An early neonatal death is defined as the death of a liveborn infant during the first 7 days after delivery. Therefore, the early neonatal mortality rate is the number of infants that die in the first week of life per liveborn deliveries. A liveborn infant is usually defined as an infant weighing more than g that shows any sign of life at birth i. Liveborn infants below g at birth almost always die within a few hours of birth, and are usually medically recorded as abortions.
The early neonatal mortality rate in a developed country is usually about 5 per In a developing country the early neonatal mortality rate is usually more than 10 per The perinatal mortality rate is the number of stillbirths plus the number of early neonatal deaths per total deliveries i. The perinatal mortality rate is about the same as the stillbirth rate plus the early neonatal mortality rate. Note that the low-birth-weight rate and early neonatal mortality rate are expressed per live births while the stillbirth rate and perinatal mortality rate are expressed per total births i.
It is very important to know the low-birth-weight, stillbirth, neonatal and perinatal mortality rates in your service as these rates reflect the living conditions, standard of health, and quality of perinatal healthcare services in that region. It is far more important to know the mortality rate for the region than simply the rates for one clinic or hospital in the region. Increased low-birth-weight and stillbirth rates suggest a low standard of living with many socio-economic problems, such as undernutrition, poor maternal education, hard physical activity, poor housing and low income in the community.
An increased early neonatal mortality rate, especially if the rate of low-birth-weight infants is not high, usually indicates poor perinatal health services.
MATERIALS AND METHODS
Both a poor standard of living and poor health services will increase the perinatal mortality rate. An increased low-birth-weight rate reflects poor socio-economic conditions, while a high early neonatal mortality rate indicates poor perinatal health services. Many of these causes are preventable with good perinatal care in level 1 hospitals and clinics. It is essential that you determine the common causes of perinatal death in your area. The avoidable causes of perinatal death should then be identified and steps taken to correct these causes.
This is a regular meeting of staff to discuss all stillbirths and early neonatal deaths at that clinic or hospital. Clinic deaths must include infants who died after transfer to a level 2 or 3 hospital as the cause of death may be due to the quality of management received at the clinic.
Management problems with sick infants who survived can also be discussed. Perinatal mortality meetings are held weekly or monthly. The aim of a perinatal mortality meeting is not only to establish the cause of death, but also to identify problems in the service and, thereby, to improve the management of mothers and infants. Care must be taken to review the management so that lessons can be learned, rather than to use the meeting to blame individuals for poor care.
The disciplining of staff should be done privately and never at a perinatal mortality meeting. Avoidable factors should be looked for whenever there is a stillbirth or neonatal death. The avoidable factors may be divided into problems with:. Some causes of death are avoidable e. By identifying avoidable factors, plans can be made to improve the perinatal care provided. Every infant referred from a level 1 clinic or hospital to a level 2 or 3 hospital must be recorded and reviewed.
The adequacy of resuscitation and management before transfer is important. Comment on the management and condition of the infant on arrival at the referral hospital is very useful. With this information, problems with management and transport can be identified, protocols improved and plans made for appropriate training. It is very helpful if staff from the referral hospital can be involved in perinatal mortality and morbidity meetings.
It tracks the common causes of stillbirth and early neonatal death and is very important in planned health services aimed at lowering the perinatal mortality rate. The mother is unbooked and does not know the date of her last menstrual period. She smokes 20 cigarettes a day.
The infant has loose, wrinkled, dry skin and scores at When plotted on a weight-for-gestational-age chart, the infant falls below the 10th centile. The loose, wrinkled, dry skin suggests wasting due to a poor supply of food to the fetus during the last weeks of pregnancy. Because the infant weighed less than g and the patient did not know the duration of pregnancy. Because it indicates that the infant is at high risk of poor breathing at birth, meconium aspiration, hypothermia and hypoglycaemia.
The infant may also have organ damage due to the lack of oxygen before delivery fetal hypoxia. A 5-day-old term infant is bathed in a cold ward. Afterwards the infant appears well but feels cold. A reading in the axilla with a digital thermometer gives a result of The infant is underweight-for-gestational-age and wasted. This may cause hypothermia as the infant has little body fat.
In addition, the infant probably became cold after the bath because of the cold room. A cold infant uses a lot of energy in an attempt to keep warm. This infant should be fed as soon as possible. This will help to prevent hypoglycaemia. Feeds will also provide the infant with energy to produce heat.
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The infant should be dressed and given a woollen cap. The infant is nursed in a closed incubator but no feed is given for 2 hours.
2500-g Low Birth Weight Cutoff: History and Implications for Future Research and Policy
At 1 hour after birth the Hemo-Glukotest reading with a Reflolux meter is normal but at 2 hours after birth the reading indicates hypoglycaemia. The infant is preterm and therefore has little energy store. In addition, the infant has not been fed for 2 hours after birth.
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The infant had energy stores to last 1 but not 2 hours. Tube feeds should be started after delivery. There is no indication to give intravenous fluids. In a week or two, when the infant starts to suck, breast or cup feeds can be introduced. Breast milk should be used if possible. If this is not available, then a standard infant formula e. NAN 1 should be given. A multivitamin liquid 0. Both should be continued for 6 months. The dose of iron drops should be increased to 0.
It is decided to determine the perinatal healthcare status of a region. Therefore, all the birth weights, together with the number of live births and perinatal deaths, in the hospitals, clinics and home deliveries in that region are recorded for a year. Only infants with a birth weight of g or more are included in the survey. Of the births, 50 infants were stillborn and were born alive. Of the live born infants, 25 infants died in the first week of life. One hundred and twenty liveborn infants weighed less than g at birth.
Because some of these infants may live if they are given emergency management and then transferred to a level 2 or 3 hospital.
Primary Newborn Care: 3. Care of low-birth-weight infants
There were 50 stillbirths and total births. Of the infants who were born alive, 25 died during the first week of life. Therefore, the rate of There were 50 stillbirths and 25 early neonatal deaths with total deliveries. It suggests that the living conditions of the mothers in the study region are satisfactory but the perinatal services are poor. Every effort must be made, therefore, to improve these services. Care of low-birth-weight infants. Open chapter quiz Close quiz First time? Register for free. Just enter your email or cell number and create a password. Unmarried teenage mother. Preterm delivery.
S 18 year old primip. Spontaneous preterm labour. No signs of fetal distress. NVD at Apgar scores 4 and 9.
Intubation and ventilation needed for 3 minutes. Environ Res. Siddiqui, A. Prenatal exposure to wood fuel smoke and low birth weight. Environ Health Perspect. Kumar, K. Maternal anemia in various trimesters and its effect on newborn weight and maturity: an observational study. Int J Prev Med. Yildiz, Y.
Ministry of Health. Annual Health Bulletin. Ministry of Finance and Planning. Impact of second trimester maternal dietary intake on gestational weight gain and neonatal birth weight. Chasan-Taber, L.