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Objective: We aimed to assess Child Death Overview Panel (CDOP) data validity, and cause of death classification, by comparison with information from a local birth cohort study (Born in Bradford, BiB), and another cause of death coding system (causes of death and associated conditions-CODAC). We then aimed to use CDOP data to calculate ethnic-specific infant mortality rates (IMRs), and compare characteristics of infants who died of congenital anomalies (CA) with those who died from other causes (non-CA)., Design: Retrospective cohort study., Setting: Bradford Metropolitan District., Patients: All infant deaths, 2008 to 2013., Main Outcome Measures: Infant mortality rates from CA and non-CA causes., Results: 315 infant deaths were included, 56 of whom were BiB recruits. Agreement between CDOP and BiB was moderate to perfect for all characteristics except ethnicity, which showed weak agreement (kappa=0.58). The same deaths (27/56) were classified as CA by CDOP and CODAC. IMRs (per 1000 live births, 2009-2013) were highest in Pakistani infants (all causes 9.8, CA cause 5.5) compared with white British (all causes 4.3, CA cause 1.3) and other infants (all causes 5.1, CA cause 1.4). In multivariate analysis, infants who died of CA cause were more likely to have been born at term (OR 3.18) and to consanguineous parents (OR 3.28) than infants who died of non-CA cause., Conclusions: Excess Pakistani mortality appears to be partly explained by an excess of deaths from CA, which in this population appears associated with a greater prevalence of consanguinity., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aim: To describe the survival to age 5 years of children born with congenital anomalies., Methods: Between 1980 and 1997, 6153 live born cases of congenital anomaly were diagnosed and registered by the population based Glasgow Register of Congenital Anomalies. They were retrospectively followed to assess their survival status from birth up to the age of 5 years., Results: The proportions of all live born infants with congenital anomalies surviving to the end of the first week, and first and fifth year were 94%, 89%, and 88%, respectively. Survival to age 5, the end point of follow up, was significantly poorer for infants with chromosomal anomalies (48%) compared to neural tube defects (72%), respiratory system anomalies (74%), congenital heart disease (75%), nervous system anomalies (77%), and Down's syndrome (84%)., Conclusion: Although almost 90% of all live born infants with congenital anomalies survive to 5 years, there are notable variations in survival between anomaly types. Our findings should be useful for both clinicians and geneticists to assess the prognosis of congenital anomalies. This information is also important for affected families and for the planning of health care needs for this high risk population.

A voluntary survey set up by local clinicians has documented all lethal abnormality in a geographically defined area of northern England where there were 361,037 registered births between 1982 and 1990, and monitored the incidence of all significant physical abnormality since January 1984. The survey aims to maintain a register of all pregnancies where an abnormality is suspected before birth, and those where an abnormality is only identified after birth, together with a record of how the diagnosis was established. Information on management and outcome a year after birth is also collected. Nearly half the total decline in perinatal mortality in the region between 1982 and 1990 is accounted for by an increase in the antenatal recognition of lethal abnormality, isolated hydrocephalus, or a neural tube defect and subsequent termination of pregnancy. Although the reporting of many non-lethal conditions was incomplete during the pilot study in 1984, it has become progressively more complete since then. The number of cases confirmed postnatally varied little between units between 1985-9, but audit showed that the proportion recognised antenatally varied fivefold for reasons unconnected with unit size or the amount of antenatal ultrasound work done. For a number of serious conditions more than 10% of all antenatal diagnoses were completely wrong. Survey data are, for the first time, making it possible to monitor the accuracy of the ultrasound-based screening and diagnostic services for identifying specific fetal abnormalities. They are also providing clinicians with an invaluable confidential database of a whole region's collective experience of dealing with complex fetal abnormality.

Forty infants with gastroschisis were referred to two paediatric surgeons during a 13 year period. Overall survival was 90%. Nine patients were transferred in utero and 31 were referred postnatally. Birth weights, gestational ages, and Apgar scores were similar for both groups. Primary closure of the defect was successfully achieved in seven (78%) patients in the prenatally transferred group compared with 17 (55%) in the postnatal group. Significantly less postoperative assisted ventilation, and a trend in favour of early discharge home, were noted after prenatal transfer. Problems arising during postnatal transfer may have contributed to these differences. No major differences resulting from the mode of delivery were identified. Patients treated by primary closure fared significantly better than those undergoing staged repairs with prosthetic material. Prospective randomised studies are required to confirm these findings.

We have analysed the cause of perinatal deaths in four hospitals in the North West Thames region over a six year period commencing January 1980. The Pakistani population had a significantly greater perinatal mortality rate (15.7/1000 births) than the Europeans (11.3/1000 births). This was due to an increased incidence of macerated stillbirths and lethal malformations, the latter resulting from a significantly higher incidence of autosomal recessive disorders, neural tube defects, and renal malformations.

A total of 440 perinatal deaths occurring in a maternity hospital over a 6 year period have been analysed clinically and pathologically. The decline in mortality could be attributed to a reduction in asphyxial deaths, lethal malformations, and macerated stillbirths. The establishment of a neonatal intensive care unit seemed to have been more successful in combating birth asphyxia than respiratory distress syndrome. Although the greatest reduction in perinatal mortality was in babies with birthweights between 1 and 1.5 kg, there was no decline in the deaths from hyaline membrane disease or intraventricular haemorrhage, or both. The most striking change was the drop in asphyxia as a cause of perinatal death which was independent of birth trauma. Earlier diagnosis of fetal distress with obstetric intervention and the establishment of the intensive care unit were seen as the main factors in this change, and their mutual dependence and evolution are emphasised.

Agonal histories were traced for 1182 of 1782 postneonatal deaths in Sheffield between 1947 and 1979. Twenty eight per cent of these deaths were histologically inexplicable, 19% were from infections and 15% from malformations. These sudden infection and malformation deaths were explicable, yet by some definitions they would be considered as cot deaths. Varying definitions may lead to confusion, hindering the search for aetiological mechanisms.

A study of all the mothers in the Northern region in 1983 whose pregnancies ended at between 24 and 31 weeks' gestation was undertaken. These pregnancies accounted for 1.3% of all the births and 44% of all the fetal and neonatal deaths in pregnancies that lasted more than 23 weeks. Most of the 389 singleton deliveries without malformations between 24 and 31 weeks were caused by spontaneous premature labour (n = 119, 31%), placental abruption (n = 79, 20%), pre-eclampsia (n = 56, 14%), and premature rupture of membranes (n = 48, 12%). The percentages of babies alive at the onset of delivery who survived the neonatal period were 66, 84, 78, and 73, respectively and the percentages of neonatal survivors with severe disabilities were 19, 13, 3, and 6, respectively. A further 65 (17%) of these babies died before the onset of labour for no obvious reason. The mode of delivery did not correlate with the outcome once the period of gestation at delivery was taken into account. The results highlight the inadequacy of the perinatal mortality index currently used in the United Kingdom, which identified 10.7 deaths/1000 registered births in 1983; 20% of the babies delivered at 24-31 weeks were excluded by this index because the birth went unregistered, as were 21% of all the babies born alive who died before discharge. An index that accounted for all babies weighing 500 g or more at birth irrespective of the period of gestation, and all neonatal (0-27 days) deaths, would be more appropriate and would bring reporting more into line with recommended international practice.

Stillbirth and infant mortality from congenital malformations in England and Wales during 1981-5 was investigated according to the mother's country of birth. Significant differences remained after standardising for maternal age and social class. The highest overall mortality was in infants of mothers born in Pakistan (standardised mortality ratio 237), followed by infants of mothers born in India (standardised mortality ratio 134), East Africa (standardised mortality ratio 126), and Bangladesh (standardised mortality ratio 118). Caribbean and West African mothers showed an overall deficit. Mortality was inversely related to social class in all groups except the Afro-Caribbean. Infants of mothers born in Pakistan had the highest mortality in every social class except I, and for most anomalies investigated. Their ratios were particularly high for limb and musculoskeletal anomalies (standardised mortality ratio 362), genitourinary anomalies (standardised mortality ratio 268), and central nervous system anomalies (standardised mortality ratio 239). Our findings highlight the need for further research to identify the causes underlying these differences.

An analysis of the frequency of post-mortem examinations was conducted in the paediatric age group. Among the factors found to influence necropsy rates were (i) age at death, the frequency of necropsy decreasing with age; (ii) cause of death, necropsy frequency varying with major diagnostic groups; (iii) investigation conducted before death, necropsy frequency decreasing when the clinical picture was ill-defined; and (iv) place of death, necropsy being less frequent when death occurred outside hospital. These findings imply (a) that necropsy practices may be governed by habit and convenience as well as by desire to complete the clinical picture, and (b) that more equitable balances in such practices should be sought if there is to be improvement in the quality of mortality data.

There were 131 deaths among children aged between birth and 14 years during a period of 18 months in one inner London area health authority. One hundred children died in hospital, 23 at home, and 8 elsewhere. Thirty three died of congenital, 46 of perinatal, and 34 of other medical causes. There were 18 violent deaths--16 among children over 1 year of age. Medical and social information, collected from analysis of records and interview with those involved, was considered by a review panel and the following conclusions were drawn: there was scope for prevention of congenital disease or malformation in only one of 33 cases; with routine pathological investigation the cause of death in postperinatal infancy was usually unclear--more detailed pathological investigation should be routinely available for the investigation of deaths in the first year of life; there were possible management failures in four of 8 non-malignant medical deaths in older children; malignant disease was promptly diagnosed; fatal accidents were almost entirely restricted to the children of families under marked psychosocial stress; and there was some evidence of faulty communication between health agencies and of the inappropriate routing of emergency admissions.

The causes of 215 infant deaths occurring in a population based cohort of 5914 infants from southern Brazil were determined. Perinatal problems were responsible for 43% of these deaths and infectious diseases for 32%. In the group who died of infectious diseases, respiratory infections and diarrhoea were equally important, each accounting for 12% of all deaths. A total of 87% of the deaths occurred in the first six months of life, and this proportion remained high (77%) even after perinatal causes had been excluded. On the other hand, 53% of the infants who died were of low birth weight, as opposed to 7.9% of the survivors. This suggests that low birthweight infants need to be carefully followed by health workers at primary level, especially during the first six months. It was estimated that if the incidence of low birth weight was reduced from the present 8.8% to 5% the likely reduction in infant mortality would be 20%. This reduction would be 33% for deaths due to perinatal causes, 14% for respiratory infections, and only 5% for diarrhoea. Efforts for the prevention of infant deaths in southern Brazil are more likely to be effective if they concentrate on improving perinatal health care and environmental conditions.