal mortality rates,substantial gaps in antenatal care remain.Strengthening the implementation of World Health Organization ANC guidelines is critical to reducing preterm birth and neonatal mortality in Ghana.
文摘<strong>Background</strong><b><span style="font-family:Verdana;">:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Neonatal mortality remains a major public health problem in low income countries. The survival within the first 28 days of life remains a challenge in such countries. Many strategies have been implemented to reduce deaths in children under five especially in sub-Saharan Africa. Laquintinie Douala Hospital benefits from some of these measures including a perinatal network and an emergency voucher. We aimed to describe the main causes of neonatal deaths at Laquintinie Douala Hospital. </span><b><span style="font-family:Verdana;">Methods</span></b></span><b><span style="font-family:Verdana;">:</span></b><span style="font-family:""><span style="font-family:Verdana;"> We carried out a cross-sectional study including files of all deceased neonates in the neonatal unit during a 24 months period from January 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2017 to De</span><span><span style="font-family:Verdana;">cember 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;">, 2018. Data collection included socio-demo</span></span><span style="font-family:Verdana;">graphic characteristics of the mothers and the newborns, clinical and therapeutic data and the evolution of the newborn. We used SPSS 20 software for data analysis with a </span><i><span style="font-family:Verdana;">p</span></i></span><span style="font-family:Verdana;">-</span><span style="font-family:""><span style="font-family:Verdana;">value less than 0.05. </span><b><span style="font-family:Verdana;">Results:</span></b></span><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">We included 270 files with an over</span><span style="font-family:""><span style="font-family:Verdana;">all mortality rate of 13.1% and a sex ratio of 1.2. The main causes of death included prem</span><span style="font-family:Verdana;">aturity (37.8%), neonatal infection (34.1%) and neonatal asph</span><span style="font-family:Verdana;">yxia (24.4%). The main factors associated with deaths included informal sector (</span><i><span style="font-family:Verdana;">OR </span></i><span style="font-family:Verdana;">= 5.49;95% </span><i><span style="font-family:Verdana;">CI </span></i><span style="font-family:Verdana;">0.86</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">34.77;</span><i><span style="font-family:Verdana;">p </span></i><span style="font-family:Verdana;">= 0.07) and a primary level of education for mothers, malaria during pregnancy (</span><i><span style="font-family:Verdana;">OR </span></i><span style="font-family:Verdana;">2.28;95% </span><i><span style="font-family:Verdana;">CI</span></i><span style="font-family:Verdana;">, 1.44</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">3.12;</span><i><span style="font-family:Verdana;">p</span></i></span><i><span style="font-family:""> </span></i><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.0001), very preterm babies (</span><i><span style="font-family:Verdana;">OR</span></i><span style="font-family:Verdana;"> 6.45;95%</span><i><span style="font-family:Verdana;"> CI </span></i><span style="font-family:Verdana;">4.68</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">- 8.89;</span><i><span style="font-family:Verdana;">p</span></i></span><i><span style="font-family:""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.001) and resuscitation (</span><i><span style="font-family:Verdana;">OR </span></i><span style="font-family:Verdana;">1.63;</span><i> </i><span style="font-family:Verdana;">95%</span><i><span style="font-family:Verdana;"> CI </span></i><span style="font-family:Verdana;">1.25</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">- 2.13;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.0001)</span></span><span style="font-family:Verdana;">.</span><i><span style="font-family:""> </span></i><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Neonatal mortality was lower than data in previous studies but remains high. This highlights </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">need </span><span style="font-family:Verdana;">for</span><span style="font-family:Verdana;"> caregiver training and improvement of antenatal visits in our setting.</span>
文摘Introduction: Neonatal mortality represents a global health problem that has been at the core of programs developed by the World Health Organization (WHO) for more than 30 years. In our country, it represents a real scourge and remains high despite the efforts made by the Ministry of Health. The goal of this study was to investigate the prevalence and causes of neonatal mortality at CHU-MEL of Cotonou in 2023. Material and Methods: This was a cross-sectional and descriptive study with retrospective data collection, carried out in the neonatology unit of the Mother and Child Teaching Hospital of Lagune (CHU-MEL) in Cotonou over a period of six months from January 1, 2023 to June 30, 2023. All neonates, premature or full-term, born alive and who died during hospitalization in the unit were included. Results: 211 cases of neonatal deaths were recorded among the 2884 neonates hospitalized in the unit during the study period, representing a hospital prevalence of 7.31%. Early neonatal mortality represented 81.5% of cases. The average age at admission was 4.6 days ± 5.3. The average weight of deceased neonates was 1609.08 ± 798.35 g. The most frequent reasons for hospitalization were represented by prematurity (60.66%) and respiratory distress (23.22%), respectively. Prematurity was the leading cause of neonatal mortality (41.7%), followed by neonatal infections (29.4%) and perinatal asphyxia (10.9%). Conclusion: The prevalence of neonatal mortality in the neonatology unit of CHU-MEL is high. Efforts to improve the quality of perinatal care departments must be intensified to reduce this prevalence.
文摘Cox Proportional Hazard model is a popular statistical technique for exploring the relationship between the survival time of neonates and several explanatory variables. It provides an estimate of the study variables’ effect on survival after adjustment for other explanatory variables, and allows us to estimate the hazard (or risk) of death of newborn in NICU of hospitals in River Nile State-Sudan for the period (2018-2020). Study Data represented (neonate gender, mode of delivery, birth type, neonate weight, resident type, gestational age, and survival time). Kaplan-Meier method is used to estimate survival and hazard function for survival times of newborns that have not completed their first month. Of 700 neonates in the study area, 25% of them died during 2018-2020. Variables of interest that had a significant effect on neonatal death by Cox Proportional Hazard Model analysis were neonate weight, resident type, and gestational age. In Cox Proportional Hazard Model analysis all the variables of interest had an effect on neonatal death, but the variables with a significant effect included, weight of neonate, resident type and gestational age.
文摘This paper concerns the Log-rank test for comparing survival curves of neonatal mortality characteristic groups in River Nile State, Sudan. In this paper, log-rank test is used to compare two or more survival curves for the characteristics of newborn associated with newborn death after using Kaplan-Meier methods to estimate and graph survival curves for the variable of interest as (sex of newborn, weight of newborn, gestational age, mode of delivery and resident type), at the hospital of River Nile state—Sudan, with a sample size 700 of newborn in which the admission to the Neonatal Intensive Care Unit (NICU) of those hospitals during the period 2018-2020. In term of risk of death for newborn we found that 25% of sample study for newborns who were born in River Nile State-Sudan died. In addition, we conclude that after the log-rank statistics and Kaplan-Meier methods were applied, gender does not affect the newborn’s risk of survival, while the risk of survival increases when the birth weight is greater than 4.35 kg and the gestational age is greater than 42 weeks. There is no difference in the probability of survival for newborns whether the delivery is normal or cesarean. However, newborns are significantly more likely to survive in urban areas than in rural areas.
文摘Introduction: The birth of a baby is a moment of joy and celebration. However, the neonatal period is a very delicate phase of life. Neonatal mortality rates remain high in low-income countries. In Guinea, after 20 years, this rate has fallen from 34.2% in 1998 to 32% in 2018. Objective: To identify the main risk factors for neonatal mortality. Methods: This was an observational, analytical case-control study, lasting 6 months from January 1 to June 30, 2019, conducted at the Institut de Nutrition et de la Santé de l’Enfant (INSE) at Donka National Hospital. Results: We collected 242 cases and 242 controls, i.e. a total of 484 records. 748 patients were registered, with 32.35% deaths. 82.86% of deaths occurred in the early neonatal period. Statistical analysis revealed the main risk factors: prematurity (RQ 7.39 95% CI 3.27 - 16.61 p = 0.0000003), hypothermia (RQ 2.29 95% CI 1.51 - 3.46 p = 0.0001), acute fetal distress (RQ 2.13 95% CI 1.33 - 3.43 p = 0.0016), low birth weight (QR 1.91 95% CI 1.12 - 3.24 p = 0.016), home birth (QR 3.26 95% CI 1.25 - 8.46 p = 0.015). Conclusion: Neonatal mortality is a health problem in the INSE neonatology department. To reduce the mortality rate in this referral facility, it is essential to equip it and provide ongoing training for staff.
基金Supported by the National Key Research and Development Program of China(grant number 2018YFC1002304).
文摘Objective:Integrated congenital heart disease(CHD)services were implemented in Beijing in 2022.This study analyzed prenatal diagnosis patterns and neonatal mortality data for duct-dependent CHDs before and after implementation to provide insights for service optimization.Methods:We conducted a retrospective analysis of 487 cases of duct-dependent CHDs identified through the Beijing Birth Defects Monitoring System from January 2021 to December 2022.The study population included fetuses and infants from 13 weeks gestation to one year after birth.Cases underwent descriptive analysis focusing on disease occurrence,diagnostic timing,and mortality outcomes.Results:The prenatal diagnosis rate for ductdependent CHDs increased from 93.39%in 2021 to 93.91%in 2022,while delayed diagnosis rates decreased from 4.28%to 3.91%.Genetic diagnosis rates improved from 27.92%to 31.94%.Live birth rates following prenatal diagnosis increased substantially from 28.75%to 40.28%.Outcomes varied significantly by CHD subtypes,with complete transposition of the great arteries with intact ventricular septum achieving an 82.14%live birth rate,while hypoplastic left heart syndrome cases resulted in no live births.Notably,neonatal mortality decreased markedly from 7.23%to 3.03%.Conclusions:Beijing’s integrated service model for CHDs has effectively strengthened the connection between secondary and tertiary prevention strategies,reduced unnecessary pregnancy terminations,and improved neonatal survival outcomes.
文摘Progress toward the fourth Sustainable Development Goal(SDG)-reducing child mortality under the age of five,to which all countries are committed-has been slow in several Central African countries in recent years.This study includes 2,886 observations from Burundi between 2019 and 2022.Early neonatal mortality(0-6 days)accounts for 50%of neonatal deaths in the country.Using survival analysis,I identified several key risk factors-notably malaria and fetal distress-as primary contributors to early neonatal mortality.Contrary to conventional wisdom,many of these health issues can be addressed with cost-effective,evidence-based interventions that do not require sophisticated skills or advanced technology,even in countries with high infant mortality rates.Improving maternal health through adequate nutrition during pregnancy,proper management of childbirth,and appropriate care of the newborn could prevent up to 32.9%of infant deaths.These findings strongly support the implementation of targeted prevention policies focused on the mother-child pair-including better monitoring of pregnancies,ensuring comprehensive vaccination coverage,and strengthening health infrastructure.
文摘Background The most common cause of death among preterm infants in low-and middle-income countries is respiratory distress syndrome.The purpose of this review was to assess whether antenatal corticosteroids given to women at risk of preterm birth at≤34 weeks of gestation reduce rates of neonatal mortality and respiratory distress syndrome in low-and middle-income countries.Methods Two reviewers independently searched four databases including MEDLINE(through PubMed),CINAHL,Embase,and Cochrane Libraries.We did not apply any language or date restrictions.All publications up to April 2020 were included in this search.Results The search yielded 71 articles,10 of which were included in this review(3 randomized controlled trials,7 observa-tional studies,36,773 neonates).The majority of studies reported associations between exposure to antenatal corticosteroids and lower rates of neonatal mortality and respiratory distress syndrome.However,a few studies reported that antenatal corticosteroids were not associated with improved preterm birth outcomes.Conclusions Most of the studies in low-and middle-income countries showed that use of antenatal corticosteroids in hospitals with high levels of neonatal care was associated with lower rates of neonatal mortality and respiratory distress syndrome.However,the findings are inconclusive because some studies in low-resource settings reported that antenatal corticosteroids had no benefit in reducing rates of neonatal mortality or respiratory distress syndrome.Further research on the impact of antenatal corticosteroids in resource-limited settings in low-income countries is a priority.
文摘Background The neonatal period is the most vulnerable period during childhood,with the risk of death being the highest even in developed countries/regions.Hong Kong’s neonatal mortality(1‰)is among the world’s lowest and has remained similar for 15 years.This study aimed to explore neonatal deaths in Hong Kong in detail and determine whether neonatal mortality is reducible at such a low level.Methods Live births in public hospitals in Hong Kong during 01 Jan 2006–31 Dec 2017 were included.Relevant data were extracted from the electronic medical records.Gestational age-specific mortality was calculated,and the trends were analyzed using the Cochran–Armitage trend test.Causes of death were summarized,and risk factors were identified in multivariate logistic regression analysis.Results In 490,034 live births,755 cases(1.54‰)died during the neonatal period,and 293(0.6‰)died during the post-neonatal period.The neonatal mortality remained similar overall(P=0.17)and among infants born at 24–29 weeks’gestation(P=0.4),while it decreased in those born at 23(P=0.04),30–36(P<0.001)and≥37(P<0.001)weeks’gestation.Neonates born at<27 weeks’gestation accounted for a significantly increased proportion among cases who died(27.6%to 51.9%),with hemorrhagic conditions(24%)being the leading cause of death.Congenital anomalies were the leading cause of death in neonates born≥27 weeks’gestation(52%),but its cause-specific mortality decreased(P=0.002,0.6‰to 0.41‰),with most of the decrease attributed to trisomy 13/18 and multiple anomalies.Conclusion Reduction of neonatal mortality in developed regions may heavily rely on improved quality of perinatal and neonatal care among extremely preterm infants.
基金supported by grants from Health Bureau of Zhejiang Province(2012KYA118),Depar tment of Educat ion of Zhejiang Province(Y201328892)Public Technology Research Program of Zhejiang Province(2013C33150).
文摘Background:To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants(≤1500 g)born by cesarean with those by vaginal delivery.Methods:In this retrospective,case-control study,we evaluated neonatal mortality,medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight(VLBW)infants born between January 2005 and December 2010.Of the 710 infants,351 were born by the cesarean and 359/710 by vaginal route.Results:There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group[56/351(15.9%)vs.71/359(19.8%),P=0.20].VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route[221/351(63.0%)vs.178/359(49.6%),P<0.001].There were no differences in other neonatal morbidities,including intraventricular hemorrhage[126/351(35.9%)vs.134/359(37.3%),P=0.69],bronchopulmonary dysplasia[39/351(11%)vs.31/359(8.6%),P=0.38]and necrotising enterocolitis[40/351(11.4%)vs.32/359(8.9%),P=0.32]between the two groups.The incidence of poor neurodevelopment after cesarean delivery was similar to that after vaginal delivery[105/351(29.9)vs.104/359(29.0%),P=0.78].Conclusions:In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants.Moreover,the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants.The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.
文摘High incidences of pre-weaning mortality continue to limit global sheep production,constituting a major economic and welfare concern.Despite significant advances in genetics,nutrition,and management,the proportion of lamb deaths has remained stable at 15–20%over the past four decades.There is mounting evidence that melatonin can improve outcomes in compromised ovine pregnancies via enhanced uterine bloodflow and neonatal neuroprotection.This review provides an overview of the major risk factors and underlying mechanisms involved in perinatal lamb mortality and discusses the potential of melatonin treatment as a remedial strategy.Supplementing pregnant ewes with melatonin enhances uterine bloodflow and fetal oxygenation,and potentially birthweight and neonatal thermogenic capacity.Melatonin freely crosses the ovine placenta and blood-brain barrier and provides neuroprotection to the fetal lamb during periods of chronic and acute hypoxia throughout gestation,with improved behavioural outcomes in hypoxic neonates.The current literature provides strong evidence that maternal melatonin treatment improves outcomes for lambs which experience compromised in utero development or prolonged parturition,though to date this has not been investigated in livestock production systems.As such there is a clear basis for continued research into the effects of maternal melatonin supplementation during gestation on pre-weaning survival under extensive production conditions.
文摘Considering the severe impacts of genetic bottlenecks and small numbers of founders in populations of reintroduced animals, it is necessary to study inbreeding and its effect on fitness in species of conservation concern. Pere David＇s deer is one of few large mammal species extinct in the wild but safely preserved in captivity. Its specific background gives us the opportunity to study the relationships between heterozygosity and neonatal fitness in relocated populations. We employed five microsatellite loci to explore heterozygosity-fitness correlations in a population of Pere David＇s deer at the Beijing Milu Ecological Research Center. We observed associations between microsatellite-based variables sMLH, IR, MD^2 and HL, and two components of fitness ex- pressed early in life （birth weight and the neonatal mortality of 123 Pere David＇s deer calves born over six consecutive years）. We found that neonatal mortality was 19.1% - 7.6%, not higher than the 19% or 18% reported in other ungulates. The heterozygosity of calves was not associated with neonatal mortality, nor birth weight. Our study implies that low genetic variability of microsa- l：ellite loci has no overt effect on birth weight and neonatal mortality in reintroduced populations of P^re David＇s deer [Current Zoology 59 （2）： 249-256, 2013].
文摘<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">The neonatal mortality rate in the Central African Republic (CAR) is 42.3 per 1000 live births in 2017, indicating that CAR is with the highest number of newborn deaths. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> T</span></span><span style="font-family:Verdana;">he objective is t</span><span style="font-family:""><span style="font-family:Verdana;">o clarify the risk factors of neonatal deaths in this area. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> A case-control study with retrospective data collection. Targets were newborns >7 days, hospitalized and dead (cases), and newborns admitted after the respective case during the study period and discharged before the 7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> day of life. This study was carried out between 2016 and 2018 in the neonatal unit of the “Complexe Hospitalier Universitaire Pédiatrique de Bangui” (CHUPB), the only national hospital for newborns care in the CAR. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> We included 902 newborns, with 451 cases of early neonatal death and 451 controls. 4168 newborns were admitted to the neonatology unit with 621 early death cases;a lethality rate of 14.9%. Early neonatal deaths factors were: newborns with low birth weight (OR = 22.59;95% CI [15.93 - 32.04];</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">P < 0.001);mothers who did not attend antenatal care (OR = 5.54;95% CI [3.95 - 7.79];P < 0.001), home delivery (OR = 0.70;95% CI [0.03 - 0.15];P < 0.001);young maternal age <</span><span style="font-family:""> </span><span style="font-family:Verdana;">25 years (OR = 2.08;95% CI [1.58 - 2.73];P < 0.001);non-medical transport (OR = 2.14;95% CI [1.03 - 4.46];P = 0.03);origin from remote areas (OR = 5.25;95% CI [3.95 - 6.98];P < 0.001);isolated prematurity (P <</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.01);anoxo-ischemic encephalopathy (OR = 12.72;95% CI [6.54 - 34.73];P <</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.01);delivery by cesarean section (OR = 0.59;95% CI [0.41 - 0.84];P < 0.001);preterm delivery (OR = 29.36;95% CI [20.12 - 42.81];P < 0.001), and maternal lower education (OR = 5.65;95% CI [4.08 - 7.81];P < 0.001). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The early neonatal mortality rate remains high in this area. Controlling the factors mentioned above might lead to improving the survival of newborns.</span></span>
文摘Aim: To identify the association between access to obstetric and neonatal hospital service and neonatal death rates. Method: Quantitative and retrospective research retrieved from Declaration of Live Newly-born Children;Declaration of Death;Investigation Chart on Municipal Child Mortality, between 2000 and 2009, at the Nucleus of Information on Mortality Rates. The population studied comprised 537 neonatal deaths and mothers with residence in the municipality, and investigated by the work team of the Committee for the Investigation of Mother-Child Deaths. Data were analyzed in Epi Info 2002<sup></sup>? computer program and the Statistical Package for the Social Sciences<sup></sup>? was used. Chi-square Test and Fischer’s Exact Test were applied at p < 0.05. Results: 63.7% of 537 neonates were born in hospitals with maternities and neonatal intensive therapy unit;60.7% weighed ≤1.500 grams;76.7% had a pregnancy age of ≤36 weeks;73% died of asphyxia in the 1st minute and 73.5% died during the perinatal period. Throughout the ten years of analysis, access to hospital obstetric service without NITU reduced death rate from 25% in 2000 to 6.8% in 2009. There was a significant statistical association between place of delivery and maternal socio-demographic variables (maternal age bracket p = 0.028;schooling p = 0.000;family income p = 0.000);occupation p = 0.000) and neonatal variables (race/skin color p = 0.007;type of delivery p = 0.000;weight at birth p = 0.000;pregnancy age p = 0.000 and Apgar Score 1st minute p = 0.000 and Apgar Score 5th minute p = 0.007). Conclusion: Although the municipal government provides obstetric services and specialized neonatal care, this right is not extensive to all;gaps at different levels in mother-child care should be identified to reduce neonatal deaths.
文摘Background & Objectives: Sustainable Development Goals (SDGs) are set up as a part of the Post Millennium Development Goals (MDGs). Then it becomes essential to review the achievement of the MDGs in India and lessons learned to incorporate into the SDGs. The present study reviews and predicts different components of under-five mortality rate beyond 2015 to assess the present situation and to determine the future possibilities of achieving the new targets for SDGs in India. Data and Methods: It uses available time series data on different components of U5MR from the India’s Sample Registration System (SRS). Autoregressive Integrated Moving Averages (ARIMA) model has been taken as the method of time series analysis to forecast the mortality rates beyond 2015. Results: There is a consistent pattern of faster decline in the under-five mortality compared with the neonatal mortality rate across all major states in India although neonatal mortality contributes largest share in under-five mortality. Again, share of neonatal death among under-five death is increasing steadily over the future projected years. This indicates very slow progress of reduction in neonatal mortality. Stimulating efforts with new intervention programmes will be needed to focus more on lowering neonatal mortality particularly in rural India.
文摘<strong>Background</strong><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Neonatal sepsis is a global health problem that mainly affects low- and middle-income countries. We have previously shown that early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We sought to determine the prevalence of neonatal sepsis, sepsis-related mortality, and bacterial species patterns in neonatal and young infant sepsis in this hospital.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods</span></b><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">A hospital-based study was conducted in the hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood samples from 96 babies clinically diagnosed with or at risk of sepsis were cultured using the BACTEC 9050<span style="white-space:nowrap;"><sup>®</sup> </span>machine. Clinical data including gravida, parity and antibiotic medication before delivery of mother and delivery type, gestation, birth weight and antibiotic medication status were collected for analysis. MALDI-TOF MS identified bacterial isolates, and their identities were confirmed via </span><i><span style="font-family:Verdana;">tuf</span></i><span style="font-family:Verdana;"> gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Blood cultures were positive in 28 of the babies, with 14 and 12 representing early-onset and late-onset neonatal sepsis, respectively, and two cases of unknown sepsis type. Of the bacterial species that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was the most prevalent isolate in 22 cases, followed by </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae </span></i><span style="font-family:Verdana;">in </span><span style="font-family:Verdana;">two and </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;">, </span><i><span style="font-family:Verdana;">Streptococcus agalactiae</span></i><span style="font-family:Verdana;">, the </span><i><span style="font-family:Verdana;">Acinetobacter</span><span> </span></i><span style="font-family:Verdana;">species</span><span style="font-family:Verdana;">, and </span><i><span style="font-family:Verdana;">Escherichia coli</span></i><span style="font-family:Verdana;"> in the rest (one each). Of the CoNS, </span><i><span style="font-family:Verdana;">S. haemolyticus</span></i><span style="font-family:Verdana;"> and </span><i><span style="font-family:Verdana;">S. epidermidis</span></i><span style="font-family:Verdana;"> were the most prevalent species, found in eight and six cases, respectively. Thirteen neonates died, of whom seven had positive blood cultures, and two were referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused by Gram-negative bacterial infection was higher than that caused by Gram-positive bacteria. </span><b><span style="font-family:Verdana;">Conclusions</span></b></span><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">These data suggest a significant burden of sepsis among neonates and young infants and are associated with substantial morbidity and mortality at the HTH. There is a need to investigate risk factors associated with the increased sepsis rate in this hospital to inform measures to reduce the neonatal sepsis rate.</span>
文摘A number of evaluations of health education interventions in developing countries for the reduction of neonatal mortality have been reported. These interventions can be divided into two categories： those which include medical professionals and those without medical professionals. No systematic review has yet been performed that compares these two types of interventions. This study is an attempt to determine whether the inclusion of medical professionals in health education interventions more greatly decreases neonatal mortality in developing countries. Databases were searched for impact evaluation studies which： 1） had both experimental and control groups, 2） conducted both pre-tests and post-tests, 3） identified the intervention as a health education package, 4） were published in peer reviewed journals, 5） used neonatal mortality as an outcome measure, and 6） were undertaken in developing countries A total 14 studies were found that fit these criteria---eight of these studies included medical professionals in the intervention, and six studies were without medical professionals. To calculate the net effect of each intervention, both the difference-in-difference method and the use of log odds ratios were tested. Interventions involving medical professionals had significantly lower neonatal mortality rates than those without medical professionals. Interventions meant to decrease neonatal mortality in developing countries are recommended to involve medical professionals.
文摘Introduction: Kangaroo mother care (KMC) or skin-to-skin contact help to prevent hypothermia, promote breastfeeding and baby-mother attachment. It’s an effective technique management of low-birth-weight (LBW) newborns. The objective of this study was to investigate the efficacy of KMC for LBW newborns admitted to the university health center of Cocody in Abidjan, Côte d’Ivoire. Population and Methods: This was a retrospective study focusing on a cohort of low birth weight newborns admitted in KMC unit during the period from September 2019 to July 2021 (23 months). We don’t include newborns whose records were incomplete or whose length of stay in kangaroo care had been less than 72 hours. We collected sociodemographic, maternal, obstetric, neonatal characteristics and KMC data (age/weight at inclusion, thermoregulation, feeding, growth evolution and complications). Results: We included 137 newborns with a mean gestational age of 31 SA. Mean birth weight was 1401 g. The majority of mothers worked in the informal sector (45%). The average length of stay in conventional care was 17 days. At inclusion in KMC, the mean weight was 1376 g (minimum 900 g). The most common complications were anemia (16.2%), weight loss (9.5%) and infection (2.9%). Only 13% of newborns received exclusive breast milk. The average daily weight gain was 25 g. Average discharge weight was 1570 g. The hypothermia rate was 17%. We notified 2 deaths (1.5%). Factors influencing regular weight gain of 25 g/day were mother’s marital status and length of stay in conventional care. Conclusion: In developing countries such as Côte d’Ivoire, KMC is a good alternative to conventional care.
文摘Introduction: Antenatal care (ANC) contributes to the reduction of maternal and neonatal morbidity and mortality. The study aimed to investigate the determinants of the low proportion of pregnant women seen for first antenatal care in the first trimester of pregnancy at the urban medical center of Koudougou, Burkina Faso. Materials and Methods: This was a cross-sectional study with data collection from June 08 to August 18, 2021. It involved a sample of 302 participants including 280 pregnant women and 22 maternity providers. Semi-structured individual interviews, non-participant observation, and a literature review were used. Results: Pregnant women age 20 and over, knowledge of the date of their last menstrual period, and knowledge of the antenatal care calendar were associated with coming into contact (1) with Antenatal care in the first trimester of pregnancy. In addition, there was a lack of availability of antenatal care services, inadequate reception of clients, and shortages of health products. Conclusion: There is a need to revisit strategies for communicating with women about ANC, reorganizing ANC services, and improving ANC services.
