Background: In Vietnam, although there were interventions in perinatal and neonatal care services, the neonatal mortality reduced slowly, accounting for >50% of under-5-year-old mortality rate and >70% of under-1-year-old mortality rate. \r\n', u'Objectives: Discover the status of prenatal, perinatal, and postnatal care services, and analyze the relationships between healthcare services and neonatal mortality in Quang Ninh province. Subjects and method: Information on births and neonatal deaths between January and December 2005 in Quang Ninh province was collected. The perinatal care services including antenatal, delivery and post partum cares were described. The relationship between neonatal deaths and places of delivery was analyzed in order to uncover the risk of death in newborns delivered at home. Results: 76% of pregnant women received 3 or more antenatal care visits. More than 90% of deliveries took place at health facilities, of them, 16% occurred in community health stations. Only 49% of mothers received post partum care visits, with 82% of them received the visits in the first week after delivery. There were 17,519 births and 284 neonatal deaths in 2005. The neonatal mortality rate was lowest in cases born in community health stations (7.5/1.000) and highest in home birth cases (39/1.000). Conclusion: Further improvement in safe motherhood and neonatal survival can be achieved by increasing the accessibility of women to perinatal cares during pregnancy, delivery. \r\n', u'
perinatal care services ; neonatal mortality

PURPOSE: The regional center for neonatal intensive care (RCNIC) in the Jeju area has provided intensive care for high-risk infants since its installation about 2.5 years ago. This study was aimed to evaluate the short-term effects of the RCNIC on the survival rates of high-risk infants in the Jeju area. METHODS: A retrospective medical record review study was performed to compare the outcomes between neonatal patients who were admitted at the RCNIC in Jeju before and those admitted after its installation. Data were classified into either period 1 (2007-2009) or period 2 (2011-2013). RESULTS: In Period 2, for infants with < or =24 weeks, 25-27 weeks, 28-31 weeks, 32-36 weeks, and > or =37 weeks, numbers of admitted patients increased by 800%, 8.3%, 81.8%, 203.2%, and 66.9%, respectively. For infants with birth weight <1 kg, 1.0-1.49 kg, 1.5-2.49 kg, and > or =2.5 kg, numbers of admitted patients increased by 162.5%, 68.4%, 236.2%, and 54.6%, respectively. For all the infants admitted at the RCNIC in Jeju, the mortality rates were 7.1% in period 1 and 1.6% in period 2. For infants with < or =24 weeks, 25-27 weeks, 28-31 weeks, 32-36 weeks, and > or =37 weeks, the mortality rates were 100%, 41.7%, 13.6%, 1.6%, and 3.8%, respectively, in period 1 and 25.0%, 7.7%, 2.5%, 0%, and 1.4%, respectively, in Period 2. For infants with birth weight <1 kg, 1.0-1.49 kg, 1.5-2.49 kg, and > or =2.5 kg, the mortality rates were 62.5%, 0%, 8.6%, and 2.84%, respectively, in period 1 and 14.3%, 0%, 0.5%, and 1.4%, respectively, in period 2. CONCLUSION: The installation of the RCNIC made an important contribution to the improvement of the neonatal survival rates in Jeju National University Hospital and the Jeju area.
Birth Weight ; Humans ; Infant ; Infant Mortality* ; Infant, Newborn ; Critical Care ; Intensive Care, Neonatal* ; Medical Records ; Mortality ; Retrospective Studies ; Survival Rate

OBJECTIVETo evaluate the clinical function and significance of establishing a regional active neonatal transport network (ANTN) in Beijing.

METHODThe authors retrospectively studied intensive care and the role of ANTN system in management of critically ill neonates and compared the outcome of newborn infants transported to our NICU before and after we established standardized NICU and ANTN system (phase 1: July 2004 to June 2006 vs phase 2: July 2006 to May 2008).

RESULTThe number of neonatal transport significantly increased from 587 during phase 1 to 2797 during phase 2. Success rate of transport and the total cure rate in phase 2 were 97.85% and 91.99% respectively, which were significantly higher than those in phase 1 (94.36% and 88.69%, respectively, P < 0.01). The neonatal mortality significantly decreased in phase 2 compared with that in phase 1 (2.29% vs 4.31%, P < 0.01). The capacity of our NICU was enlarged following the development of ANTN. There are 200 beds for level 3 infants in phase 2, but there were only 20 beds in phase 1. Significantly less patients in the phase 2 had hypothermia, acidosis and the blood glucose instability than those in phase 1 (P < 0.01, 0.05, 0.01 and 0.05, respectively). The proportion of preterm infants transported to our NICU were higher in phase 2 compared with that in phase 1, especially infants whose gestational age was below 32 weeks. The proportions of asphyxia and respiratory distress syndrome were lower in phase 2 than that in phase 1, but the total cure rates of these two diseases had no significant changes between the two phases. The most important finding was that the improvement of outcome of premature infants and those with asphyxia and aspiration syndrome was noted following the development of ANTN.

CONCLUSIONEstablishing regional ANTN for a tertiary hospital is very important to elevate the total level in management of critically ill newborn infants. It plays a very important role in reducing mortality and improving total outcomes of newborn infants. There are still some problems remained to solve after four years practice in order to optimize the ANTN to meet needs of the development of neonatology.

Humans ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; standards ; Transportation of Patients ; standards

PURPOSE: To examine whether preterm small for gestational age (SGA) infants have a different perinatal outcome than preterm appropriate for gestational age (AGA) infants. METHODS: A retrospective chart review was done for 203 (50 SGA and 153 AGA) singleton nondiabetic preterm infants with gestational age between 27-35 weeks who were admitted to Yeungnam University hospital neonatal intensive care unit between January 1999 and February 2002. A comparative analysis of various parameters, including maternal and neonatal variables, was done in SGA and AGA groups. RESULTS: There were no significant differences in perinatal morbidity even mortality for the SGA group compared with AGA group. CONCLUSION: Our results may be helpful to predict the perinatal complications and to manage the preterm infants. For the confirmation of perinatal outcome in SGA versus AGA in preterm infants, a larger number of infants will be needed.
Gestational Age* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Mortality ; Retrospective Studies

Respiratory distress syndrome (RDS) of preterm infants remains a significant cause of morbidity and mortality despite improvements in neonatal intensive care and artificial ventilatory techniques. After identification of the deficiency of pulmonary surfactant is major pathophysiologic basis in RDS, artificial surfactant replacement therapy in RDS was first successfully tested by Fujiwara and co-workers in 1980. therefore, exogenous surfactant replacement produced exellent results in improved clinical and repiratory status during the acute period and decreased incidence of late complications and mortality. According to comparison of administration timing between early (within 6 hours after birth) and late (after 6 hours)group, early replacement therapy is more effective in improving of clinical course and prognosis. Because of that, early, just after birth, recognition and detection of RDS is also important procedure. There are many investigations and methods for the detection of RDS in prenatal or postnatal period. Among then, stable microbubble rating (SMR) test was a simple method and SMR test has a higher diagnostic accuracy. To determine the relation of the SMR and purified natural surfactant (PNS) concentration in vitro, the author conducted each 5 times test of SMR method according to 5 groups of PNS concentration by using modified Pattle's method. The results were as follows: 1) The mean and standard deviation of SMR according to 5 groups of PNS concentration were 119.4 (15.0in 20mug PL (phospholipid)/ml, 452.2 (160.2 in 40mug PL/ml, 879.0 (93.4 in 60mug PL/ml, 1311.8 (274.8in80mug PL/ml, 1710.6(272.3 in 100mug PL/ml. 2) The regression curve of SMR and PNS concentration showed statistically significant relation(p<0.005). In conclusion, the SMR test was a good method in estimation of surfactant concentration in vitro and also in diagnosis of RDS recognized as a surfactant deficiency. In the future, we expected that prophylactic surfactant replacement therapy. immediate after birth, will be more popular in the field of neonatal care of RDS. So, we recommended the use of this method for early detection and serving optimal care of RDS.
Diagnosis ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Microbubbles* ; Mortality ; Parturition ; Prognosis ; Pulmonary Surfactants*

Respiratory distress syndrome (RDS) in the newborn infants remains a major cause of mortality and morbidity in the newborn period despite much improvements in neonatal intensive care and artificial ventilatory techniques. Gastric fluid was obtained from 151 patients within 6 hours after delivery. The sensitivity, specificity, and predictive value of the simple shake test (133 cases) and stable microbubble rating (SMR) test (151 cases) were assessed in the diagnosis of RDS, as well as the relation between both tests and RDS. We carried out both tests of on gastric aspirates all newborn who admitted to NICU of Presbyterian Medical Center from June 1991 to August 1992. The results were summarized as follows: 1) Among the total 151 cases, RDS were found in 41 cases(27.2%). 2) RDS occurence rate of the simple shake test was 11/11 in 0 group, 17/26 in +1 group, 8/28 in +2 group, 2/41 in +3 group, and 2/27 in +4 group. RDS occurence rate was high the 0 and +1 group. 3) RDS occurence rate of the SMR test was 4/4 in very weak group, 32/36 in weak group, 1/33 in medium group, and 4/78 in strong group. RDS occurence rate was high in the very weak and weak group. 4) Among the positive group of the SMR test 95 cases, positive group of the shake test were found in 87 cases. Among negative group of the SMR test 38 cases, negative of the shake test were found in 29 cases (correlation coefficient=0.763). 5) Sensitivity of the shake test and SMR test were 70%, 87.8% respectively. Specificity of the shake test and SMR test were 93.3%, 96.4% respectively. Positive predictability were 75.7%, 90% respectively and negative predictability were 87.5%, 95.5% respectively. The shake test, as Well as SMR test, has significant value to diagnosis of the RDS. We predict RDS occurence rate of the SMR test was significantly higher than shake test.
Diagnosis ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Microbubbles* ; Mortality ; Protestantism ; Respiratory Distress Syndrome, Newborn* ; Sensitivity and Specificity

PURPOSE: Neonates in neonatal intensive care units(NICU) have a high risk of acquiring nosocomial infection because of their impaired host defence mechanism and invasive procedures. Nosocomial infection result in considerable morbidity and mortality among neonates. This study was carried out to survey both the epidemiology of nosocomial infection in our NICU and the annual trends of pathogens. METHODS: We retrospectively reviewed culture proven nosocomial infection which occurred in our NICU from January 1995 to December 1999. The data included clinical characteristics, site of infection, pathogens, and mortality. RESULTS: Nosocomial infection rates was 9.0 per 100 NICU admissions during the five-year period. Major sites of infection were bloodstream(32.3%), skin(18.4%), endotracheal tube(17.2%), and catheter(10.6%). The most common pathogen was S. aureus(29.9%). and the others were coagulase-negative staphylococci(CONS)(14.8%), Enterobacter(12.4%), and Candida(9.0%). During the five-year period, nosocomial infection rates increased from 9.5 to 11.6 per 100 admissions with the increase of CONS, Candida, Klebsiella, and Acinetobacter baumannii. The infection rate of S. aureus decreased. Multiple episodes of nosocomial infection occurred in 26.1% of all nosocomial infections. Overall bloodstream infection rates were 3.6 per 100 NICU admissions during five years. CONS(29.1%) and S. aureus(27.1%) were the two most common pathogens. Increasing rates of bloodstream infection by CONS, Candida, Klebsiella, and Acinetobacter baumannii were observed. Bloodstream infection related mortality was 11.9%. CONCLUSION: The predominant pathogens of nosocomial infection in NICU were S. aureus and CONS. Bloodstream infection, the most frequent nosocomial infection, should be a major focus of surveillance and prevention efforts in NICU.
Acinetobacter baumannii ; Candida ; Cross Infection* ; Epidemiology ; Humans ; Infant, Newborn ; Intensive Care, Neonatal* ; Klebsiella ; Mortality ; Retrospective Studies

PURPOSE: The score for neonatal acute physiology (SNAP) based on physiologic derangements, is applied to variable fields including morbidity as well as mortality estimate. We evaluate the clinical usefulness of SNAP and SNAP variants for neonatal acute severity and mortality. METHODS: Twenty-one neonates were evaluated the SNAP, SNAP-PE, SNAP-II, and SNAPPE-II, who survived more than 24 hours in Neonatal Intensive Care Unit in Department of Pediatrics, Kyunghee University from July 2003 to December 2004. A study group included 21 neonates as death group and a control group matched for gestational age and birth weight. We analyzed the differences of clinical usefulness of SNAP and SNAP variants indices between the two groups. RESULTS: 1) SNAP:The scores were ranged 2-18 (median 6.5) in survival group and 9-31 (median 13.0) in death group. 2) SNAP-PE:The scores were ranged 2-48 (median 16.5) in survival group and 23-75 (median 32.0) in death group. 3) SNAP-II:The scores were ranged 0-16 (median 10.5) in survival group and 10-62 (median 21.0) in death group. 4) SNAPPE-II:The scores were ranged 0-45 (median 24.5) in survival group and 35-109 (median 44.0) in death group. The median values were higher in those who were died:SNAP<0.05 (P-value), SNAP-PE<0.01, SNAP-II<0.01, SNAPPE-II<0.01 showing the significant differences. CONCLUSION: The study shows that SNAP and SNAP variables are useful for the evaluation of acute severity and excellent predictors of neonatal survival. They would help the management of neonatal intensive care unit.
Birth Weight ; Gestational Age ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Mortality ; Pediatrics ; Physiology

OBJECTIVETo assess the predisposing factors, frequency and mortality of pneumothorax (PTX) among the newborns hospitalized in a neonatal intensive care unit (NICU) in Isfahan, Iran.

METHODSThe data of 43 cases of PTX among the 738 neonates hospitalized in the NICU were analyzed retrospectively according to gestational age, birth weight, Apgar score, type of delivery, age of mother, parity, perinatal asphyxia, resuscitation at birth, side of PTX, mechanical ventilation, surfactant therapy, and underlying lung disorders.

RESULTSMean gestational age was 31 weeks and birth weight was 1 596 g in the PTX cases. The gestational age of 12 (28%) neonates was less than 28 weeks. Twenty-eight (65%) neonates were below 1,500 g. In total, PTX occurred in 43 (5.8%) neonates. Sixty-three episodes of PTX (97%) were unilateral and 2 (3%) were bilateral. Respiratory distress syndrome (RDS) (40/43, 93%) and mechanical ventilation (37/43, 86%) were common predisposing factors of PTX. Overall, 28 (65%) neonates with PTX died. Birth weight, gestational age and chest tube duration were significantly different between dead and surviving infants. The mortality rate was significantly higher in neonates who required surfactant therapy than that in those who did not require it.

CONCLUSIONSThe incidence and mortality of PTX in this study were higher than some other reports and this might be attributed to lower birth weight and gestational age. RDS and mechanical ventilation were the most common predisposing factors for the development of neonatal PTX, and mortality increased with lower birth weight, lower gestational age and more severe underlying primary lung disease.

Humans ; Incidence ; Infant, Newborn ; Intensive Care Units, Neonatal ; Iran ; epidemiology ; Pneumothorax ; epidemiology ; etiology ; mortality ; Retrospective Studies

Due to the decreasing birth rate and the increasing percentage of babies in need of neonatal intensive care, the Korean government has changed its policy to support the institutions that need neonatal intensive care units (NICU). In order to keep up with this change, it is critical to further publicize and educate the importance of neonatal intensive care and newborn baby care because it is the duty of our society to decrease the rate of neonatal death. The most likely reason for the sudden decrease of the neonatal death rate in Korea is probably the advancement of neonatology. Although the constant efforts by neonatologists to improve the quality of the treatment of newborn babies have decreased the neonatal death rate, the general support for neonatal intensive care is still insufficient, as a result of impractical medical fees and the shortage of health care providers for neonatal intensive care compared to in other developed countries. In conclusion, the support from the government through the increment of medical insurance fee is needed to improve the medical environment including neonatal intensive care, which, in turn, could secure general investment and international competitiveness.
Birth Rate ; Developed Countries ; Fees and Charges ; Fees, Medical ; Health Personnel ; Humans ; Infant, Newborn ; Insurance ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Investments ; Korea* ; Mortality ; Neonatology