OBJECTIVESevere asphyxia during peripartum may lead to some sequela of the nervous system. Currently the neurologic outcome of asphyxiated neonates is assessed by using imaging techniques such as cranial ultrasound, CT and MRI except for evaluating perinatal abnormal factors and routine physical examinations of nervous system. These assessment approaches are based on the changes of anatomic structures of neonates. Electroencephalography (EEG) can show early abnormal cerebral functions. This study examined the EEG background activity and investigated the parameters associated with the prognostic assessment in full-term neonates with asphyxia.

METHODSA standard EEG was recorded in 49 asphyxiated full-term neonates aged from 24 hrs to 8 days. Of the 49 neonates, 14 had concurrent mild, 5 had moderate and 9 had severe hypoxic-ischemic encephalopathy (HIE). Thirty-one aged-matched full-term neonates without asphyxia severed as the control group. Forty-three of 49 asphyxiated neonates were followed-up for neurological development for 6-12 months. Important parameters associated with neurological prognosis were evaluated by the principle of data statistics.

RESULTSThe mean interburst intervals was prolonged, the amplitude of brain electrical activity during all the states were lower, and the incidence of brief burst and sleep-wake cycle disturbance was higher in the asphyxiated group when compared with the control group (P < 0.05). In the follow-up, 4 infants had poor fine motor function and 7 showed retarded psychomotor development in the asphyxiated group. Gestational age, birth weightamplitude of brain electrical activity, severity of HIE, occurrence of sleep-wake cycle disturbance and imaging abnormality were shown as important parameters for predicting neurological outcomes in asphyxiated neonates. The infants who EEG showed isoelectric tracings or isoelectric tracings accompanied with much abnormal discharge had very poor prognosis.

CONCLUSIONSEEG background pattern is valuable in predicting neurological outcomes for term neonates with asphyxia. EEG in combination with clinic data such as gestational age, birth weight, imaging examination, and severity of HIE may provide an accurate evaluation of neurological outcome.

Asphyxia Neonatorum ; mortality ; physiopathology ; Electroencephalography ; methods ; Humans ; Infant, Newborn ; Prognosis

BACKGROUNDSeventeen million births occur in China each year. Neonatal mortality is the leading cause of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth. The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program (NRP) on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants.

METHODSThe Chinese NRP incorporated policy change, professional education, and creation of a sustainable health system infrastructure for resuscitation. Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade. The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality. Program evaluation data came from 322 representative hospitals in those provinces.

RESULTSChanges in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure. From 2004 through 2009 more than 110,659 professionals received NRP training in the 20 target provinces, with 94% of delivery facilities and 99% of counties reached. Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4 per 10,000 from 2003 to 2008, and the incidence of Apgar ≤ 7 at 1 minute decreased from 6.3% to 2.9%.

CONCLUSIONSThe Chinese NRP achieved policy changes promoting resuscitation, trained large numbers of professionals, and contributed to reduction in delivery room mortality. Improved adherence to the resuscitation algorithm, extension of training to the township level, and coverage of births now occurring outside health facilities can further increase the number of lives saved.

Asphyxia Neonatorum ; epidemiology ; mortality ; China ; Clinical Competence ; Humans ; Infant Mortality ; Infant, Newborn ; Resuscitation ; education ; instrumentation

OBJECTIVETo find out optional resuscitation gas for asphyxiated newborn infants based on a systemic review of the published studies that compared the effects of resuscitation of asphyxiated newborn infants with room air or pure oxygen.

METHODSInclusion criteria were randomized or pseudo-randomized studies of asphyxiated newborn infants resuscitated with room air or pure oxygen. The studies published between Jan. 1966 and June. 2005 were searched in PubMed/EMBASE/the Cochrane library databases. All identified studies that fulfilled our inclusion criteria were included. We did a systemic review and a meta-analysis of studies that compared parameters of efficacy, such as mortality, incidence of hypoxic ischemic encephalopathy (HIE) and the rate of resuscitation failure of newborn infants resuscitated with room air or pure oxygen.

RESULTSSix identified studies were included, in which 988 infants were resuscitated with room air and 952 infants with pure oxygen. The mortality of asphyxiated newborn infants within the first week was 8.7% versus 13.4% in room air and pure oxygen groups, respectively, OR = 0.64, 95% CI 0.44 - 0.94. In 5 of the 6 studies, the mortality of term asphyxiated newborn infants was 5.9% versus 9.8% in room air and pure oxygen groups, OR = 0.59, 95% CI 0.40 - 0.87. The result for premature asphyxiated newborn infants was similar. In 4 studies, the incidence of moderate to severe neonatal HIE was 17.5% versus 20.1% in room air and pure oxygen groups, respectively, OR = 0.91, 95% CI 0.68 - 1.21. In 3 studies, the rate of resuscitation failure was 26.9% versus 29.1% in room air and pure oxygen groups, respectively, OR = 0.92, 95% CI 0.70 - 1.19.

CONCLUSIONThe systemic review and the meta-analysis demonstrated that the mortality of asphyxiated newborn infants was significantly lower when resuscitated with room air, and no significant differences were found in the incidence of neonatal HIE and the rate of resuscitation failure. However, this conclusion should be used cautiously because of the limited number of studies.

Air ; Asphyxia Neonatorum ; mortality ; therapy ; Humans ; Infant, Newborn ; Neonatology ; Oxygen ; therapeutic use ; Oxygen Inhalation Therapy ; Resuscitation ; methods ; Treatment Outcome

OBJECTIVETo understand the age-specific and cause-specific mortality rate among children under 5 years old in Beijing from 2003 to 2012.

METHODSDeath surveillance data of children under the age of 5 were obtained from Beijing children mortality surveillance network from 2003 to 2012. Neonatal mortality rate (NMR), infant mortality rate (IMR), under 5-year old children mortality rate (U5MR) and the leading cause of death for under 5-year old children in urban, suburbs, and outer suburbs in Beijing were analyzed.

RESULTSThe NMR, IMR and U5MR in Beijing were 2.08 (253/121 747), 3.11 (379/121 747) and 3.57 (435/121 747) per 1000 live births in 2012, respectively, which declined 54.88%, 50.24% and 54.75% compared with the level in 2003 respectively. The children mortality rates showed a decreasing trend in urban, suburb, and outer suburbs during 2003 and 2012 (NMR was decreased from 0.53%, 0.42%, and 0.48% in 2003 to 0.20%, 0.19%, and 0.23% in 2012; IMR was decreased from 0.73%, 0.58%, and 0.63% in 2003 to 0.30%, 0.29%, and 0.35% in 2012; U5MR was decreased from 0.90%, 0.72%, and 0.82% to 0.33%, 0.34%, and 0.39% in 2012, P < 0.01). There was a steady decline in the U5MR due to congenital heart disease, birth asphyxia, premature birth or low birth weight and traffic accident in Beijing from 2003 to 2012. The mortality rate of congenital heart disease declined from 140.63 to 41.89 per 100 000 live births, birth asphyxia declined from 109.38 to 59.96 per 100 000 live births, premature birth or low birth weight declined from 85.94 to 52.57 per 100 000 live births, traffic accident declined from 26.04 to 6.57 per 100 000 live births (P < 0.01). The mortality rate of congenital heart disease declined remarkably from 216.56 to 52.47, from 119.75 to 23.50, and from 134.58 to 63.11 per 100 000 live births in urban, suburb, and outer suburbs(P < 0.01). Six of the top 8 leading causes of death among children under 5 years old declined remarkably in rural areas. They were congenital heart disease, birth asphyxia, premature birth or low birth weight, traffic accident, drowning, and septicemia, and the mortality rate of them declined from 134.58 to 63.11, from 127.85 to 65.54, from 100.94 to 60.69, from 33.65 to 12.14, from 33.65 to 0.00, and from 26.92 to 4.85 per 100 000 live births, respectively (P < 0.05). There was no drowning death case in rural areas in recent 4 years. The top 5 leading causes of death among children under 5 years old in Beijing in 2012 were birth asphyxia, premature birth or low birth weight, congenital heart disease, pneumonia, and accidental suffocation. The mortality rate of these top 5 leading causes were 59.96, 52.57, 41.89, 24.64, and 15.61 per 100 000 live births in 2012.

CONCLUSIONFrom 2003 to 2012, the NMR, IMR, U5MR and mortality rate of congenital heart disease declined remarkably in urban, suburb, and outer suburb areas in Beijing. There was a decrease trend for the six of the top 8 leading causes of death among children under 5 years old. The mortality rate of drowning dropped markedly in outer suburbs.

Accidents, Traffic ; Asphyxia ; Asphyxia Neonatorum ; Cause of Death ; Child Mortality ; Child, Preschool ; China ; Drowning ; Female ; Heart Defects, Congenital ; Humans ; Infant ; Infant Death ; Infant Mortality ; Pneumonia ; Pregnancy ; Premature Birth ; Rural Population ; Sepsis ; Suburban Population ; Urban Population

OBJECTIVETo study the epidemiology of births in urban China.

METHODSA retrospective study was conducted on neonates born in 2005 in the maternity departments of 72 urban hospitals from 22 provinces in China.

RESULTSA total of 45722 infants born between January 1, 2005 and December 31, 2005 were enrolled. The male to female sex ratio was 1.13:1. Preterm births accounted for 8.1%. The incidence of very low birth weight infants was 0.7%. A total of 99.7% of mothers delivering at term had conceived naturally and 0.3% had experienced assisted reproduction. A total of 98.4% of mothers who delivered preterm had conceived naturally and 1.6% had experienced assisted reproduction. The proportion of vaginal deliveries was 50.8% compared to 49.2% delivered by cesarean sections. Many cesarean sections (38.1%) were due to social factors. Infants with an Apgar score≤7 at 1 minute accounted for 4.8%, and 1.6% of infants had an Apgar score≤7 at 5 minutes. Of all the infants included in the study, 7.14% were admitted to neonatal units for treatment. The death rate of all included infants was 0.74%.

CONCLUSIONSThe proportion of preterm births was higher in 2005 than in 2002-2003. The proportion of cesarean section deliveries was much higher in urban China than in most other Asian countries and America.

Asphyxia Neonatorum ; epidemiology ; Cesarean Section ; statistics & numerical data ; China ; Humans ; Infant Mortality ; Infant, Newborn ; Premature Birth ; epidemiology ; Retrospective Studies ; Risk Factors ; Time Factors

BACKGROUNDPopulation based epidemiologic study on the main diseases and birth status of liveborn neonates remains scarce in China, especially in rural areas where a large number of neonates are born. The aim of this study was to establish an epidemiological basis of live births in Julu County, a representative of the northern and mid-western parts of China in terms of demography, disease pattern and women and children's health care infrastructure.

METHODSThe perinatal data of all live births were prospectively collected in three participating county-level hospitals from September 1, 2007 to August 30, 2008.

RESULTSThere were 5822 live births in these hospitals. Among all live births, 53.7% were male and 4.5% were born prematurely. Mean (SD) birth weight (BW) was (3348 ± 503) g. The low (< 2500 g) and very low BW (< 1500 g) infants accounted for 3.8% and 0.5% of the total births, with 6.5% as small for gestational age and 2.8% as multi-births. Cesarean section rate was 30.2%, of which 68.6% were elective. There were 745 infants (12.8% of the live births) admitted to local neonatal wards within 7 days of postnatal life, in which 48.3% and 19.3% were due to perinatal asphyxia and prematurity, respectively. The incidences of perinatal aspiration syndrome, transient tachypnea and respiratory distress syndrome were 4.9%, 0.6% and 0.5%, respectively. Neonatal mortality was 7.6‰ (44/5822), with 16 in delivery room and 28 in neonatal ward before discharge.

CONCLUSIONSThis study provided a population-based perinatal data of live births and neonatal mortality in a northern China county with limited resources. Neonatal disorders related to perinatal asphyxia remain a serious clinical problem, which calls for sustained education of advanced neonatal resuscitation and improvement in the quality of perinatal-neonatal care.

Asphyxia Neonatorum ; epidemiology ; Birth Weight ; China ; epidemiology ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Infant, Newborn, Diseases ; epidemiology ; therapy ; Male ; Prospective Studies ; Respiratory Distress Syndrome, Newborn ; epidemiology ; therapy

OBJECTIVETo investigate the birth information of newborn infants from obstetric departments in the Central South Region of China.

METHODSA retrospective investigation was carried out in 15582 newborns from obstetric departments of 23 hospitals in the Central South Region of China between January 1 and December 31 of 2005.

RESULTSThe sex ratio (male/female) of neonates was 1.16∶1. The proportion of preterm infants was 8.11%. The very low birth weight infants accounted for 0.73%. The neonates born by spontaneous labor accounted for 57.52%. Cesarean sections accounted for 40.82% (social factor of cesarean section: 29.91%). The incidence of neonatal asphyxia was 3.78%, in which 0.75% of the cases were severe asphyxia. The mortality of newborn infants was 0.55%, in which the mortality of preterm infants was 5.56%.

CONCLUSIONSThe proportion of preterm infants and the incidence of neonatal asphyxia is high in the Central South Region of China. The proportion of births delivered by cesarean section is high, and social factors are probably responsible for the high rate.

Asphyxia Neonatorum ; epidemiology ; Cesarean Section ; statistics & numerical data ; China ; epidemiology ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Logistic Models ; Male ; Retrospective Studies

Medical tangles caused by the death of women and infants in perinatal period are very normal in the forensic appraisal. The author collected and analyzed 49 cases of these tangles from many aspects, such as sex and age of the dead, hospital,information of autopsy, fault of medical action and so on,and discovered the normal causes of death, medical action's effects and the causes of tangle. It would be useful to the forensic appraisal, settlement and prevention of these medical tangles.
Adult ; Asphyxia Neonatorum/mortality* ; Autopsy ; Cause of Death ; Female ; Forensic Pathology ; Humans ; Infant, Newborn ; Male ; Malpractice/legislation & jurisprudence* ; Maternal Mortality ; Postpartum Hemorrhage/mortality* ; Pregnancy ; Respiratory Tract Diseases/mortality* ; Retrospective Studies ; Young Adult

OBJECTIVE: A proportion of elective repeated cesarean sections where a trial of labor in a uterus with a previous scar was not attempted is on the increase. This study aimed to assess how reduced the use of trial of labor has impacted on neonatal outcomes in the United States. METHODS: Pregnant women with one previous cesarean delivery and a singleton live birth of the index pregnancy were abstracted from the 1995 to 2002 birth registration data of the United States. Adjusted odds ratios for adverse neonatal outcomes of trial of labor were estimated by multiple logistic regression models, in overall study subjects and in the two periods with high and low rates of trial of labor. RESULTS: A total of 1833407 eligible subjects were included in the analysis. Rate of trial of labor after one previous cesarean section dropped from 38.5% in 1995 to 15.0% in 2002. No significant change was observed in the patient population profile. Successful vaginal birth after cesarean delivery (VBAC) also declined from 76.6% in 1995 to 66.0% in 2002. A trial of labor after one previous cesarean section was correlated with increased risks of asphyxia-related neonatal death and neonatal morbidity. This risk was even more pronounced in low risk women and in the last study years with the lowest rate of trial of labor. CONCLUSION The reduced use of trial of labor after one cesarean delivery in recent years in the United States has actually resulted in increased risk of adverse neonatal outcomes associated with a trial of labor.
Adult ; Asphyxia Neonatorum ; epidemiology ; etiology ; Cesarean Section, Repeat ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Pregnancy ; Trial of Labor ; United States ; epidemiology ; Vaginal Birth after Cesarean ; adverse effects ; statistics & numerical data ; Young Adult

A statistical observation was performed on 13,317 cases of neonates who had been delivered at Taegu Catholic Hospital during the past 3 years from Jan, 1st 1988 to Dec. 31st 1990. The results obtained were as follows: 1) Among 13,317 neonates, the male was 7,234 and the female 6,083, with the sex ratio of male to female being 1.19:1 2) Percentage distribution by birth weight was 5.6% for 2.500gm or less, 3.3% for 4,001gm or more. The mortality rate was 8.4 per 1,000 live births and 61.1% for very low birth weight infants. 57.1% of neonatal death occured within 24 hours after birth and the most common cause of death was prematurity (53.6%). 3) The mean growth data at birth were as following: Weight: 3,253+/-484gm in male, 3,160+/-456gm in female; Height: 50.11+/-2.59cm in male, 49.57+/-2.50cm in female; Head circumference: 33.60+/-1.74cm in male, 33.12+/-1.64cm in female; Chest circumference: 32.83+/-1.83cm in male, 32.41+/-1.75cm in female. 4) Among 13,317 noenates, 352 (2.6%) were under 37 wks and 555 (4.2%) above 42 wks and 92.6% very low birth weight infants under 37 wks. 5) 44.2% of 13,317 neonates, was the highest-density distribution which was between 47.5~52.4cm by length and 3,001~3,500gm by weighing. 6) The admission rate was 13.7% and the causes of admission in order of frequency were neonatal infection (47.9%), premature or low birth weight infant (12.9%), neonatal jaundice (11.3%), asphyxia neonatorum (6.9%), respiratory disress syndrome (5.4%), etc. 7) Among all neonates, 2.2% had neonatal asphyxia (a 1-minute Apgar score of 6 or less). The highest incidence was 19.7% in the breech delivery group by delivery mode and 33.6% in the prematurity by gestational age. 8) The types of delivery in order of frequency were spontaneous vaginal delivery (72.5%), Cesarean section (21.9%), vacuum delivery (5.0%), breech delivery (0.5%) and forceps delivery (0.1%). 9) The incidence of twin babies was 182 (91 pairs), 1.37% of all neonates, 1 pair per 145 neonates. Of all twins, 50.5% were below 2,500gm of birth weight and 20.9% premature. 10) The incidence of neonatal jaundice was 63.0%. Of icteric neonates, 8.2% had pathologic jaundice treated by phototherapy or exchange transfusion. 11) Among all neonates, there were 7,705 cases (57.9%) with high risk factors; the order of frequency was Cesarean section (37.8), meconium stained (13.3%), premature rupture of membranes over 24 hours (12.7%), birth weight 2,500gm or less (9.6%), etc.
Apgar Score ; Asphyxia ; Asphyxia Neonatorum ; Birth Weight ; Cause of Death ; Cesarean Section ; Daegu ; Female ; Gestational Age ; Head ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Infant, Very Low Birth Weight ; Jaundice ; Jaundice, Neonatal ; Live Birth ; Male ; Meconium ; Membranes ; Mortality ; Parturition ; Phototherapy ; Pregnancy ; Risk Factors ; Rupture ; Sex Ratio ; Surgical Instruments ; Thorax ; Twins ; Vacuum