[The effect of intrauterine development and nutritional status on intrauterine and neonatal mortality]

The authors study to what extent bodily development and nutritional status influence the viability of foetuses and neonates, that is, their perinatal mortality. They developed a new method, the MDN system (MDN: Maturity, Development, Nutritional status) to determine the weight and length standard positions of neonates in relation to reference standards on the basis of their gestational ages, birth weights and lengths. The system contains a chessboard-like matrix (or MDN Table) comprising 64 cells arranged in eight horizontal lines of the most common zones of weight percentile standards and eight vertical columns of the length percentile standards. Depending upon its weight and length, each neonate can be positioned in one of the cells of the MDN Table. The table allows differentiating the major neonate groups with significantly different developmental and nutritional statuses. The authors used a computerised program to process in one MDN table the data of 680,947 neonates born in the 7 five years from 1997 to 2003 in Hungary. When the ratio of body length and weight was considered, 90.6% of this neonate population was found normally (proportionally) nourished. 4.9% of the population was relatively over-nourished, while 4.5% was relatively undernourished. Then, the authors computed the intrauterine and neonatal mortality rate of the newborns in each cell of the MDN Table. Intrauterine (neonatal) mortality rate in the neonate group with an absolute average development was 3,6 per thousand (4,4 per thousand), that in the proportionally retarded group under weight and length percentiles 10 was 21 per thousand (14 per thousand). This rate was 41 per thousand (24 per thousand) under weight and length percentiles 3. The mortality rate was 51 per thousand (49 per thousand) in the extremely overnourished group and 124 per thousand (78 per thousand) in the extremely undernourished group. The authors believe that the MDN system including the MDN table is a suitable method to differentiate the most endangered groups of neonates on the basis of their development and nutritional status.