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Objective:To investigate early neonatal deaths born to pregnant women with syphilis and the risk factors.Methods:Data were obtained from the maternal syphilis surveillance system in Zhejiang Province. Pregnant women with syphilis who delivered ≥28 weeks during January 2014 to December 2020 were included. Demographic characteristics (age, education level, occupation, gravidity, parity, adverse pregnancy history, etc.), maternal and perinatal health records, syphilis laboratory test results, syphilis treatment regimen, delivery information, and infant information were collected. Trend chi-square analysis was conducted to track the early neonatal mortality over years. Pearson correlation coefficient was used to estimate the relationship between maternal syphilis treatment and early neonatal mortality. Logistic analysis was conducted to investigate the risk factors for early neonatal death.Results:Among the 71 cases with early neonatal death, 49 cases (69.01%) were aged from 21 to 34 years old, 52 cases (73.24%) had middle school education, 39 cases (54.93%) had no fixed occupation, 39 cases (54.93%) had more than three gravidities, 48 cases (67.61%) were multiparas. There were eight cases (11.27%) of stillbirth abortion. Forty-nine cases (69.01%) with rapid plasma reagin circle card test (RPR) or tolulized red unheated serum test (TRUST) titer ≥1∶4. Among the 72 early neonatal deaths, 40 were males and 32 were females. The leading cause of death was preterm birth/low birth weight (56 cases, 77.78%). From 2014 to 2020, the early neonatal mortality rate of pregnant women with syphilis in Zhejiang Province decreased from 10.37‰ (24/2 314) to 1.49‰(3/2 007) (trend χ2=20.05, P<0.001). The rate of maternal antisyphilitic treatment was negatively correlated with early neonatal mortality ( r=-0.895, P=0.006). Multivariate analysis showed that standard treatment reduced the risk of early neonatal death (Wald=24.845, P<0.001, odds ratio ( OR)=0.181). However, RPR or TRUST titer ≥1∶4 in the last trimester (Wald=72.026, P<0.001, OR=10.112) increased the risk of early neonatal death. Conclusions:Preterm birth and low birth weight are the leading causes of early neonatal death in pregnant women with syphilis. Strengthening the treatment of syphilis in pregnancy women, especially the standard treatment, is beneficial to reduce the risk of early neonatal death.
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Background: Neonatal death is defined as no. of deaths during the first 28 completed days of life per 1000 live births in a given year or period. Around 2.6 million deaths or roughly 46% of all under five deaths had occurred during this period in 2016 which means that 7000 newborn deaths occur each day. Most of the neonatal deaths occur on the first day and week accounting to about 1 million dying on the 1st day. Objective of this study was to ascertain various causes of neonatal mortality using verbal autopsy in Etawah district.Methods: The present study was a retrospective cross-sectional study carried out for a period of 1 year (July 17 to June 2018) using WHO verbal autopsy questionnaire by finding out the study subjects from medical information system of UPUMS, Saifai and district hospital, Etawah. A total of 89 neonatal deaths were found out of which 87 were interviewed by going to their residences to get the relevant information regarding the causes of deaths.Results: Most common cause of neonatal mortality came out to be low birth weight with prematurity 44 of 87 (50.6%), followed by birth asphyxia 23 of 87 (26.4%) and sepsis 8 of 87 (9.2%).Conclusions: Effective interventions should be incorporated into policy decisions to reduce neonatal mortality due to these causes.
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Background: This study was aimed to assess newborn referral and factors contributing to outcome of referred newborns.Methods: This prospective observational study was conducted in a tertiary newborn referral facility for a period of one year. Referred newborns fulfilling inclusion criteria were enrolled in study, and assessed in terms of demographic profile, transport characteristics, physiological variables. Investigations, management of neonatal illness was done as per standard management protocols, they were followed up to their outcome.Results: Out of 2000 enrolled referred newborns, 30.10% were expired. Mean gestational age for survived newborns was 36.54'2.92 (SD) weeks, for expired newborns 35.24'3.99 (SD) weeks. Mean weight for survived newborns 2312.27 gms '555.71 (SD), for expired newborns 1936.71 gms '665.67 (SD). Out of total 60.05% newborns transported from periphery, had higher mortality i.e. 35% as compared to newborns transported from urban place i.e. 25%. Mean transport duration for survived newborns 61.94 minutes '55.18 (SD), for expired newborns 89.51 minutes '88.94 (SD). Prolonged CRT was observed' in 57.45% newborns, grunting'' 19.70%, Cyanosis 11%, gasping 7.6%, apnea 5%, respiratory distress 39.80%, hypothermia 74.95%, and 25.50% required resuscitation on admission. Unattended delivery, self-arranged mode of transport, prolonged CRT, respiratory distress, apnea , hypothermia on admission, weight on admission(<1500gms), hypoglycaemia and duration of transport more than 1 hour' found statistically significant independent variables associated with mortality of referred newborns.Conclusions: A significant number of neonatal deaths can be prevented, if referral system is structured and organized. Improper referral leads to poor physiological profile of referred newborns, which leads to their poor outcome. There are many independent variables which are affecting the outcome of referred newborns. These independent variables can be taken care in holistic way once the referral system is cultured and nurtured in existing health system.
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Lots of problems has exposed in medical system,especially in unreasonable utilization of health resources.This article,from the viewpoint of utilization of health resource,analyzes current problems and countermeasures of the reasonable utilization of health resources.