Towards reducing variations in infant mortality and morbidity: a population-based approach

Abstract

BackgroundOur aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity.ObjectiveTo undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates.DesignTwo interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies.SettingCohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester.Data sourcesFor stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies.Main outcome measuresDetailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies.ResultsThe deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs.ConclusionsHealth professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background.Future workFuture work could include studies to improve our understanding of how deprivation increases the risk of mortality and morbidity in early life and investigation of longer-term outcomes and interventions in at-risk LMPT infants to improve future attainment.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

The magnitude of neonatal mortality and its predictors in Ethiopia: a systematic review and meta-analysis

“…Those who had neonatal sepsis were nearly two times increase risk of mortality as compared to those who did not have sepsis. This finding is supported by a result in developed and developing country [19] [48] [7], [49] , [50] [51], ( [52], [53]. The possible reason might be due to newborns have many physiologic challenges when adapting to the extrauterine environment which might contributed to common problem like immature immunity, RDS., neurologic, cardiovascular, hematologic, nutritional, gastrointestinal and poor thermoregulation which farther increase risk of sepsis and mortality.…”

“…Another possible reason could be that people living in rural areas tend to be poorer than their urban counterparts' area, a factor known to have an impact on the neonatal outcome.GA is also another important determinant of neonatal mortality in our metaanalysis. Accordingly, neonates born as preterm were almost one and half times more likely to die than those term neonates [49][50][51][52][53][54][55][56][57][55], [56] , [52] , [53], [50] , [7] [51] , [49,57].RDS are an important determinant of neonatal mortality although not statistically significant in our meta-analysis. Neonates who had RDS were one times more likely to die as compared to those who did not have RD.…”

Mode of Delivery and Long‐Term Health‐Related Quality‐of‐Life Outcomes: A Prospective Population‐Based Study

“…A total of 2,161 mothers of 2,404 live births or still births were recruited into the LAMBS study . The characteristics of the 1,374 (63.6%) responders and 787 (36.4%) nonresponders to the 12 months postpartum health‐related quality‐of‐life questionnaire are summarized in Table .…”

“…LAMBS was approved by the Derbyshire Multicentre Research Ethics Committee, United Kingdom. Further details about LAMBS, including its sampling and recruitment procedures, are available elsewhere .…”

The Correlation of SKA2 with Cortisol, IL-1β and Anxiety in Pregnant Women with the Risk of Preterm Delivery

“…The cost of care is very high for premature infants. 2 Preterm delivery has multifactorial etiology in which vari- ous factors synergistically result in premature birth in pregnant women include genetic, environmental and hormonal factors. It has been reported that placental Hypothalamic-Pituitary-Adrenal (HPA) axis plays a significant role in the development of preterm delivery.…”