Risk Factors for Neonatal Mortality at the Institute of Nutrition and Child Health of the Donka/Guinea-Conakry National Hospital

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.

Etiologies of Neonatal Mortality in a Tertiary Care Hospital in a Resource-Limited Setting

Background: 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. Methods: We carried out a cross-sectional study including files of all deceased neonates in the neonatal unit during a 24 months period from January 1st, 2017 to December 31st, 2018. Data collection included socio-demographic 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 p-value less than 0.05. Results: We included 270 files with an overall mortality rate of 13.1% and a sex ratio of 1.2. The main causes of death included prematurity (37.8%), neonatal infection (34.1%) and neonatal asphyxia (24.4%). The main factors associated with deaths included informal sector (OR = 5.49;95% CI 0.86 - 34.77;p = 0.07) and a primary level of education for mothers, malaria during pregnancy (OR 2.28;95% CI, 1.44 - 3.12;p = 0.0001), very preterm babies (OR 6.45;95% CI 4.68 - 8.89;p < 0.001) and resuscitation (OR 1.63; 95% CI 1.25 - 2.13;p = 0.0001). Conclusion: Neonatal mortality was lower than data in previous studies but remains high. This highlights the need for caregiver training and improvement of antenatal visits in our setting.

Cox Proportional Hazard Model for Survival Time of Neonatal Mortality in Neonatal Intensive Care Unit of Hospitals in River Nile State-Sudan

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.

Log-Rank Test for Comparing Survival Curves of Neonatal Mortality Characteristic Groups in River Nile State-Sudan

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.

Gestational age-specific neonatal mortality in Hong Kong:a population-based retrospective study

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.

Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth:a scoping review on the impact of antenatal corticosteroids in low-and middle-income countries

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.

No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years

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.

Neonatal lamb mortality:major risk factors and the potential ameliorative role of melatonin

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.

Risk Factors of Early Neonatal Deaths in Pediatric Teaching Hospital in Bangui, Central African Republic

Background: 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. Objective: The objective is to clarify the risk factors of neonatal deaths in this area. Methodology: 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 7th 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. Results: 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]; 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 < 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 < 0.01);anoxo-ischemic encephalopathy (OR = 12.72;95% CI [6.54 - 34.73];P < 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). Conclusion: The early neonatal mortality rate remains high in this area. Controlling the factors mentioned above might lead to improving the survival of newborns.

Neonatal Death Rates: Lack of Equal Access to Hospital Obstetric Service and Intensive Therapy

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? computer program and the Statistical Package for the Social Sciences? 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.

Post Millennium Development Goals Prospect on Child Mortality in India: An Analysis Using Autoregressive Integrated Moving Averages (ARIMA) Model

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.

Neonatal and Young Infant Sepsis in a Regional Hospital in Ghana

Background: 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. Methods: 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® 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 tuf gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2. Results: 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 Klebsiella pneumoniae in two and Staphylococcus aureus, Streptococcus agalactiae, the Acinetobacter species, and Escherichia coli in the rest (one each). Of the CoNS, S. haemolyticus and S. epidermidis 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. Conclusions: 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.

Profile of Newborns Hospitalized for Maternal Fetal Infection and Having a Positive CRP in the Pediatric Department of the Gabriel TouréCHU in Bamako, Mali

Objective: Early bacterial neonatal infection (INBP) or maternofetal infection (early neonatal sepsis) remains a concern of the pediatrician due to diagnostic difficulties and its increased morbidity and mortality. No study has been done in Mali on the profile of newborns admitted for INBP with positive CRP, hence the initiation of this work with the aim of studying the epidemiological, biological and bacteriological profile of newborns with a bacterial maternal-fetal infection. Method: Longitudinal study descriptive (from 27 June to 3 September 2016) which concerned all newborns aged from 0 to 72 hours of life hospitalized for confirmed early bacterial neonatal infection with a positive C-reactive protein (CRP) in the neonatal department of the CHU Gabriel Touré. INBP was defined by the presence of maternal and neonatal infectious risk factors, positivity of CRP with a germ in the blood culture. Results: During the study period we included 244 newborns for probable maternofetal infection and who benefited from the CRP assay, 43 had a positive CRP, i.e. a frequency of 17.62%. The sex ratio was 2.30. The majority had a low birth weight (<2500 g) in 69.8% of cases. Mothers were aged 18 to 35 in 93%. The majority were out of school (43.8%) and housewives in 74.4%. The main reasons for consultations were prematurity and/or low birth weight, respiratory distress and neonatal distress, i.e. 46.5%, 25.6% and 11.6% respectively. Among the 43 newborns with a positive CRP, the blood culture returned positive in 79.1% (n = 34). We deplore 2 deaths (4.7%). The main bacteria were gram-positive cocci (Staphylococcus aureus 53.01% and Streptococccus agalactiae 4.10%), gram-negative bacilli (GNB) type Enterobacteriaceae (Klebsiella pneumoniae 11.25% and E. coli at 5.70%) and non-fermentative GNBs (Pseudomonas aeruginosa 2.80% and Acinetobacter baumannii complex 2.24%). Conclusion: Maternal-fetal infection is a hospital pathology frequently encountered in the neonatal period. Its clinical presentation is dominated by respiratory distress, neurological disorders and low birth weight.

Impact of a nationwide training program for neonatal resuscitation in China

Background Seventeen million births occur in China each year. Neonatal mortality is the leading cause of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth. The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program （NRP） on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants. Methods The Chinese NRP incorporated policy change, professional education, and creation of a sustainable health system infrastructure for resuscitation. Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade. The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality. Program evaluation data came from 322 representative hospitals in those provinces. Results Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure. From 2004 through 2009 more than 110 659 professionals received NRP training in the 20 target provinces, with 94% of delivery facilities and 99% of counties reached. Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4 per 10 000 from 2003 to 2008, and the incidence of Apgar 〈7 at 1 minute decreased from 6.3% to 2.9%. Conclusions The Chinese NRP achieved policy changes promoting resuscitation, trained large numbers of professionals, and contributed to reduction in delivery room mortality. Improved adherence to the resuscitation algorithm, extension of training to the township level, and coverage of births now occurring outside health facilities can further increase the number of lives saved.

Outcome in neonates with necrotizing enterocolitis and patent ductus arteriosus

Background:There is no agreement of the influence of patent ductus arteriosus(PDA)on outcomes in patients with necrotizing enterocolitis(NEC).In this study,we assessed the infl uence of PDA on NEC outcomes.Methods:A retrospective study of 131 infants with established NEC was performed.Outcomes(death,disease severity,need for surgery,hospitalization duration),as well as multiple clinical parameters were compared between NEC patients with no congenital heart disease(n=102)and those with isolated PDA(n=29).Univariate,multivariate and stepwise logistic regression analyses were performed.Results:Birth weight and gestational age were significantly lower in patients with PDA[median(95%CI):1120 g(1009-1562 g),28.4 wk(27.8-30.5 wk)]than in those without PDA[median(95%CI):1580 g(1593-1905 g),32.4 wk(31.8-33.5 wk);P<0.05].The risk of NEC-attributable fatality was higher in NEC patients with PDA(35%)than in NEC patients without PDA(14%)[univariate odds ratio(OR)=3.3,95%CI:1.8-8.6,P<0.05;multivariate OR=2.4,95%CI:0.82-2.39,P=0.111].Significant independent predictors for nonsurvival within the entire cohort were advanced disease severity stage III(OR=27.9,95%CI:7.4-105,P<0.001)and birth weight below 1100 g(OR=5.7,95%CI:1.7-19.4,P<0.01).Conclusions:In patients with NEC,the presence of PDA is associated with an increased risk of death.However,when important differences between the two study groups are controlled,only birth weight and disease severity may independently predict mortality.