Background Each year 4 million children die in the first 4 weeks of life Global average of 30-36/1000 Live Birth Geneva WHO report,2005 Many neonatal deaths are preventable with existing low-cost intervention Planners and policy makers required reliable cause-of –death information Int J Epidemiol 2003;362-65-70
The reduction of child mortality has been included among the Millennium Development Goals(MDG-4) that the United Nations has set to be attained by year 2015. With out reduction in global NMR MDG-4 will not be achieved Strategies, which address inequalities both within a country and between countries, are necessary if there is going to be further improvement in global perinatal health. Report of the Secretary General. New York, NY: United Nations; 2001. UN document A756/326 4 million neonatal deaths: when? where? Why? Lancet 2005;365:891-900
Causes of Neonatal Deaths Estimation WHO report before 2005 provide little detail with respect to perinatal-neonatal causes of death WHO,the world helth Report:2004Geneva Neonatal infection the single largest cause of deaths globally national inst of science2003,pp.1-333
Estimating the cause of 4 million neonatal death in the year 2000 NMRs ranged from 2 to 18 per 1000 livebirths. Based on 193 countries; the major causes Infection (sepsis/pneumonia, tetanus, and diarrhea 35% Preterm birth 28% Asphyxia 23% 98% information on cause of death is lacking because of inadequate vital registration (VR) International Journal of Epidemiology 2006;35:706–718
The estimated distribution of causes for 4 million neonatal deaths for the six WHO regions in the year 2000. Size of circle represents number of deaths in each region. Afr = Africa, Amr = Americas, Emr = Eastern Mediterranean, Eur = Europe, Sear = Southeast Asia, and W pr = Western Pacific
1.El Shafei AM, Sandhu AK, Dhaliwal JK. Perinatal mortality in Bahrain. Aust N Z J Obstet Gynaecol 1988;28:293–98. 2.Ebrahim AH. Perinatal mortality in Ministry of Health Hospitals- Bahrain, 1985 and 1996. J Bahrain Med Soc 1998;10:95–99. 3.Kishan J, Soni AL, Elzouki AY, Mir NA. Perinatal mortality and neonatal survival in Libya. J Trop Pediatr 1988;34:32–33. 4.el-Zibdeh MY, Al-Suleiman SA, Al-Sibai MH. Perinatal mortality at King Fahd Hospital of the University Al-Khobar, Saudi Arabia. Int J Gynaecol Obstet 1988;26:399–407. 5.Asindi AA, Archibong E, Fatinni Y, Mannan N, Musa H. Perinatal and neonatal deaths. Saudi Med J 1998;19:693–97. 6.Dawodu A, Varady E, Verghese M, al-Gazali LI. Neonatal audit in the United Arab Emirates: a country with a rapidly developing economy. East Mediterr Health J 2000;6:55–64. 7.Yassin KM. Indices and sociodemographic determinants of childhood mortality in rural Upper Egypt. Soc Sci Med 2000;51:185–97. 8.Campbell O, Gipson R, el Mohandes A et al. The Egypt National Perinatal/Neonatal Mortality Study 2000. J Perinatol 2004;24:284–89.
Year IMRRank% ChangeDate 2003 47.9473-72.38 %2003 est. 2004 13.241450.00 %2004 est. 2005 13.24144-3.25 %2005 est. 200612.811442006 est. Source: CIA World Factbook - Unless otherwise noted, information in this page is accurate as of November 1, 2006 Infant and NMR in Saudi Arabia
DateFIFA Ranking position Mar 200850 Feb 200850 Jan 200857 200761 200664 200533 200428 200326 200238 200131 200036 199939 199830 199733 199637 199554 199427 199338 Saudi Arabia average position from FIFA World Ranking creation is 38 http://www.fifa.com/
Neonatal Mortality Rate North Saudi Arabia NMR account for 60% of all infant deaths (65.6%) occured in the neonatal period Three main causes of death were identified: perinatal causes, genetic disorders and infection 44% of infant deaths considered as preventable JELLY A. E. (1) ; WARNASURIYA N. (1) Saudi medical journal 1998, vol. 19, no2, pp. 136-140 Avery’s Neonatology: Pathophysiology& Management of the Newborn. 6th ed. Philadelphia,Pa: Lippincott Williams & Wilkins;2005:459–489
Perinatal and neonatal deaths Department of Pediatrics, Abha Maternity Hospital, Abha The average perinatal mortality rate was 14 per 1000 total births and the neonatal mortality rate was 9.6 per 1000 live-births during the period. The major death determinants were low birth weight (LBW)/ prematurity, congenital malformation and birth asphyxia. Respiratory insufficiency (89.9% of cases) and sepsis (36% of cases) were the main causes of neonatal deaths in low birth weight infants. Ann Saudi Med 1997;17(5):522-526.
Causes of neonatal deaths in ACH Causes of death No. of infants% of total (n=169) Low birth weight7745.5 Congenital malformation5230.8 Infection2313.6 Birth asphyxia137.7 Meconium aspiration syndrome 21.2 Inborn error of metabolism21.2 Ann Saudi Med 1997;17(5):522-526.
Factors contributing to death in 77 LBW infants. Conditions No. of cases Hyaline membrane disease33 Sepsis23 Necrotizing enterocolitis14 Pulmonary hemorrhage4 Intraventricular hemorrhage3 Persistent pulmonary hypertension 3 Undetermined10 Ann Saudi Med 1997;17(5):522-526.
Neonatal vital statistics: a 5-year review in East P of Saudi Arabia. The overall neonatal mortality rate declined from 15.6 to 8.1/1000 live births (LB), and after excluding lethal malformations mortality fell from 14.0 to 5.6/1000 LB Congenital malformations, RDS, and asphyxia were the 3 most common causes of death. These conditions and severe immaturity account for 74% of deaths. Ann Trop Paediatr. 1988 Sep;8(3):187-92.
CAUSE-SPECIFIC INFANT MORTALITY RATE IN QATIF AREA, EASTERN PROVINCE, SAUDI ARABIA Hussain Abu Srair, FRCP(C), FAAP; Joshua A. Owa, FNMC (Nig), FWAC; Hussain Ahmed Aman, MD Hussain Abu Srair, FRCP(C), FAAP; Joshua A. Owa, FNMC (Nig), FWAC; Hussain Ahmed Aman, MD Forty-five (70.3%) of the deaths occurred in the neonatal period Major causes of IMR were premature delivery (39.1%) infections (25%) birth defects (18.8%) difficult delivery (4.7%) Ann Saudi Med 1995;15(2):156-158
The NICU N mortality rate between 1990 and 2000 decreased from 8.3 to 5.7 per 1000 live births. Prematurity related IVH & Sepsis(36%) Congenital malformation 23% Alnemri, etal CP Resh 2002;6(1):1-6 NMR At KKUH
Objective To describe trend in neonatal mortality in AFH Southern region between 1 st January 2001 to 31 st Dec 2006 Determine the major causes of death in different birth weight group The data could be used to plan the future direction of perinatal neonatal care at Armed Force hospitals south regions Compare the outcome with Armed force hospitals programme.
METHODS AFH SR NICU, is the tertiary centre in the region accommodate up to 40 newborns There are 3 levels of care IC, IMC& feeder and grower Descriptive analysis of data of all neonates died IN neonatal intensive care unit at AFHSR from January 2001 to Dec 2006 All perinatal and neonatal data collected from the maternal and neonatal medical records The “underlying cause of death” is derived from the diagnosis listed on each death certificate according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), ( 4th edition, Craig D. Puckett: volume 1,2,3 channel publishing LtdLotus approach 97 data program
METHODS In cases where the cause of death was in doubt, case notes were reviewed with the doctor who certified the death of the neonate to arrive at a consensus direct cause of death Exclusion criteria (DR DEATHS+STILL BIRTH) The birth weight of 6-year study period was grouped into 3 groups 1)ELBW infants below 1000gm 2)VLBW infants 1000 -1499gm 3)Near term infant more than or equal to 1500gm
General Statistic yrBirthSt.birthC.PMRENDLND 200155996712.22011 20025708427.18186 20036265415.74204 20046322529.42111 20056567488.52114 200669237211.816(3.7)6 Total3738453.79.6198.6 The average perinatal mortality rate was 14 per 1000 total births and the neonatal mortality rate was 9.6 per 1000 live-births
yearT. admissionT D (%) 200159440 (6.5) 200268631 (4.5) 200383335 (4) 200478034 (4.3) 200567550 (7.4) 200678457 (7.3) Total4352 (11.6%)247 (5.7) General Statistic NICU Mortality Review
Inborn Vs out-born NICU Death *Saudi med. j 2003, vol. 24, no12, pp. 1374-1376 58 out-borne neonate Mortality (9) 15.5%
Early Mortality MEAN 3.6 DAYSMEAN 23 DAYS 7- 45 DAYS
Causes of all neonatal death Prematurity < 34wk, MCA multiple cong anomalies, BA+ birth asphyxia The major death determinants were low birth weight (LBW)/prematurity, stillbirth, congenital malformation and birth asphyxia Saudi medical journal, 1998, vol. 19, no6, pp. 693-697
Admission on birth weight B. wtTotal admission DeathsM R(%) ELBW< 1000gm 2348536% 1000-14994054010% > 1500gm37131223.3% Total43522475.7 Exclude multiple congenital and lethal deaths Corrected M R = 3.4%
ELBW Mortality (< 1000gm) Total deaths 85 Average Mortality Rate 36%
CuasesNo (%) MCA 45 (37%) B. Asp +PPHN 37 (30%) IEM WITH L ACID 13(10.5%) D. hernia 9(7.5%) COMP. CHD 9 (7.5%) Hydropes 4 (3%) Sepsis 4 (3%) AWD 1 (1.5%) Total 122 MCA = Multiple congenital Anomalies
Risk Factors The risk factors independently associated near term death included low birth weight (IUGR) P value <.001 complications during labour p.001 lethal deformities P value 0.001 Infection 0.1
2007 Changes Separate the unit coverage Isolation Feeding protocol Inodomethacine prophylaxis
Summary Total live birth 37384 Total Admission 4352 = 11.6 % of T. Birth Total Death 229 (5.3%) Prematrity related is the major cause of mortality(61%) especially ELBE 45% IVH resposible for early death (45%) while sepsis is the major killer in late death (50%) Multiple congenital anomalies is the 1 st cause of death in near term infant >34wks of gestation 37% Followed by Prenatal asphyxia with or with out PPHN 30% Poor antenatal care, multiple congenital anomalies, multiple pregnancy are major risk factors need to be evaluated
Conclusion The perinatal neonatal services cooperation National registry Sepsis and IVH are the major contributing causes for mortality in ELBW infant Antenatal steroid Prematurity 15.5% Congenital anomalies is very high (6 -8/1000 Live Birth) Need revaluation of the service annually