Perinatal and childhood mortality

Question 1

Miscarriage

Answer 1

Pregnancy loss <24 weeks

Question 2

Stillbirth

Answer 2

Baby born >24/40 showing no signs of life

Question 3

Neonatal death

Answer 3

Baby born alive but dies in first 28 days of life

Question 4

Early neonatal death

Answer 4

Death 0-7 completed days

Question 5

Late neonatal death

Answer 5

Death 7-28 days

Question 6

Infant death

Answer 6

All deaths within first year of life

Question 7

Post-neonatal death

Answer 7

Deaths 28 days–>1 year

Question 8

Rates

Answer 8

Stillbirth + Perinatal mortality rate –> per 1000 total births (live and stillbirths)
Neonatal + infant mortality rate- per 1000 live births

Question 9

Factors that contribute to Stillbirth

Answer 9

Maternal health
Access to maternity care
Uteroplacental function

Question 10

Factors that contribute to Early Neonatal death

Answer 10

Uteroplacental function
Perinatal infection
Neonatal resuscitation
Effective neonatal care

Question 11

Factors that contribute to Late Neonatal death

Answer 11

Effective neonatal care

Postnatal infection

Question 12

Factors that contribute to Postneonatal infant death

Answer 12

Postnatal infection

SIDS

Question 13

Prematurity

Answer 13

Surfactant deficiency
Periventricular haemorrhage
Necrotising enterocolitis
Infection

Question 14

Congenital abnormalities

Answer 14

Congenital heart disease
Chromosomal
Neural tube
Diaphragmatic hernia

Question 15

Asphyxia

Answer 15

Before or during labour

Question 16

Infections

Answer 16

Congenital
Intrapartum
Acquired

Question 17

Unexplained stillbirth

Answer 17

Probably a major contribution from impaired placental function

Question 18

Sudden infant death

Answer 18

Mostly neo-natal deaths

Question 19

Stillbirth causes

Answer 19

Unexplained
Congenital anomaly
Antepartum haemorrhage
Maternal disorder
Pre-eclampsia
Infection

Question 20

Meckel-Gruber syndrome

Answer 20

Autosomal recessive
42 weeks
Characterised by CNS malformations, renal cystic dysplasia, pulmonary hypoplasia etc.

Question 21

Funisitis

Answer 21

Infection of connective tissue of umbilical cord

Question 22

Stillbirth Baby- Acute

Answer 22

Well grown
Absence of maceration <12h
Traces meconium
Petechiae on serosal surfaces
Liquid blood

Question 23

Stillbirth baby- chronic

Answer 23

Moderate to severe/advanced maceration

IUGR

Question 24

SIDS

Answer 24

Sudden unexplained death under 1 year

Autopsy doesn’t reveal anything

Question 25

Baby found dead in cot

Answer 25

``` CHD Resp. infections CNS infections Septicaemia Intoxication Seizure disorders SIDS Suffocation and NAI ```

Question 26

SIDS facts

Answer 26

Commonest 4-20 weeks Winter Sleep

Question 27

SIDS RFs

Answer 27

``` Social Class IV or V Co-sleeping Male baby Maternal smoking Low birth weight ```

Question 28

SIDS triple risk hypothesis

Answer 28

``` Vulnerable infant (physiologic responses) Critical Developmental period (age) Exogenous stressor (environment) ```

Question 29

Vulnerable infant

Answer 29

Males 60% Abnormality of serotoninergic network Slower responses to changes (increase in HR or breathing) Alterations in heart ion channels

Question 30

SIDS external findings

Answer 30

Body well developed and nourished Frothy fluid around nose (often blood tinged) Cyanosis of lips and nail beds

Question 31

SIDS internal findings

Answer 31

``` Large thymus with petechiae Petechiae in pleura Epicardial petechiae Full expansion of lungs Liquid heart blood Empty bladder Prominent LN + Peyer's patches ```

Question 32

SIDS microscopic findings

Answer 32

Pulmonary congestion + oedema Mild inflammation of URT Focal fibrinoid necrosis of vocal cords Persistent haemopoiesis in liver

Question 33

Reducing Pneumonia

Answer 33

Breastfeeding promotion | Haemophilius influenzae type b and pneumococcal vaccines

Question 34

Reducing diarrhoea

Answer 34

``` Improved water and sanitation Rotavirus vaccine Zinc supplementation ORS Community case management ```

Question 35

Reducing malaria

Answer 35

Insecticide treated bed, nests Intermittent preventive treatment in pregnancy Artemisin based combination therapy

Question 36

Reducing Neonatal deaths

Answer 36

Improved labour and delivery management

Question 37

Preterm birth outcomes

Answer 37

Antenatal steroids | Kangaroo care

Question 38

Critical developmental period (age)

Answer 38

``` 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 ```