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Author(s): Mubiri, Paul; Nambuya, Harriet; Kajjo, Darious; Butrick, Elizabeth; Namazzi, Gertrude; Santos, Nicole; Walker, Dilys; Waiswa, Peter | Abstract: BackgroundAn estimated 2.8 million neonatal deaths occur each year globally, which accounts for at least 45% of deaths in children aged less than 5 years. Birthweight and gestational age-specific mortality estimates are limited in low-resource countries like Uganda. A deeper analysis of mortality by birthweight and gestational age is critical in identifying the cause and potential solutions to decrease neonatal mortality.ObjectivesWe studied mortality before discharge in relation to birthweight and gestational age using a large sample size from selected tertiary care facilities in Uganda.MethodsWe used secondary data from the East Africa Preterm Birth Initiative study conducted in six tertiary care facilities. Birth records of infants born between October 2016 and March 2019 with a gestational age greater than or equal to 24 weeks and/or birthweight greater than or equal to 500 g were reviewed for inclusion in the analysis. Newborn death before discharge was the outcome variable of interest. Multivariable Poisson regression modeling was used to explore birthweight and gestational age-specific mortality rate.ResultsWe analysed 50 278 birth records. Among these 95.3% (47 913) were live births and 4.8% (2365) were stillbirths. Of the 47 913 live births, 50% (24 147) were males. Overall, pre-discharge mortality was 13.0 per 1000 live births. For each 1 kg increase in birthweight, mortality before discharge decreased by -0.016. As birthweight increases, the mortality before discharge decreased from 336 per 1000 live births among infants born between 500 and 999 g, to 4.7 per 1000 live births among infants born weighing 3500 to 3999 g, and increased again to 11.2 per 1000 live births among infants weighing more than 4500 g.ConclusionsOur study highlights the need for further research to understand newborn survival across different birthweight and gestational categories.

Background In 2003, a perinatal helicopter air ambulance service was introduced for remote areas of Wakayama and Mie prefectures, Japan. However, its long-term impact on perinatal medicine has not yet been analyzed. Methods A retrospective observational study was conducted on helicopter air ambulance cases recorded between January 2003 and December 2016 at Wakayama Medical University Hospital (WMUH). Results During that period, 61 pregnant mothers were transferred by helicopter air ambulance to WMUH. Between 2003 and 2009, the mean period from transfer to birth was 0.6 weeks, whereas between 2008 and 2016, this increased to 1.6 weeks, and the survival rate of infants who were born after transfer did not differ significantly (84.2% [32/38] and 82.1% [23/28]). Seventy-three neonates were transferred. The number transferred between 2003 and 2009 was 46, whereas this decreased to 27 between 2010 and 2016. The neonatal mortality rate in south Wakayama plus south Mie gradually decreased. The reasons for the longer period from transfer to birth, and the decrease in the rate of very low birth weight infants after transfer may be developments in the management of threatened premature labor, and the earlier transfer of such cases by regional obstetricians. The reasons for the decline in neonatal transfer cases may have included the development of fetal diagnostic techniques and improved efficiency of neonatal ground-transport in the South Wakayama region. Conclusions The helicopter air ambulance is an important form of medical transportation in the south Kii peninsula. This article is protected by copyright. All rights reserved.

UNLABELLED In a population-based study including 35,218 infants born alive during the 15-y period 1982-96, 360 (1%) were diagnosed as having a congenital heart defect (CHD). At a follow-up 3-18 y after birth (median 9.5 y) 154 patients (42.8%) were spontaneously cured; of these, 142 (92.2%) had ventricular septal defects (VSDs). Forty-two patients (11.7%) died, 22 of these (52.4%) during the neonatal period (0-28 d after birth). A total of 119 patients (33.1%) underwent therapeutic procedures (surgery, catheter interventions), 24 (20.2%) of whom died. Of the 95 children surviving therapeutic procedures, 54 (56.8%) had their defects completely repaired, while 41 (43.2%) had residual defects or cardiac sequelae, often of minor importance. In 69 children (19.2%) with persistent non-operated defects, 43 (62.3%) had VSDs. A chromosomal disorder, syndrome or associated extracardiac malformation occurred in 72 children (20%). CONCLUSIONS The study underlines the broad variety in severity of CHDs, with a high neonatal mortality rate as well as a high rate of spontaneous cure. It is estimated that 25% of infants born with a CHD will grow into adult age with persistent non-operated defects, residual defects or cardiac sequelae after therapeutic procedures.

Because of the increasing survival rate of extremely low birthweight infants in recent years, the viability limit in the Eugenic Protection Act in Japan was amended from 24 to 22 completed weeks of gestation. The Japan Pediatric Society's survey on the outcome of infants born in 1990 focused on infants born before 24 weeks gestation and less than 500 g. The survival rates of infants born in 23, 22 and before 22 weeks gestation overall at 511 hospitals throughout Japan were 43/118 (36%), 3/36 (8%) and 0/8 (0%), respectively. Of 16 infants, none weighing less than 400 g at birth survived but 16 (12%) of 50 infants between 400 and 499 g survived. Up-to-date statistical data is essential to the amendment of the concept of viability and subsequent ethical decision-making on extremely low birthweight infants.

A spontaneous genodermatosis in 13 cotton-top tamarins is described as a retrospective study. The disease appeared as alopecia, pigmentary disturbances, and claw dystrophy similar but not identical to human Pachyonychia congenita. The disease in the tamarins seems to be inherited as an autosomal recessive trait, becoming clinically apparent around adolescence. In certain families the neonatal mortality rate was also above average, reaching 100%.

This paper presents the growth rate of 21 clinically normal, mother-raised. captive cheetah cubs from birth through 45 days of age. The development of a growth curve for healthy, mother-raised cheetah cubs provides a diagnostic tool for individuals involved in cheetah propagation. Use of the curve may alert caretakers to problems early and thus help reduce the high neonatal mortality rate seen in captive-born cheetah cubs. The growth curve was constructed using 21 (11 males and 10 females) captiveborn cheetah cubs from six litters (offspring of three unrelated adult males and three unrelated adult females) born at the Columbus Zoo from September 1985 through December 1989. Each cub was weighed to the nearest gram the morning after birth and approximately the same time every consecutive morning for 45 days. The mean weight the morning after birth was 463 g (range 385–542 g). The average litter size was 3.5 (range 2–4, n = 6). The daily weight gain was 40–50 g/cub/day.

Summary The outcome of 59 triplet pregnancies from four hospitals was analyzed. The combined stillbirth and neonatal mortality rate was 232/1000. Preterm labour and birth order were the most important identifiable factors in relation to neonatal death. Birth weight within a triplet set and malpresentation were not related to neonatal death. Elective cervical suture appeared to be of no value in prolonging gestation.

Summary. We have compared the mortality and morbidity of low birthweight breech-presenting singleton infants born in the Coventry Maternity Hospital during the years 1973 and 1974 with those born during 1979 and 1980. During this period changes in management have included an increase in the caesarean section rate and the continuing development of methods of intensive care for the newborn infants. The neonatal mortality rate has fallen but the increased survival rate is accounted for largely by the survival of handicapped infants. The value of routine caesarean section in the absence of other obstetric pathology for low birthweight breeches is unproven and may be deleterious to mother and baby.

IN Victoria about 1,600 children die each year. Of these, at least 53 per cent die in the first month of life, and 46 per cent in the first week. There is an undeniable challenge to the medical profession in these figures. In the first year of life the number of deaths per 1,000 live births, i.e. the infant mortality rate, has fallen continuously and dramatically throughout this century. However, although the infant mortality rate has fallen to less than one-fifth of the rate in 1900, the fall in the neonatal mortality rate has been much less gratifying (Fig. 1). Thus, in this State the infant mortality rate has fallen from 100 in 1900 to 19.2 in 1958, while the neonatal mortality rate has only fallen from 34 in 1900 to 13.5 in 1958. Half a century ago the neonatal period provided 30 per cent of all deaths in the first year of life; today it provides 75 per cent. These figures surely speak for themselves and we must ask ourselves: how often is this loss of neonatal life preventable?

This paper analyses the contribution of low birth-weight (birth-weight between 500 and 2,500 g) and prematurity (gestation less than 37 weeks) to neonatal death in Chinese and Western populations. The incidences of low birth-weight in the Tsan Yuk Hospital, Hong Kong, the State of Victoria, and the Mercy Maternity Hospital, Melbourne, were 4.63%, 4.29% and 5.66% respectively and the incidences of prematurity were 2.08%, 4.89% and 7.42% respectively. The neonatal mortality rate (per 1,000 livebirths) for premature infants born in Victoria was 64, 89 for those born at the Mercy Maternity Hospital and 119 for the Tsan Yuk Hospital. This paper has demonstrated that a striking differences exists in prematurity rates between Chinese and Western populations, and also that the mortality rate of premature infants is lower in Western populations. If the reason for the lower incidence of prematurity in the Chinese population could be determined and the mortality of premature infants maintained in the Western population, a significant lowering of perinatal mortality would result. Studies to determine causes for premature births in Chinese and Western populations should therefore be undertaken.