Perinatal and childhood mortality Flashcards
Miscarriage
Pregnancy loss <24 weeks
Stillbirth
Baby born >24/40 showing no signs of life
Neonatal death
Baby born alive but dies in first 28 days of life
Early neonatal death
Death 0-7 completed days
Late neonatal death
Death 7-28 days
Infant death
All deaths within first year of life
Post-neonatal death
Deaths 28 days–>1 year
Rates
Stillbirth + Perinatal mortality rate –> per 1000 total births (live and stillbirths)
Neonatal + infant mortality rate- per 1000 live births
Factors that contribute to Stillbirth
Maternal health
Access to maternity care
Uteroplacental function
Factors that contribute to Early Neonatal death
Uteroplacental function
Perinatal infection
Neonatal resuscitation
Effective neonatal care
Factors that contribute to Late Neonatal death
Effective neonatal care
Postnatal infection
Factors that contribute to Postneonatal infant death
Postnatal infection
SIDS
Prematurity
Surfactant deficiency
Periventricular haemorrhage
Necrotising enterocolitis
Infection
Congenital abnormalities
Congenital heart disease
Chromosomal
Neural tube
Diaphragmatic hernia
Asphyxia
Before or during labour
Infections
Congenital
Intrapartum
Acquired
Unexplained stillbirth
Probably a major contribution from impaired placental function
Sudden infant death
Mostly neo-natal deaths
Stillbirth causes
Unexplained Congenital anomaly Antepartum haemorrhage Maternal disorder Pre-eclampsia Infection
Meckel-Gruber syndrome
Autosomal recessive
42 weeks
Characterised by CNS malformations, renal cystic dysplasia, pulmonary hypoplasia etc.
Funisitis
Infection of connective tissue of umbilical cord
Stillbirth Baby- Acute
Well grown Absence of maceration <12h Traces meconium Petechiae on serosal surfaces Liquid blood
Stillbirth baby- chronic
Moderate to severe/advanced maceration
IUGR
SIDS
Sudden unexplained death under 1 year
Autopsy doesn’t reveal anything
Baby found dead in cot
CHD Resp. infections CNS infections Septicaemia Intoxication Seizure disorders SIDS Suffocation and NAI
SIDS facts
Commonest 4-20 weeks
Winter
Sleep
SIDS RFs
Social Class IV or V Co-sleeping Male baby Maternal smoking Low birth weight
SIDS triple risk hypothesis
Vulnerable infant (physiologic responses) Critical Developmental period (age) Exogenous stressor (environment)
Vulnerable infant
Males 60%
Abnormality of serotoninergic network
Slower responses to changes (increase in HR or breathing)
Alterations in heart ion channels
SIDS external findings
Body well developed and nourished
Frothy fluid around nose (often blood tinged)
Cyanosis of lips and nail beds
SIDS internal findings
Large thymus with petechiae Petechiae in pleura Epicardial petechiae Full expansion of lungs Liquid heart blood Empty bladder Prominent LN + Peyer's patches
SIDS microscopic findings
Pulmonary congestion + oedema
Mild inflammation of URT
Focal fibrinoid necrosis of vocal cords
Persistent haemopoiesis in liver
Reducing Pneumonia
Breastfeeding promotion
Haemophilius influenzae type b and pneumococcal vaccines
Reducing diarrhoea
Improved water and sanitation Rotavirus vaccine Zinc supplementation ORS Community case management
Reducing malaria
Insecticide treated bed, nests
Intermittent preventive treatment in pregnancy
Artemisin based combination therapy
Reducing Neonatal deaths
Improved labour and delivery management
Preterm birth outcomes
Antenatal steroids
Kangaroo care
Critical developmental period (age)
Developmental immaturity Rapid changes between 2-4 months Delayed development of arousal, CR control or CV control + thermal regulation Laryngeal spasm with GOR Failure to auto-resuscitate from apnoea
