Early Neonatal Death

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Maternal Age, Low Birth Weight and Early Neonatal Death in Tertiary Hospital in the Volta Region of Ghana

Maternal Age, Low Birth Weight and Early Neonatal Death in Tertiary Hospital in the Volta Region of Ghana

Objectives: Current study sought to determine an association between Low Birth Weight (LBW) and early neonatal mortality at a resource limited coun- try’s referral hospital and to determine relationship between maternal age and birth outcomes. Method: A retrospective study analyzing data on births in the Volta Regional Hospital, Ghana from the period of November 2011 to June 2016. A total of 8279 births were analyzed. Results: Results suggest that tee- nage mothers (8.60%) are more likely to give birth to pre-term babies than the elderly (6.60%) and the adult mothers (4.61%) . LBW is highest among the tee- nage mothers (12.69%) followed by the elderly mothers (7.87%) and then the least among the adult mothers (6.48 % ). Extremely Low Birth Weight (ELBW) and Macrosomia births were more observed among the elderly mothers (0.90%; 2.17%) than the teenage (0.28%; 0.14%) and adult mothers (0.34%; 1.61%) re- spectively. Data suggest that 100% of the ELBW were pre-term birth, 88.28% Very Low Birth Weight (VLBW), 34.56% LBW and only 1.06% of the pre-term birth were with Normal Birth Weight (NBW). Death rate ranges from 50% for ELBW, 33.59% for VLBW, 8.22% for LBW, 5.43% for Macrosomia and 1.5% for NBW. However, death rate distribution among the various age groups was statistically not significant ( P < 0 . 106). Conclusions: Our study suggests that early neonatal death, especially deaths among ELBW and VLBW is still high at the VRH of Ghana and therefore there is the need for further studies into in- terventions to reduce death among neonates born with VLBW and ELBW. How to cite this paper: Afeke, I., Mac-Ankrah,
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Exposure to artemether lumefantrine (Coartem®) in first trimester pregnancy in an observational study in Zambia

Exposure to artemether lumefantrine (Coartem®) in first trimester pregnancy in an observational study in Zambia

Safety assessments included monitoring and recording of all adverse events (AEs) and serious adverse events (SAEs) up to six weeks post-delivery. Pregnancy-specific assessments included rates of perinatal mortality defined as stillbirth (>28 weeks gestation) and early neonatal death (within seven days of birth); neonatal mortality (≤28 days of birth); maternal mortality (up to six weeks post-delivery); spontaneous abortion (≤28 weeks gesta- tion); stillbirth; preterm delivery (≤37 completed weeks); incidence of low birth weight; gestational age at delivery (estimated from LMP, or by a Dubowitz score [20,21] if the LMP was unknown); and incidence of major and minor birth defects. Concomitant infections were recorded.
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Timing and cause of perinatal mortality for small-for-gestational-age babies in South Africa: critical periods and challenges with detection

Timing and cause of perinatal mortality for small-for-gestational-age babies in South Africa: critical periods and challenges with detection

Secondary analysis of the South African Perinatal Problems Identification Program (PPIP) database allowed for the analysis of gestational age at death and clinically confirmed diagnosis of stillbirth and early neonatal death (END) across gestation. The program also allowed for comparisons between SGA, appropriate-for-gestational- age (AGA) and large-for-gestational-age (LGA) babies from 1 October and 2013 and 31 August 2015 and between three provinces: Western Cape, Limpopo and Mpumalanga. Western Cape has fortnightly antenatal care visits between 32 and 38 weeks, while Limpopo and Mpumalanga do not have visits between 32 and 38 weeks, preventing the opportunity for detection of SGA at these gestations. These provinces were chosen (from nine available) as they have the greatest PPIP coverage, auditing >90 % of perinatal deaths. PPIP is a perinatal quality audit system that has been described in
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Safety of artemether lumefantrine in pregnant women with malaria: results of a prospective cohort study in Zambia

Safety of artemether lumefantrine in pregnant women with malaria: results of a prospective cohort study in Zambia

Safety assessments included monitoring and recording all adverse events (AEs) and serious adverse events (SAEs) up to six weeks after delivery. Pregnancy-specific assess- ments included rates of perinatal mortality defined as still- birth (>28 weeks gestation) and early neonatal death (within seven days of birth), neonatal mortality (≤28 days of birth), maternal mortality (up to six weeks post-deliv- ery), spontaneous abortion (≤28 weeks gestation), still- birth, preterm delivery (≤37 completed weeks), incidence of low birth weight, gestational age at delivery (estimated from the last menstrual period [LMP], or by a develop- mental score [Dubowitz assessment] [16], if the LMP was unknown), and incidence of major and minor birth defects. Concomitant infections were recorded. Minor/ major birth malformations were documented using a checklist. Neurodevelopmental assessment was performed at 14 weeks and 12 months after birth. The development of infants was assessed by the investigators either through a general assessment (e.g. smiling, lifting head, sitting unsupported, standing without assistance, crawling) or the Shoklo neurodevelopment assessment [17], or both.
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Pregnant women adherence level to antenatal care visit and its effect on perinatal outcome among mothers in Tigray Public Health institutions, 2017: cohort study

Pregnant women adherence level to antenatal care visit and its effect on perinatal outcome among mothers in Tigray Public Health institutions, 2017: cohort study

This study shows that incidence of neonatal complica- tion is higher among the women’s neonate with incom- plete adherence to antenatal visit. Incidence of still birth among women’s with incomplete adherence is four fold of the women’s with complete adherence to antenatal visit which is 3.6 and 0.9% respectively. The incidence of early neonatal death and late neonatal death among women’s with complete adherence to antenatal visit was almost similar which is 1.5 and 1.1% respectively where as among the women’s with incomplete adherence to ante- natal care visit the incidence of the early neonatal death is higher than the late neonatal death which is 4 and 2.7% consecutively and this could be due to the vulnerability of the neonate to many things in the earlier period than late after they customize the environment. The incidence of low birth weight among the non exposed group was almost twice of the exposed group (9.4%:5.6%) and this might be probably due to the counseling regarding nutri- tional methods during antenatal visit.
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First-day and Early Neonatal Mortality in Nigeria: A Pooled Cross-sectional Analysis of Nigeria DHS Data

First-day and Early Neonatal Mortality in Nigeria: A Pooled Cross-sectional Analysis of Nigeria DHS Data

Interestingly, a new pattern of distribution of child mortality by age has appeared over the period 1990-2015. That is, increasing proportion of child deaths occurring around labour and immediate postpartum period [2]. Over this period, proportions of child death occurring with the neonatal period, early neonatal period and within the first day of life have constituted large percentages of child deaths. Globally, around 44% of all deaths in children less than 5 years occur in the neonatal period (between birth and first 28 days of life) and this proportion is increasing as the numbers of post-neonatal deaths fall more rapidly [3,4]. Similarly, early neonatal death (death within the first seven days of life) contributes approximately 16% of under- five deaths and 36% of neonatal deaths respectively. Furthermore, in 2015, there were approximately 2 million early neonatal deaths or 32% of all under-five deaths or 73% of all neonatal deaths. Therefore, both early neonatal death and first-day mortality constitute large
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Perinatal complications associated with preterm deliveries at 24 to 33 weeks and 6 days gestation (2011- 2012): A hospital-based retrospective study

Perinatal complications associated with preterm deliveries at 24 to 33 weeks and 6 days gestation (2011- 2012): A hospital-based retrospective study

The growing number of preterm neonates in tertiary centers substantiates the importance to better understand and medically approach preterm infants. Short-term and long-term evaluation, monitoring and follow up of preterm infants are needed to optimize neonatal care and improve human health status. The aims of this investigation were to evaluate the rate of mortality and discharge home morbidity of preterm infants with gestational age at less than 34 weeks and to analyze risk factors associated with preterm birth.

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Effect of antenatal care and social well being on early neonatal mortality in Bangladesh

Effect of antenatal care and social well being on early neonatal mortality in Bangladesh

and her future offspring. Child survival can be improved by improving care during antenatal period. The present study examined the effects of antenatal care and social well-being on early neonatal mortality (ENM) in Bangladesh. In this study the Bangladesh Multiple Indi- cator Cluster Survey data was used which was con- ducted from December 2012 to March 2013 with the collaboration of the Bangladesh Bureau of Statistics (BBS) and Ministry of Planning. The survey used the multistage stratified sampling method for collecting data. This is one of the few studies that focus on the impact of antenatal care and social well-being on early neonatal mortality using a large scale secondary data set.
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Neonatal Outcome after Preterm Delivery in HELLP Syndrome

Neonatal Outcome after Preterm Delivery in HELLP Syndrome

the normotensive group in neonatal death (ND) (19.5% vs. 2.0%, p = 0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p = 0.0045), intra- ventricular hemorrhage (IVH) (61.9 vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), inten- sive care (IC) (85.7% vs. 24%, p < 0.0001), and mechanical ventilation (MV) rate (81.0% vs. 14%, p < 0.0001). There were significant differences be- tween the HELLP syndrome group and the severe preeclampsia group in intraventricular hemor- rhage (IVH) (61.9% vs. 26%, p = 0.006), sepsis Table 2. Comparison of Clinical Characteristics
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Incidence, bacteriological profile and risk factor analysis of neonatal sepsis in a peri urban set up of North India

Incidence, bacteriological profile and risk factor analysis of neonatal sepsis in a peri urban set up of North India

However, these neonates are exposed to NICU flora, they undergo multiple invasive procedures, including intravenous access and intubation. All the interventions and exposures lead to breach of the natural immunity of the neonate making them susceptible to infections. Premature rupture of membrane, prolonged labour, maternal fever within seven days before delivery were some of the factors significantly related to neonatal sepsis. Late and inadequate prenatal care, low socioeconomic status of the mother, poor maternal nutrition are additional factors associated with neonatal sepsis. 36
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Neuroprotection by heat shock protein 27 in sensory and motor neurons

Neuroprotection by heat shock protein 27 in sensory and motor neurons

The ability o f the small heat shock protein 27 (Hsp27) to prevent apoptotic neuronal death has been examined in primary sensory and motor neurons. The first part o f the thesis investigates whether there is a correlation between the expression o f Hsp27 and the survival o f adult and neonatal sensory and motor neurons. Peripheral nerve injury is well known to induce a substantial death o f neonatally injured, but not o f adult injured sensory and motor neurons. In the adult, sciatic nerve axotomy results in a rapid upregulation o f Hsp27 expression in all injured sensory and motor neurons. In contrast, sciatic nerve injury performed at birth induces Hsp27 upregulation only in a very small proportion (-5% ) o f injured neurons. Those neonatal neurons that express Hsp27 after nerve injury survive, and those that do not undergo apoptosis. The hypothesis that Hsp27 functions as an intrinsic neuronal survival factor is directly tested. Employing viral vectors to induce human Hsp27 expression in neonatal sensory neurons in vitro and neonatal motor neurons in vivo, Hsp27 is demonstrated to rescue both sensory and motor neurons from nerve injury induced cell death. Delivery o f an antisense human Hsp27 construct with a Herpes-Simplex viral vector to knockdown endogenous Hsp27 is shown to induce apoptotic cell death in adult primary sensory neurons. These findings suggest that Hsp27 is both necessary and sufficient for cell survival in these neurons. Immunohistochemical analysis o f the apoptotic pathway reveals that Hsp27 inhibits apoptosis in sensory neurons by acting downstream o f cytochrome-c release from the mitochondria but upstream o f caspase-3 activation. The contribution o f post-translational changes in conferring a survival role for Hsp27 is studied by examining the ability o f a non-phosphorylatable mutant o f Hsp27 to protect neonatally injured motor neurons from death in vivo, and by investigating changes in the phosphorylation o f Hsp27 on S e ri5 after nerve injury. These findings suggest phosphorylation is important in the neuroprotective role o f Hsp27.
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Neonatal death factors in very low birth weight infants

Neonatal death factors in very low birth weight infants

The study was conducted in compliance with the provisions of the Guidelines and Regulatory Standards for Research Involving Human Beings imposed by Resolution CNS 466/12, the Department of Teaching and Research and the Research Ethics Committee of the Santa Casa de Misericórdia do Pará Foundation (CAAE 44804515.4. 0000.5171) with the approval of Plataforma Brasil through the opinion nº 1.074.331 dated 05/22/2015. This is a retrospective descriptive epidemiological study through the analysis of medical records of newborns weighing ≤ 1500 grams at birth and who were hospitalized in the neonatal intensive care units of a high-risk university referral hospital in the Brazilian Amazon during the period. from January 1 to December 31, 2014. For operational reasons, the sample was random and convenient, based on hospitalizations and weight cutoff ≤ 1,500 grams. We excluded all medical records with incomplete information according to the data collection protocol of newborns greater than 1,500 g who were born in another hospital, with some kind of congenital and / or twin malformation. The maternal variables used in the research were: age (in years); provenance (own municipality versus others); schooling; parity (primiparous versus non-primiparous); number of prenatal consultations (<6 or ≥ 6 consultations); gestational risk (usual versus high); hospitalization during pregnancy; use of antenatal corticosteroids and type of delivery (vaginal versus cesarean). The neonatal variables used were: gender, birth weight (in grams), gestational age (in weeks), Apgar score, delivery room resuscitation, use of mechanical ventilation, use of surfactant, corticosteroids and dosage number, use of sedation and vasoactive drugs, length of stay in the unit (in days), time of invasive and noninvasive mechanical ventilation (in days), use of drains, use of antibiotics, use of analgesia and discharge information. Data were processed in a database created by the Statistical Package for Social Sciences (SPSS) for Windows (version 20.0). Descriptive analysis of the data with absolute and percentage numbers was performed to obtain the absolute and relative average frequencies and standard deviation of the numerical variables studied, and the prevalence of the
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Patterns of preterm neonatal death and associated factors in ayder referral hospital neonatal unit from 2010  2014 (five years record review), Tigray Region, North Ethiopia

Patterns of preterm neonatal death and associated factors in ayder referral hospital neonatal unit from 2010 2014 (five years record review), Tigray Region, North Ethiopia

The diagnosis of neonatal sepsis was made based on clinical evidence in 331(80.5%) of preterm neonates and only one neonate was proved to have neonatal sepsis by the gold standard test, blood culture. Except for three preterm neonates all the rest neonates were started on empirical antibiotics, once they were clinically diagnosed to have sepsis before blood sample was taken for Culture and Sensitivity. The culture intake was much less than the study done in Black Lion hospital in Addis Ababa, Ethiopia. The reason for the delay of sample for Blood Culture in black lion hospital was the Bacteriology Unit closes after the Off Duty hours and weekends, and sometimes the attendants don’t pay for the Investigation soon enough. Apparently the admitting physicians are obliged to start empirical antibiotics, to avoid any delay of life saving treatment. The reason is similar in this hospital too (Yusuf et al., 2010). The death in preterm neonates was inversely related with birth weight and gestational age and this is consistent with other studies from different countries (deFreitas et al., 2012; Sritipsukho et al., 2007; Hyagriv et al., 2012; Carlo Waldemar et al., 2011 and Lee et al., 2008). It was observed that 14.6% of the population died in the hospital, resulting in 85.6% survival rate, which was directly related to the GA.
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Neonatal Sepsis – A Review

Neonatal Sepsis – A Review

nosocomial infection rates in the NICU Future Developments and Research Priorities There are a number of important gaps in our knowledge, and there is an urgent need for studies looking at simple and sustainable interventions to reduce the burden of neonatal infection. Longitudinal surveillance to describe the varied pathogens causing neonatal sepsis as well as their changing antibiotic susceptibility profile is important. Without such a platform, the introduction of new methods of prevention is difficult. 5

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Maternal risk factors and early neonatal outcome among late preterm and term neonates in a neonatal intensive care unit in Punjab, India

Maternal risk factors and early neonatal outcome among late preterm and term neonates in a neonatal intensive care unit in Punjab, India

Neonatal outcomes assessed were death and common neonatal morbidities like neonatal hyperbilirubinemia, respiratory distress syndrome (RDS), birth asphyxia, hypoglycemia, hypocalcemia, seizures, necrotising enterocolitis (NEC), sepsis, intrauterine pneumonia, meconium aspiration pneumonia, patent ductus arteriosus (PDA) and persistent pulmonary hypertension (PPHN). Need for and mode of ventilation was also noted. Statistical analysis

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Incidence and Risk Factors of Neonatal Mortality in Eastern Ethiopia, A Prospective Cohort Study in Kersa Health and Demographic Surveillance System (Kersa HDSS)

Incidence and Risk Factors of Neonatal Mortality in Eastern Ethiopia, A Prospective Cohort Study in Kersa Health and Demographic Surveillance System (Kersa HDSS)

The main outcome variable was neonatal death. The survival time was calculated in days using the time interval between the date of birth and the date of death. STATA Version 11 statistical software was used to perform the analysis. Cox-proportional hazard model was used to identify the risk factors of the neonatal death. Kaplan-Meier curve was used to depict the pattern of death and estimate the probability of the neonates’ survival and to compare the survival curves. An initial univariate analysis of the individual variables with neonatal death was carried out to determine the possible significant explanatory variables to be included in the Cox-proportional hazard model. An explanatory Cox-proportional hazard model analysis was performed to explore the relations between the variables while simultaneously adjusting for all other variables that have influence on the neonatal death. After confounding variables were identified, the variables with p-values of 0.05 or less were retained in the final model analysis. All the statistical tests were two sided and p<0.05 was considered as a significant level of association. The neonate was censored if it is alive at the end of the follow- up period.
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LISTERIA MONOCYTOGENES AND QUEEN ANNE

LISTERIA MONOCYTOGENES AND QUEEN ANNE

bitual abortion, stillbirth, neonatal death, and postnatal meningitis with residual hy- drocephalus. Because Anne was childless,[r]

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Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study

Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study

yes/no), infant’s sex (male/female), congenital anom- alies and stillbirths. Congenital anomalies were identi- fied from BERD and included the following conditions observed within the first 24 hours after birth: anencephaly, meningomyelocele or spina bifida, cyanotic congenital heart disease, congenital diaphragmatic hernia, ompha- locele, gastroschisis, limb reduction, cleft lip, cleft palate, Down syndrome, chromosomal disorders and hypospa- dias. We adjusted for temporal trends in these conditions as a potential risk factor for adverse outcomes. Stillbirth was defined as spontaneous intrauterine death of a fetus. Gestational age-specific rates of stillbirths were calculated using the fetuses-at-risk (FAR) approach. 22 Under this
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Prospective audit and feedback on antibiotic use in neonatal intensive care: a retrospective cohort study

Prospective audit and feedback on antibiotic use in neonatal intensive care: a retrospective cohort study

Starting in October 2012, a pediatric infectious diseases-trained physician and/or a pharmacist specializ- ing in antimicrobial stewardship performed PAF fives day a week on every neonate who received antibiotics. They participated in dedicated ASP rounds five morn- ings a week with the NICU medical team, which in- cluded staff physicians, fellows, nurse practitioners, residents and students. Neonates who were being con- sidered for antibiotic treatment were not reviewed. The discussions included reviews of the evidence with the team, such as use of serial C-reactive protein for sus- pected sepsis, or clarithromycin to prevent bronchopul- monary dysplasia; discussions around microbiology and pathophysiology, such as the management of a baby born to a mother with chorioamnionitis with in-utero antibiotic exposure and negative neonatal blood cultures; support of changes in practice by individuals, such as discontinuing antibiotics with negative cultures in the context of clinical sepsis; and affirmed these changes in presentations at staff meetings. The antibiotic courses for babies followed by the infectious diseases service were not reviewed but were included in the analysis. Suggestions were made around antimicrobial use, in- cluding, but not limited to, choice of antimicrobial and duration of therapy. Eight months into the program, the frequency of ASP rounds was decreased to 4 days a week.
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Zinc Supplementation during Pregnancy: A Randomized Controlled Trial

Zinc Supplementation during Pregnancy: A Randomized Controlled Trial

outcome have been carried in industrialized countries and results have been inconclusive [ 8]. However, women from developing countries are more likely to be zinc deficient; therefore, they may be at higher risk of producing low birth weight infants. Despite these risks, few data are available from developing countries in this regard. In a review published in 2003, Osendarp et al. [ 6] discussed preliminary findings from eight recent randomized controlled intervention trials in less- developed countries. These findings indicated that maternal zinc supplementation has a beneficial effect on neonatal immune status, early neonatal morbidity and infant infections; with respect to labour and delivery complications, gestational age at birth, maternal zinc status and health, and neurobehavioral development of the foetus. However, these findings are conflicting and more researches are required [ 6]. The results of a national survey in Iran showed low plasma zinc is prevalent among pregnant women [ 9]. Zinc intake was shown to be low among women in both urban and rural areas [ 10]. We performed a double-blind, placebo- controlled zinc-intervention trial among pregnant women to find whether zinc supplementation can reduce risk of delivering low birth weight infants or not.
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