The total number of neonates admitted to the NICU during the period under the study was 3,276, of which 110 neonates left against medical advice, 67 neonates had deficient. We believe there are two reasons for this finding. Pepler PT, Uys DW, Nel DG. For all neonatal deaths and stillbirths, the study physician and nurse interviewed the mother about the circumstances leading to the event. Other factors, such as stress level, might be able to be managed, but are not entirely controllable. The unit is staffed with pediatricians, pediatric residents and neonatal nurses and located adjacent to the labour ward to receive high-risk newborns from this unit. •  Recommend this site Table 3 Aggregated categories of causes of admission and death by outcomes among neonates admitted to Neonatal ICU of JUMC. Maternal pregnancy complications. Fikree FF, Azam SI, Berendes HW. Limitations include the use of medical records of newborns and since the study is institutionally based, the results might lack generalizability to the entire population in the catchment area. The types of infant mortality shown in the charts below include neonatal mortality and postneonatal mortality: Neonatal mortality: death of a live-born infant within the first 27 days of life. This site is owned and operated by Informa PLC ( “Informa”) whose registered office is 5 Howick Place, London SW1P 1WG. P V S, Thammanna PS, Sandeep M. Morbidity pattern and hospital outcome of neonates admitted in a tertiary care teaching hospital, Mandya. 2016;13:4. Congenital abnormality accounted for 8%. 6. a. Aga Khan University, Karachi, Pakistan. The same was true for the birth weight; the risk of mortality decreased as the birth weight increased and the highest risk was seen in a neonate who had birth weight less 1,000 g (AOR 44.8, 9%CI9.43–200). We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. Hasan IJ, Khanum A. (See Mortality in the United States, 2018). The Pattinson et al. Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data. The neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. In conclusion, this study found that babies born outside the city, gestational ages, the length of stay in the ICU, prematurity, low birth weight, RDS, and congenital malformations all had a significant association with neonatal mortality. Ethiopian Journal of Pediatrics and Child Health. 2016;201:17–23. causes of infant death in 2018 accounted for 67.6% of all infant deaths in the United States. Further permission was obtained from the medical director of JUMC and the department head of pediatrics and gynecology for the utilization of medical records. However, the change in neonatal mortality is not as significant as the change in post-neonatal and child mortality.5 In Ethiopia, the main causes of neonatal deaths were birth asphyxia, prematurity and sepsis.6–9. Baird D, Walker JR, Thomsan AM. Proportionately, there were more male deaths in the early neonatal period, a finding consistent with the well described biological survival advantage of girls in the neonatal period. Neonatal survival: a call for action. Parental residency, the length of stay, low birth weight, prematurity, RDS, perinatal asphyxia, and congenital malformations were factors associated with neonatal mortality, which could be avoidable. In JUMC, the causes of neonatal admissions and deaths were recorded based on clinical presentation and supportive laboratory results. Knowing the disease patterns and causes in the Neonatal Intensive Care Unit (NICU) and the disease-wise mortality rate can inform the requisite efforts to reduce morbidity and mortality. Prior to enrolment, all eligible women provided informed consent. 8. adaptation of the Aberdeen classification was used because it identifies the potential for both preventing and reducing avoidable fetal and neonatal mortality.12 The primary obstetric cause of neonatal death was defined in the classification as the obstetric antecedent factor or event that initiated the process or sequence of events leading to the death of the neonate. 4. stillbirths plus all early neonatal deaths), 70.4 per 1000 births (95% CI: 55.7–85.1); and perinatal mortality-2 (i.e. Mortality rates for other leading causes of infant death did not change significantly. Jalil F. Perinatal health in Pakistan: a review of the current situation. Shah S, Zemichael O, Meng HD. However, the change in neonatal mortality is not as significant as the change in children aged 1–59 months (63%).2 Africa contributed to one third of the world’s neonatal mortality burden. Qazi GR, Akhtar S. Obstetrical correlates of the first time cesarean section, compared with the repeated cesarean section. We therefore believe that the risk of biased reporting of neonatal mortality for this population is small. India is moving faster than the world in achieving a steady decline in the infant mortality rate. This prospective population-based study was conducted from September 2003 to August 2005 in four of 12 administrative units in the town of Latifabad, Hyderabad, Pakistan. Sultan Qaboos University Med J. The study populations were all neonates admitted to the Neonatal Intensive Care Unit (NICU) of JUMC from September 11, 2014 to September 10, 2017. In other words, causes of deaths were defined as the underlying neonatal factors or conditions, which presented in the admitted or deceased neonate. Overman DM. Infant mortality rates are the number of deaths of infants under one year old, measured per 100,000. MCEE-WHO methods and data sources for child causes of death 2000-2015. The highest admission of neonates was observed in 2015 which accounted for half (50%) of the total neonatal admissions studied (Table 2). The LHWs tracked all enrolled women until delivery. 18. First, we suspect that, because of underreporting, actual Pakistani neonatal mortality rates may be higher than reported and, second, that, despite the seemingly appropriate quantity of care provided for women in the study, the quality may have been suboptimal. 35. Research staff also developed liaisons with public and private delivery facilities and home birth attendants to ensure complete birth reporting for the study. Texto Contexto - Enferm. Yasmeen S, Ahmad K, Waheed I, Gul R. Spectrum of neonatal admissions and their outcome in a tertiary Care hospital. Baker R, Sullivan E, Camosso-Stefinovic J, Rashid A, Farooqi A, Blackledge H, et al., et al. A stillbirth was defined as any fetus born without a heartbeat, respiratory effort or movement, or any other sign of life. The study was reviewed and approved by the Aga Khan University Ethical and Review Committee in Pakistan and institutional review boards at the University of Alabama at Birmingham and Research Triangle International in the United States of America. Fetuses and young children may be particularly susceptible to … Stillbirths in an urban community in Pakistan. The perinatal death rate is the sum of neonatal deaths and stillbirths per 1000 births. [Internet]. Because most neonatal deaths occurred in hospitals, maternal reports were supplemented by a review of hospital records by the study physician. Seventy-five per cent of all neonatal deaths and 91% of deaths within 48 hours occurred in the hospital. These four units covered an area with a low-to-middle income population of about 90 000 individuals, or about 9000 households. Ranjan A, Singh A. Front Public Health. The data were collected by professional nurses and training was given to the data collectors on how to collect data from the records to augment data accuracy and validity. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We hypothesized that the neonatal mortality rate in this urban population, with relatively good access to obstetric care and Caesarean section, would be substantially lower than that generally reported for Pakistan. Table 4 presents details of the medical care received by infants who died in the 28 days following delivery and their mothers both at birth and before neonatal death. the unit also has 2 incubators,10 radiant warmers, 4 continuous positive airway pressure (CPAP), phototherapy and oxygen concentrator machines. Sudden infant death syndrome. Volume 2019:10 Pages 39—48, Editor who approved publication: 2014;64(10):1123–1126. Available from:: http://www.jcnonweb.com/text.asp?2016/5/3/183/191258. Since we were evaluating many different risk factors and the sample size was fixed, the following calculation was performed to determine the likelihood that a specific risk factor would have a significant association with neonatal mortality: with an expected neonatal mortality rate of 50 per 1000 live births, the expected 95% confidence interval associated with a sample size of 1300 births is ±12 neonatal deaths per 1000 live births. In multivariate analysis of neonatal conditions prematurity, low birth weight, birth asphyxia, congenital malformations and respiratory distress syndrome were identified as predictors of neonatal mortalities. Professor Roosy Aulakh, Sheka Shemsi Seid, Shemsedin Amme Ibro, Abdulwahid Awol Ahmed, Adugna Olani Akuma, Ebrahim Yimam Reta, Tura Koshe Haso, Gutema Ahmed FataSchool of Nursing and Midwifery, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, EthiopiaBackground: The neonatal period is the most susceptible phase of life. International study of caesarean section surgical techniques: a randomised fractional, factorial trial. Since most mothers and newborns are referred to the center after they had already developed complications, this could contribute significantly to loss of life during neonatal periods. ), Bulletin of the World Health Organization 2009;87:130-138. doi: 10.2471/BLT.08.050963. 2017;51:1–7. Ethical clearance to conduct the study was obtained from the institutional review board of the Institute of Health, Faculty of Health Sciences, Jimma University. The risk of mortality decreased as the gestational age increased. UK VAT Group: GB 365 4626 36. doi:10.1016/j.jtcvs.2016.05.061, 34. Out of 3093 neonates admitted 412 died, giving a death rate of 13.3%. Okechukwu AA, Achonwa A. Morbidity and mortality patterns of admissions into the special care baby unit of university of abuja teaching hospital, Gwagwalada, Nigeria. 2015;3(October). These are both common measures of health care quality, but they are also influenced by social, economic and environmental factors. •  Testimonials   Table 5 presents the primary obstetric and final causes of neonatal death as determined using the Pattinson et al. Kousar T, Memon Y, Sheikh S, Memon S, Sehto R. Risk factors and causes of death in Neonates. Bivariate and multivariate logistic regressions were used to determine factors associated with neonatal mortality and P-values <0.05 were considered statistically significant.Results: Of 3,276 neonates admitted during the study period, 412 (13.3%) died, equating to a rate of 30 deaths per 1,000 institutional live births. Preterm birth and low birth weight. Fikree FF, Mir A, Haq IU. Stillbirth and neonatal and perinatal mortality rates, by gender and in total, in a prospective study in an urban Pakistani population, 2003–2005, Table 2. Predicting mortality and length-of-stay for neonatal admissions to private hospital neonatal intensive care units: a Southern African retrospective study. 2016;3(3):854–857. In: Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L, et al., et al. Over 21,000 infants died in the United States in 2018. The odds of neonatal mortalities among preterm neonates were 2.2 times higher than that of term neonates (AOR 2.2, 95%CI 1.41, 3.42). Furthermore, neonatal mortality rates were higher for most causes in boys than in girls, although neonatal mortality rates were similar between sexes for diarrhoeal diseases . Registered in England and Wales. Death due to birth asphyxia was recorded when a normally formed term baby was unable to initiate and sustain respiration at birth or had a low Apgar score or clinical signs of hypoxia or meconium aspiration. Other possible explanations for this might also be due to delay in receiving adequate health care due to poor facilities and lack of medical supplies in low income countries. 15. Recent reports from developing countries have shown improvements in perinatal and neonatal outcomes with increased coverage by health services and skilled birth attendants.2,8,22 However, our findings suggest that women experienced avoidable antenatal and obstetric complications despite good availability of antenatal care, a high rate of births in a health facility with skilled birth attendants, and a “high” Caesarean section rate. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The relative importance of these causes is reflected in the distribution of the final causes of neonatal death: immaturity-related in 26%, birth asphyxia or hypoxia in 26% and infection in 23%. In this region about 75% of deaths occurred during the first week of life almost half being within the first 24 hrs. Korejo R, Bhutta S, Noorani KJ, Bhutta ZA. Infant mortality is the death of young children under the age of 1. In multivariate analysis, only five variables were found to be the significant predictors of the neonatal mortalities. The majority, 2349(76.0%) of the newborns admitted within 24 hrs of life while 135(4.3%) were admitted within 8–21 days of life. •  Privacy Policy   involving sepsis, pneumonia or meningitis) in the first 48 hours. Study nurses supervised the LHWs in the required fieldwork. J Thorac Cardiovasc Surg. The major causes of neonatal mortality in the current study were low birth weight 8%, prematurity, 7.4%, RDS 5.4%. … The mean age at admission was 1.84(SD±2.4) days. Available from: http://www.who.int/intellectualproperty/documents/thereport/ENPublicHealthReport.pdf. Given the paucity of reliable population-based information in Pakistan, this study was undertaken to examine the prevalence, sex distribution, timing and causes of neonatal death in a population-based pregnancy cohort in urban Pakistan. Reduced care-seeking for girls compared with boys has been reported in several settings, especially in south Asia.15,16, The most common primary obstetric causes of neonatal death were preterm delivery in 34%, intrapartum asphyxia in 21% and antepartum haemorrhage in 9%. Factors found to be significantly associated with neonatal death in the univariate analysis include gestational age  37> 2000 g> 37>. open access to scientific and medical research. All rights reserved. Evidence-based, cost-effective interventions: how many newborn babies can we save? However, women were enrolled into the study by LHWs during routine home visits, and a substantial majority of all eligible women were enrolled. 3. Cause of neonatal deaths in Northern Ethiopia: a prospective cohort study.. BMC Public Health. Permanent residents who planned to give birth in the catchment area were screened by lady health workers (LHWs) of the Pakistan Ministry of Health. Women who indicated interest were scheduled for an appointment at the research clinic closest to their home. Pre-term births can have many different maternal causes, many of whichsuch as high blood pressure, diabetes, Zika and other infections and ageare not entirely within an expectant mothers control. Thus, 83% of those eligible, or 1369 women, were enrolled at 20–26 weeks’ gestation. Primary obstetric and final causes of neonatal deaths that occurred within 28 days postpartum in prospective study in an urban Pakistani population, according to the time of death, 2003–2005. doi:10.1136/bmjopen-2011-000792. Hospital-acquired neonatal infections in developing countries. Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al., et al. Birth defects cause about 21 percent of … Bulletin of the World Health Organization, Volume 87, Number 2, February 2009, 81-160. For the period under the study it was observed that the magnitude of admissions increased from 453(14.6%) admissions during 2014/15 to 1085(35.1%) during the year 2016/2017. No obstetric cause was found in 19% of cases. al, 2010). Neonates who had a history of birth asphyxia had five fold higher odds of death (AOR4.9, 95%CI 3.6, 7.34) and low birth weight had 1.54 times increased risk of mortality (AOR 1.54, 95%CI 1.06, 2.25). Lawn JE, Cousens S, Zupan J. The reason for this difference was that the late neonatal mortality rate (i.e. The post-neonatal rate was calculated by subtracting the number of neonatal deaths from the number of infant deaths, divided by the number of live births for that year, multiplied by 1,000. Although low birth weight was not considered as an independent cause of death, in 54% of neonatal deaths the infant weighed  2500 g>. The under-five mortality rate per 1000 live births is 74.9 and the neonatal mortality rate is 44 per 1000 live births. adaptation of the Aberdeen classification was used because it identifies the potential for both preventing and reducing avoidable fetal and neonatal mortality. 2017;1–8. 2009;12:389–394. %)of them died. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Ali SR, Hospital I, Ahmed S, Lohana H. Disease patterns and outcomes of neonatal admissions at a secondary care hospital in Pakistan. Furthermore, 157(5.1%), 112(3.6%), and 86(2%) of the neonates were admitted due to meningitis, sub-glial haemorrhage, and macrosomia, respectively (Table 4). Two-thirds of the world’s neonatal deaths occur in just 10 countries, mostly in Asia. This study therefore examines delivery outcomes in pregnant women with reasonably good access to professional health care who were enrolled at 20 to 26 weeks’ gestation and followed with their infants to 28 days postpartum. Of the 53 neonatal deaths, 39 (75%) occurred in the first 7 days. 23. 2013;13(1):1. doi:10.1186/1471-2458-13-483. Almost every 5th child born in that year died in childhood.Over the last decades we have seen a very rapid decline of child mortality globally. Rates of caesarean section: analysis of global, regional and national estimates. 22. a. Aga Khan University, Karachi, Pakistan.b. 9. Available from: https://www.dovepress.com/patterns-of-admission-and-factors-associated-with-neonatal-mortality-a-peer-reviewed-article-PHMT. Of the estimated 130 million infants born each year worldwide,1 4 million die in the first 28 days of life. Correspondence to Elizabeth M McClure (e-mail: Of the estimated 130 million infants born each year worldwide. The leading causes of neonatal death are disorders related to premature birth and low birth weight. (Submitted: 09 January 2008 – Revised version received: 21 June 2008 – Accepted: 25 June 2008 – Published online: 06 January 2009. Neonatal conditions were divided into five major categories, four adapted from the Global Burden of Diseases (GBD 2017) classification catalog, and one category, Low Birth Weight (LBW) added from the National strategy for newborn and child survival in Ethiopia.35,36 The presentation conditions included under these five categories is presented in the Table 1. Data were extracted from the medical records of neonates admitted during a three year period from September 07, 2014 to August 31, 2017, using pretested checklists. We guaranteed confidentiality by excluding names or any other personal identifiers from data-collection sheets and reports. They provide basic maternal care, including child health services, and maintain logs of all pregnancies and birth outcomes among their assigned households. On the other hand, in countries where infant mortality rates are high, the majority of infant deaths occurs after the neo-natal stage and is due mainly to environmental factors. Sime H, Workneh N, Girma E. Morbidity and Mortality of Neonates Admitted in Jimma University Specialized Hospital Paediatrics Neonatal Ward: A One Year Retrospective Analysis. 2017. Pak Armed Forces Med J. Study nurses cross-checked enrolment and LHW delivery logs to ensure that women enrolled prenatally and those for whom we had delivery results were the same women. Table 6 Multivariate and Univariate analysis of factors associated with Neonatal mortalities among neonate admitted to JUMC. Between September 2003 and August 2005, LHWs identified 2205 pregnant women from the study area, 25% of whom were not eligible for study enrolment. Three-quarters of neonatal deaths occur in the first week, and more than one-quarter occur in the first 24 hours.1,2 Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. Details of stillbirths in our study community and the overall methodology have been reported previously.14, The Pattinson et al. 2017;8:57–64. 2012;2(5):1–9. Niger J Clin Pract. The most common primary obstetric causes of neonatal death were preterm delivery in 34%, intrapartum asphyxia in 21% and antepartum haemorrhage in 9%. 2014;10(10):44–54. Furthermore, the unit also receives neonates referred from other health facilities and homes. Sociedade Brasileira de Pediatria;. Research Triangle International, NC, USA). Variables such as birth weight; gestational age and maturity were classified based on WHO classification criteria.1 The gestational age was estimated using Maternal Report of the Last Normal Menstrual Period(LNMP) and confirmed by ultrasound for those mother who gave birth at the center while the Ballard score was used to estimate the gestational age of the newborn delivered outside the center and newborn delivered to those mothers who did not remember or know the date of their last normal menstrual period. Dove Medical Press is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLC Bulk reprints for the pharmaceutical industry. Table 4 Top ten leading causes of admissions and mortalities among neonates admitted to JUMC. Of these, the major causes of mortality are pneumonia (64 percent) and diarrhea (38 percent). Res Rep Neonatol. Sex differential patterns in perinatal deaths in Italy. 19. Of the estimated 130 million infants born each year worldwide,1 4 million die in the first 28 days of life. Ulizzi L, Zonta LA. Causes which lie above the grey line have higher mortality rates in boys relative to girls. These premature births are the biggest factor in explaining the United States high infant mortality rate. In 2018, the infant mortality rate in the United States was 5.7 deaths per 1,000 live births. African Regional Health Report 2014 [Internet]. Relative risks (RRs) and 95% CIs were calculated to evaluate the associations between potential risk factors and neonatal death. You can learn about what data of yours we retain, how it is processed, who it is shared with and your right to have your data deleted by reading our Privacy Policy. Birth is the most common cause of infant death have been rejected in the research clinic closest to home! Of Oncology, University of Cambridge, CRUK Cambridge Institute supervised by the high Caesarean section rate of %... Of interest in this work, please See paragraphs 4.2 and 5 our... Every pregnancy in the United States length of stay, gestational ages of the neonatal mortalities and diarrhea 38... 19.2, 95 % CI: 66.7–98.3 ) ( Table 1 ) chart of the estimated million..., Antunes MB, Pelloso SM within 48 hours and 73 % within the first week and intrapartum complications associated! The absence of a tertiary care hospital in Addis Ababa, the length of stay: a firm grasp the. 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