Search

Background: The recently published European Perinatal Health Report showed wide variability in perinatal mortality rates between European countries. We investigated the gestational age patterns of mortality in order to better understand differences between low versus high mortality countries. Setting: The Euro-Peristat project developed a list of valid and reliable indicators for monitoring and evaluating perinatal health, including fetal and neonatal mortality. Data from 2004 on 29 countries/regions were analyzed. Results: The fetal mortality rate ranged from 2.6 per 1000 births in Slovakia to 9.1 in France (weighted average of 5.4 per 1000 births) and the neonatal mortality rate ranged from 1.6 per 1000 live births in Cyprus to 5.7 in Latvia (weighted average of 3.0 per 1000 live births). In some countries, fetal mortality rates declined dramatically after excluding extremely preterm births (< 28 weeks), while elsewhere rates stayed stable. The exclusion of the extremely preterm births hardly influenced the variability in neonatal mortality rates, although a large decline was observed for the Netherlands, where active intervention is very conservative before 26 weeks of pregnancy. We did not find that countries with low mortality rates had higher proportions of extremely preterm births (which could be considered less preventable) and lower proportions of deaths among term or near term births. Conclusions: Registration differences are still important contributors to variability, but these differences do not explain the variability between countries which persists after removing extremely preterm births. There were different levels and patterns of fetal and neonatal mortality between European countries.

Aim: To identify the determinants of neonatal mortality to support strategy development to reduce neonatal mortality rate in the study area as well as on a national level.

Object: To determine neonatal mortality rate, and its associated factors we conduct this study as a basis for the following surveys.

Neonatal Mortality Rate (NMR) in Very Low Birth Weigh Infants (VLBWI). Comparison Between Neonatal Networks from Spain (SEN1500) and Japan (NRNJ)

Improvements in obstetric and neonatal care over the last several decades have lead to a decline in neonatal mortality. This study utilized South Carolina's linked live birth and infant death records from 1975-1992. We analyzed mortality rates at 7 & 28 days by race, gestational age (GA) and birthweight (BW). Neonatal mortality rate decreased from 14.9 to 9.1 (deaths per 1,000) for African-Americans (AA) and from 10.2 to 4.3 for Whites (W). The most dramatic decrease was in 7 day mortality (12.4 to 7.3 for AA; 8.8 to 3.3 for W). Neonatal mortality decreased overtime for both races in each GA category, but the decrease was most dramatic at 26-32 wks GA. The limit of viability (< 50% survival) was lowered from 26 wks in 1975 to 24 wks GA in 1992 for W. For AA, the limit of viability was already 24 wks GA in 1975,& did not change over the time period. Neonatal mortality rates are lower for AA than for W up to 32 wks GA, but by 37 wks GA, W have lower neonatal mortality. There were no appreciable temporal changes for either race in rates of preterm delivery or of infants with BW < 2500g, although AA demonstrated an increase in births with BW < 1500 g (from 1.8/1000 in 1975 to 2.5/1000 in 1992). CONCLUSION: This decline in neonatal mortality over an 18 year period, due primarily to a reduction in GA-specific and 7 day mortality, reflects high risk obstetric and neonatal intensive care efforts. Renewed efforts should be made in devising strategies to change the GA/BW distribution toward term, and to maximize the health and developmental outcome of surviving high risk preterm infants.

Babies of multiple pregnancies born

We statistically compared neonatal mortality data from Tripler Army Medical Center (TAMC) to those recently reported from the University of Colorado Health Sciences Center (UCHSC). TAMC delivery and neonatal death summaries from 1977 through 1981 were reviewed: 17,102 live births and 102 in-born deaths occurred. These results were compared to similar data obtained from 14,413 births and 252 deaths at UCHSC from 1974 through 1980. Premature deliveries were less common at TAMC, possibly resulting from fewer high-risk pregnancy referrals: 0.57% were born before 29 weeks gestation at TAMC, compared to 1.61% at UCHSC. Fifty-three percent of the neonatal deaths at TAMC and 54% at UCHSC occurred in this category. The overall neonatal mortality rate was 0.67% at TAMC, in contrast to 1.75% at UCHSC. However, analysis of mortality in relation to birthweight, gestational age, and combined BW-GA categories developed by UCHSC Mortality by Combined BW-GA Category revealed no significant differences between TAMC and UCHSC (Table). We conclude that in terms of outcome, neonatal care delivered at TAMC is similar to that delivered in a prestigious civilian institution.

The low birth weight (LBW) neonatal mortality is known to be better in black than in white population, but the reasons are not clear. To test the hypothesis that a relatively high LBW fetal mortality might be occurring in black LBWs to explain the low NMR, we used a computerized regional perinatal data base, (Spellacy, AM.J.Ob Gyn.’84> and analyzed data from 65,387 births (1982-85). Standard perinatal vital rates weight specific FMR and NMR and their ratios, and log odds ratio of FMR at 250 g b wt intervals in 16,874 black, 35,966 white and 12,547 Hispanic births were analyzed. (Table). The black LBW NMR was significantly lower than white and Hispanic rates, but LBW-FMR/NMR ratio showed that for every 10 LBW neonatal deaths at 1.5-2.5Kg wt. range, (which forms 11.2% of black total births), there were 25 fetal deaths in blacks as compared to 12 fetal deaths in white and Hispanics. The log odds ratios of weight specific NMR models showed that the odds of FMR decreased exponentially with increasing weight in all races, but the slope in the black was 26% flatter, (p

In 1971 we reported (SPR) a reduction in neonatal mortality in Arizona associated with the establishment of a statewide system for newborn transport and intensive care. From its inception the program included State supplemental funding of catastrophic illness and transport costs for American Indian newborns delivered in or transported to State-designated newborn intensive care centers. The cumulative Indian neonatal mortality rate for the Phoenix Indian Service Area for the 3 years preceding establishment of this program (1964-66) was 18.9 deaths/1000 live births. During the first 3 years of the program (1968-70) cumulative Indian neonatal mortality rate fell to 10.3 deaths/1000, and during the next 3 years (1971-73) to 9.0 deaths/1000. These data suggest that previously high mortality rates among American Indian newborns have been reduced by active inclusion into the general regional newborn transport and intensive care program.

Reorganisation of perinatal medicine and increasing neonatal fellowship programs have decreased the role of the general pediatrician in the care of the sick newborn. The majority of deliveries still occur in community hospitals and the transfer of infants to regional centers increases morbidity and places a burden on family visitation. The pediatrician who cares for the sick neonate has become an “endangered species”. Six pediatricians are working in a recently established “private neonatal ICU”. Ancillary services were trained and pediatric sub-specialists were added to the medical staffing. From Nov. 1972 - Nov. 1976, 835 infants were admitted to the ICU. 453 were inborn and 382 were transferred from other institutions. The neonatal mortality rate was aa fellows: 1973 - 8.5; 1974 - 7.8; 1975 - 4.0; 1976 - 5.8. The pediatricians were able to maintain full practice and staff the ICU. Community support for the unit was overwhelming and included donations, educational tours and volunteer services. This experience demonstrates that the pediatrician can continue to care for acutely ill neonates and if interested can develop and maintain neonatal intensive cere center.

In the USA, very little data is available on UUUD. Maternal characteristics and perinatal outcome of 70 UUUD from Oct.′76 to Nov.′77 were identified. All mothers of UUUD were admitted to Lincoln Hospital within 4 hrs. of delivery. During the same period, there were a total of 3,703 in-hospital deliveries (HD), giving an UUUD incidence of 18.5 per 1,000 HD. The main features of UUUD consist of: 1)59% Black (23% HD); 2)37% more than 24 yrs. old (28% HD); 3)17% with parity more than 3 (12% HD); 4)77% on public assistance (43% HD); 5)89%, education below high school (76% HD); 6)58% no prenatal care (19% HD); 7)67% broken families (57% HD); and 8)13% drug-addicted (4% HD). Low-birth-weight rate (no.≤2,500 gm/1,000 livebirth), perinatal mortality rate (no. per 1,000 deliveries) and neonatal mortality rate (no./1,000 livebirth) associated with UUUD are compared with those of HD as below: The UUUD is associated with poor antenatal planning, lack of education and low socioeconomic condition. These mothers are at great risk for future pregnancies and must be provided with intensive education and medical care.

The very low birth weight rate (infants ≤ 1500gm/1000 births) has increased linearly at our institution (r = .84) from 35 to 55 from 1974 to 1979. The proportion of VLBW infants weighing ≤ 1000gm remained unchanged during this period and averaged 31%. However, the number of extreme low birth weight (≤ 700gm) infants increased dramatically from a mean of 3.8% of very low birth weight infants for 1974-1977 to 10% in 1978 and 1979 (p < .02). In spite of this increase in very tiny infants, the neonatal mortality rate fell progressively from 25.8 deaths/thousand births in 1974 to 17.9 in 1979 (r = -.76). Neonatal mortality has been shown to be closely linked with the very low birth weight rate, both within one institution and in the United States, as well as from country to country. The ratio of neonatal mortality rate to very low birth weight rate has been suggested to be a measure of quality of care.* This ratio declined linearly (r = -.97) in our perinatal service from 0.74 in 1974 to 0.32 in 1979. This ratio was 1.09 for the USA in 1975. Thus, a vast improvement in quality of care appears to have occurred in our hospital in the six year span, despite an increased very low birth weight rate, an increased proportion of whom have been ≤ 700g in birthweight.