Addressing the challenge of neonatal mortality.

Reducing neonatal mortality remains a challenge with an estimated 3.0 million neonatal deaths in 2011, three-quarters of these in sub-Saharan Africa and Southern Asia. The leading causes of neonatal death globally are complications of preterm birth, intrapartum-related causes and infections. While post-neonatal, under-5 deaths fell by 47% between 1990 and 2011, neonatal deaths only fell by 32% and they now account for 43% of all under-5 child deaths. This article reviews the progress in reducing neonatal deaths in high-burden countries and presents an overview of known effective interventions to reduce neonatal mortality and the challenges faced in implementing these in high-burden settings. Effective action is possible to reduce neonatal mortality, but innovative approaches to implementation will be required if these preventable deaths are to be avoided

FAKTOR­-FAKTOR RISIKO TERJADINYA ASFIKSIA NEONATORUM DI RSD JOMBANG PERIODE 1 JANUARI ­- 31 DESEMBER 2007

Neonatal Asphyxia is an emergency condition when the baby failed to breath spontaneously and regularly after they were born. Neonatal asphyxia remains the main cause of neonatal mortality as well as permanent neurological abnormality. With informed consideration about risk factors, more than half baby who need resuscitation could be identified prior to birth. Objectives: to identify antepartum and intrapartum risk factors in neonatal asphyxia. Sample: mother who delivered an asphyxia neonatal baby in Jombang General Hospital since January 1st to December 31st 2007 (total sampling). Result: the incidence of neonatal asphyxia was 12,56%. The antepartum factors which increased the risk of neonatal asphyxia were premature baby (48.94%), small for gestational of age baby (39,53%), mother’s age <16 &>35 accompanied by other risk \ud factor (14.89%), maternal hypertension (14.89%) and postmature baby (12.77%). lntrapartum factors were meconeum stained of amnion fluid (29.79%) and premature amnion fluid broke accompanied by other risk factor (21.28%). Conclusion: premature baby, small for gestational of age (SGA) baby, meconium stained of amnion fluid, premature broke of amnion fluid accompanied by other risk factor, mother’s age <16 &>35 years old accompanied by other risk \ud factor and maternal hypertension increased the risk of neonatal asphyxia

Brainstem auditory evoked responses in an equine patient population. Part II: foals.

BackgroundReports of the use of brainstem auditory evoked response (BAER) as a diagnostic modality in foals have been limited.Hypothesis/objectivesTo describe BAER findings and associated causes of hearing loss in foals.AnimalsStudy group 18 foals (15 neonatal, 3 nonneonatal), control group (5 neonatal foals).MethodsRetrospective. BAER records from the Clinical Neurophysiology Laboratory were reviewed from the years of 1982 to 2013. Peak latencies, amplitudes, and interpeak intervals were measured when visible. Clinical data were extracted from the medical records. Foals were grouped under disease categories. Descriptive statistics were performed.ResultsTen neonatal foals had complete absence of BAER bilaterally and 5 had findings within reference range. Abnormalities were associated with common neonatal disorders such as sepsis, neonatal encephalopathy, neonatal isoerythrolysis, and prematurity. BAER loss also was observed in foals with specific coat color patterns such as completely or mostly white with blue irides or lavender with pale yellow irides. An American Miniature foal with marked facial deformation also lacked BAER bilaterally. One nonneonatal foal with an intracranial abscess had no detectable BAER peaks bilaterally, and 2 older foals, 1 with presumed equine protozoal myeloencephalitis and the other with progressive scoliosis and ataxia, had BAER within normal limits.Conclusions and clinical importanceIn neonatal foals, BAER deficits commonly are complete and bilateral, and associated with common neonatal disorders and certain coat and eye color patterns. Sepsis, hypoxia, bilirubin toxicity, and prematurity should be investigated as potential causes of auditory loss in neonatal foals

HUBUNGAN FAKTOR MATERNAL DAN PERAWATAN BAYI DENGAN KEMATIAN NEONATAL PADA KELUARGA MISKIN DI KABUPATEN PADANG PARIAMAN TAHUN 2004 (RELATION OF MATERNAL FACTOR AND BABY NURSING WITH DEATH OF NEONATAL AT IMPECUNIOUS FAMILY OF YEAR 2004)

Kematian bayi merupakan indikator utama dalam pembangunan kesehatan. 50% Angka Kematian Bayi terdiri dari Angka Kematian Neonatal. Di Kabupaten Padang Pariaman Angka Kematian Bayi sebesar 1,9%, 87,9% dari kematian bayi berasal dari neonatal, dan 75,2% dari kematian neonatal terjadi pada keluarga miskin. Salah satu usaha untuk menurunkan Angka Kematian Neonatal adalah dengan mengenal faktor risiko di antaranya yang berasal dari ibu (maternal) dan faktor perawatan bayi. Tujuan penelitian ini adalah untuk mengetahui hubungan faktor maternal dan perawatan bayi dengan kematian neonatal pada keluarga miskin di Kabupaten Padang Pariaman. Jenis penelitian ini adalah explanatory research dengan rancangan penelitian case control study. Populasi seluruh bayi gakin yang dilahirkan di Kabupaten Padang Pariaman Tahun 2004. Sampel sebesar 50 untuk kelompok kasus. Pengambilan sampel dengan acak sederhana sedangkan kontrol dipilih dengan melakukan matching. Analisis data dilakukan dengan uji statistik Chi square dengan tingkat kemaknaan 0,05% dengan menggunakan program SPSS For Windows versi 13.0. Dari hasil penelitian menunjukkan bahwa kematian neonatal 50% terdapat pada ibu dengan paritas lebih dari 3, sebesar 60% dengan jarak kehamilan yang kurang dari 24 bulan, 26% yang mengalami komplikasi di saat kehamilan, 68% yang memeriksakan kehamilan tidak sesuai dengan standar K4, 60% yang sudah memberikan makanan padat dini kepada bayi dan 42% perawat tali pusat bayi dilakukan selain petugas kesehatan. Sedangkan faktor risiko yang berhubungan dengan kematian neonatal adalah jarak kehamilan (p-value = 0,000 ; OR = 6,000), ANC (p-value = 0,000 ; OR = 8,500), pemberian makanan padat dini (p-value = 0,001 ; OR = 4,269) dan petugas perawat tali pusat (p-value = 0,008 ; OR = 3,802). Terdapat 3 faktor dominan untuk memprediksi probabilitas kematian neonatal, yaitu jarak kehamilan, ANC dan pemberian makanan padat dini. Prediksi probabilitas kematian neonatal oleh ketiga faktor risiko dominan sebesar 92%. Disarankan kepada pengelola KIA untuk meningkatkan penyuluhan individu kepada ibu hamil mengenai pentingnya ANC dan ASI ekslusif, mengadakan pelatihan kader dan pembinaan dukun di tingkat Puskesmas dan Kabupaten. Infant mortality rate a main indikator in health development. About 50% infant mortality consist of neonatal mortality. There were about 82 of infant mortality the District Padang Pariaman In 2004. And about 75,6% of infant mortality was happened on poor family. One of the effort to degrade neonatal mortality is by recognizing the risk factor among others coming from maternal and neonatal care. Target of this research is to know maternal factors and infant care influences to neonatal mortality on family in the District Padang Pariaman. This research is using by explanatory research with case control study. The populations of this research is all baby who have borned in The District Padang Pariaman in year of 2004. Sampele equal to 50 for the group of case dan control.In take of sample simple random sampling while control selected by doing matching. Data analysis done with statistical test of chi square with significan level 0,05 by using SPSS program for window with version 13,0. From the result of this research indicated that neonatal mortality 50% were happened on mother with parity more than 3, equal to 60%. With pregnancy interval which less than 24 months, 26% natural of conplication of pregnancy moment,68% ante natal care with K4 standart, 60% which have given solid food early to baby and 42% centre string neonatal care done by besides health officer. While the risk factor influences to neonatal mortality is pregnancy interval (p value = 0,000; OR = 6,000), ANC (p value = 0,000; OR = 8,500),giving early solid food (p value = 0,001); OR = 4,269) and centre string nurse officer (p= value =0,008; OR = 3,802). There are there dominant factors to predict the probability of neonatal mortality that are pregnancy interval, ANC and giving early solid food. Probability prediction of neonatal mortality by three dominant risk factors equal to 91%. In sugesting to KIA organizer to increase individual conseling to pregnant mother regarding importantly ANC and exlusive ASI. Performing a cadre training and contruction of traditional health provider in health centre and the district level. Kata Kunci: Maternal, Neonatal, Perawatan Bayi, 200

Neonatal mortality in the developing world

This paper examines age patterns and trends of early and late neonatal mortality in developing countries, using birth history data from the Demographic and Health Surveys (DHS). Data quality was assessed both by examination of internal consistency and by comparison with historic age patterns of neonatal mortality from England and Wales. The median neonatal mortality rate (NMR) across 108 nationally-representative surveys was 33 per 1000 live births. NMR averaged an annual decline of 1.7 % in the 1980s and 1990s. Declines have been faster for late than for early neonatal mortality and slower in Sub-Saharan Africa than in other regions. Age patterns of neonatal mortality were comparable with those of historical data, indicating no significant underreporting of early neonatal deaths in DHS birth histories.birth history, early neonatal mortality rate, heaping, late neonatal mortality rate, mortality, neonatal mortality

Determinants of neonatal mortality in rural India, 2007-2008.

Background. Despite the growing share of neonatal mortality in under-5 mortality in the recent decades in India, most studies have focused on infant and child mortality putting neonatal mortality on the back seat. The development of focused and evidence-based health interventions to reduce neonatal mortality warrants an examination of factors affecting it. Therefore, this study attempt to examine individual, household, and community level factors affecting neonatal mortality in rural India.Data and methods. We analysed information on 171,529 singleton live births using the data from the most recent round of the District Level Household Survey conducted in 2007–08. Principal component analysis was used to create an asset index. Two-level logistic regression was performed to analyse the factors associated with neonatal deaths in rural India.Results. The odds of neonatal death were lower for neonates born to mothers with secondary level education (O R = 0.60, p = 0.01) compared to those born to illiterate mothers. A progressive reduction in the odds occurred as the level of fathers’ education increased. The odds of neonatal death were lower for infants born to unemployed mothers (O R = 0.89, p = 0.00) compared to those who worked as agricultural worker/farmer/laborer. The odds decreased if neonates belonged to Scheduled Tribes (O R = 0.72, p = 0.00) or ‘Others’ caste group (O R = 0.87, p = 0.04) and to the households with access to improved sanitation (O R = 0.87, p = 0.02), pucca house (O R = 0.87, p = 0.03) and electricity (O R = 0.84, p = 0.00). The odds were higher for male infants (O R = 1.21, p = 0.00) and whose mother experienced delivery complications (O R = 1.20, p = 0.00). Infants whose mothers received two tetanus toxoid injections (O R = 0.65, p = 0.00) were less likely to die in the neonatal period. Children of higher birth order were less likely to die compared to first birth order.Conclusion. Ensuring the consumption of an adequate quantity of Tetanus Toxoid (TT) injections by pregnant mothers, targeting vulnerable groups like young, first time and Scheduled Caste mothers, and improving overall household environment by increasing access to improved toilets, electricity, and pucca houses could also contribute to further reductions in neonatal mortality in rural India. Any public health interventions aimed at reducing neonatal death in rural India should consider these factors

Effect of case management on neonatal mortality due to sepsis and pneumonia.

BACKGROUND: Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST). METHODS: We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where appropriate. For interventions with biological plausibility but low quality evidence, a Delphi process was undertaken to estimate effectiveness. RESULTS: Searches of 2876 titles identified 7 studies. Among these, 4 evaluated oral antibiotics for neonatal pneumonia in non-randomised, concurrently controlled designs. Meta-analysis suggested reductions in all-cause neonatal mortality (RR 0.75 95% CI 0.64- 0.89; 4 studies) and neonatal pneumonia-specific mortality (RR 0.58 95% CI 0.41- 0.82; 3 studies). Two studies (1 RCT, 1 observational study), evaluated community-based neonatal care packages including injectable antibiotics and reported mortality reductions of 44% (RR = 0.56, 95% CI 0.41-0.77) and 34% (RR = 0.66, 95% CI 0.47-0.93), but the interpretation of these results is complicated by co-interventions. A third, clinic-based, study reported a case-fatality ratio of 3.3% among neonates treated with injectable antibiotics as outpatients. No studies were identified evaluating injectable antibiotics alone for neonatal pneumonia. Delphi consensus (median from 20 respondents) effects on sepsis-specific mortality were 30% reduction for oral antibiotics, 65% for injectable antibiotics and 75% for injectable antibiotics on pneumonia-specific mortality. No trials were identified assessing effect of hospital management for neonatal infections and Delphi consensus suggested 80%, and 90% reductions for sepsis and pneumonia-specific mortality respectively. CONCLUSION: Oral antibiotics administered in the community are effective for neonatal pneumonia mortality reduction based on a meta-analysis, but expert opinion suggests much higher impact from injectable antibiotics in the community or primary care level and even higher for facility-based care. Despite feasibility and low cost, these interventions are not widely available in many low income countries. FUNDING: This work was supported by the Bill & Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US

Draft genome sequence of a meningitic isolate of Cronobacter sakazakii clonal complex 4, strain 8399

The Cronobacter sakazakii clonal lineage defined as clonal complex 4 (CC4), composed of nine sequence types, is associated with severe cases of neonatal meningitis. To date, only closely related C. sakazakii sequence type 4 (ST4) strains have been sequenced. C. sakazakii strain 8399, isolated from a case of neonatal meningitis, was sequenced as the first non-ST4 C. sakazakii strain

Pediatric liver transplantation from neonatal donors

Sixteen recipients of neonatal liver grafts were compared with 114 contemporaneous pediatric recipients of grafts from older donors. Graft and patient survival were worse in the neonatal group although the differences were not statistically significant. Patients with neonatal livers who had no technical complications required a longer time postoperatively to correct jaundice and a prolonged prothrombin time. These functional differences were limited to the 1st postoperative month and the end result was the same as with liver transplantation from older donors. © 1992 Springer-Verlag