Analysis of perinatal and neonatal mortality causes in Almaty in 2008-2010

Abstract Analysis of mortality and juvenile neonatal mortality in Almaty for the period 2008-2010 was carried out. Among the causes of juvenile neomortality the leading position belongs to infections. 82.6% of neomortality cases fall within premature infants.

Immediate problem of modern pediatry is still the prevention of exigent conditions and reduction of infant mortality, including neomortality (juvenile and late). Neomortality rate is one of the key indicators of healthcare system and it is used for political, administrative and managerial decisions. Proper and on-time analysis of infant mortality enables to develop a series of specific measures focused on improvement of pregnant women and children's health, to evaluate effectiveness of preventive measures, work of local healthcare authorities related to protection of motherhood and childhood.

The aim of the study was to conduct a perinatal audit with regards to the rate level and causes as a basis for the development of measures focused on reduction of perinatal and neonatal mortality. Material and methods of study

We conducted a retrospective analysis of 2760 mortality cases in Almaty during the period of 2008-2010.

Study results and discussion

During the study of direct neonatal mortality cases (anatomopathological diagnosis) it was found that the leading position belongs to asphyxia (31.1%), second position to intrauterine pneumonia (27.5%), respiratory distress syndrome, (20.5%), congenital malformations (14.9%), other (6.1%).

The studies revealed that 1139 newborns died in the juvenile neonatal period and it amounted to 41.3% out of the whole number of mortality cases of 0-27 days old infants and stillborns. Out of the total number of stillborns and infants who died within the first 27 days, 605 newborns died within the late neonatal period which amounts to 21.9%. 1016 cases (36.8%) of stillbirths were registered. As for the place of death, most mortality cases occurred in maternity hospitals (32.7%), perinatal center (54.7%), infectious hospitals (3.5%) and children's hospitals (9.1%).

Of all cases of mortality in neonatal period there were 82.6% of preterm infants, 15.5% of full-term infants and 1.9% of post-term infants.

Only 32.1% of infants with birth weight between 500 and 999 and 24.4% of infants with birth weight between 1000 and 1499 grams died. Consequently there were 56.5% of small premature infants.

There were 26.1% of newborns with birth weight between 1500 and 2499 grams and 17.4% of newborns who weighted more than 2500 grams (see Table 1 below).

Table 1. Information on stillbirths and infants who died within first 27 days of their life (including those born at 22 weeks of pregnancy and more) 2008-2010 in Almaty

Birth weight (in grams)

Stillbirths

of which

Died in juvenile neonatal period (0-6 days)

Died in late neonatal period (7-27 days)

death occurred in antenatal period

death occurred in intrapartum period

500-999

332

189

143

446

108

1000-1499

210

171

39

297

168

1500-2499

278

256

22

252

189

2500 and more

196

143

53

144

140

Total

1016

759

257

1139

605

2760

Among all stillbirths the majority of infants (74.4%) died in antenatal period, and 25.3 died in intranatal period.

In the structure of mothers' illnesses infections are leading: coldrelated diseases (72.1%), chronic tonsillitis (46.3%), chronic pyelonephritis (74.5%), chronic adnexitis (31.8%), sexually transmitted infections (53.2%). The high frequency of anemia (92.6%) indicates to abnormal conditions, nutrition, lifestyle and is an unfavorable factor for gestational process. Among social and domestic factors it should be noted that 38% of women were not in a registered marriage, so most pregnancies were not planned and wanted, 17.8% live in inadequate housing conditions.

If distributed by Almaty districts, the highest percentage of cases was noted in Turksib, Auezov and Zhetysu districts.

According to data received, an important risk factor of perinatal and neonatal mortality is gestational toxicosis of pregnant women (88.3%), severe preeclampsia (17.8%). A threat of pregnancy termination was observed in 44% of women. Young mothers amounted to 2.6%, primiparas of older age 22.9%.

It was found out that 85.7% of children were born prematurely and among them 52.5% had severe conditions at birth with Apgar score of 1-5 points. Most (45.5%) children died within the first two days, 17.1% on 3-4 day, 23.4% on 5-6 day, 8.1% on the 7th day. We noted that among the causes of juvenile neonatal mortality the frequency of asphyxia and birth trauma decreases from the 1st day of newborn's life and the frequency of fetal infection increases to the 3rd-4th day of life.

Fast and rapid labors resulted in the death of 37.5% of newborn children, prolonged labor of 21.3% of women resulted adversely.

Thus, the analysis of postnatal deaths causes and risk factors (social and domestic conditions, woman's health, peculiarities of pregnancy and labors) has shown that all these factors in varying degree influence the state of a newborn child, however the major importance among the reasons of juvenile neonatal mortality has infectious factor. In this regard, prevention of juvenile neonatal mortality for mothers should include sanitation of infection focal points and pregnancy planning.

Conclusions

  1. Among the causes of newborn children morbidity and mortality the "leading" factors occurring in perinatal period are the following: growth retardation and malnutrition, neonatal icterus, fetal hypoxia, birth asphyxia, birth trauma.
  2. Within the years analyzed the frequency of "fetal hypoxia, asphyxia at birth" significantly decreased, and the frequency of "birth trauma" decreased too but to a lesser extent.
  3. In the dynamics of most indicators shown by the official statistics that characterize basic obstetric practice there are distinct positive trends that prove the effectiveness of events carried out in accordance with clinical guidelines being introduced.

 

Литература

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Year: 2012
City: Almaty
Category: Medicine