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Strategies for reduction of neonatal mortality
A Finan1, T A Clarke, T G Matthews
1Department of Paediatrics, Rotunda Hospital, Dublin.
Insights
Neonatal deaths, primarily from congenital malformations and prematurity, remain a concern in developed countries. Increased use of folate may reduce infant mortality through community-focused measures.
Area of Science:
- Perinatal Medicine
- Public Health
- Neonatology
Background:
- Infant mortality rates have declined in developed nations, yet neonatal deaths persist.
- A significant proportion of infant deaths occur during the neonatal period.
- Understanding causes of neonatal mortality is crucial for targeted interventions.
Purpose of the Study:
- To review the causes of neonatal deaths.
- To identify areas for potential improvement in reducing neonatal mortality.
- To analyze mortality data using the Wigglesworth classification.
Main Methods:
- A six-year review (1991-1996) of neonatal deaths.
- Inclusion criteria: live-born infants > 500g birthweight.
- Utilized the 1989 amended Wigglesworth classification for cause of death categorization.
Main Results:
- 153 neonatal deaths occurred among 34,375 births.
- Congenital malformations (51%) and prematurity (38%) were the leading causes.
- Neural tube defects comprised 10% of total neonatal mortality.
Conclusions:
- Reducing neonatal mortality is achievable through focused interventions.
- Community-based strategies, including preconception folate supplementation, show promise.
- Prematurity deaths were concentrated in infants < 1000g, with survival rates comparable internationally.
Abstract:
Infant mortality rates in developed countries have shown significant decreases in recent years. Two-thirds of infant mortality still occurs in the neonatal period and our aim in this study was to review the causes of these neonatal deaths and see where further improvements may be possible. A 6-yr review of all neonatal deaths of live-born infants over 500 g birthweight from 1991 to 1996 was made. The 1989 amended Wigglesworth classification was used to categorize cause of death and other perinatal variables were also recorded. Results show there were 34,375 births and 153 neonatal deaths. Classification of these deaths by Wigglesworth found 78 (51 per cent) due to congenital malformations, 58 (38 per cent) due to prematurity, 6 (4 per cent) due to asphyxia and 11 (7 per cent) due to specific other causes. The corrected neonatal mortality was 2.18. Neural tube defects alone accounted for 10 per cent of the total neonatal mortality. Fifty-five out of 58 infants who died due to prematurity had birthweight < 1000 g and survival rates in this group compared well to international standards. We conclude that a reduction in neonatal mortality is possible but is most likely to result from community focused measures such as increased use of pre- and peri-conceptional folate.