Intro to neonatalogy

Introduction to Neonatology

At the end of the lecture the student should be able to

• Define the following terms used in neonatology

1.Neonate

2. Term/preterm/post-term

3. Life birth/still birth

4. NMR/PNMR/SBR/IMR

Learning objectives

Calculate mortality rate using available data

List the common causes of neonatal deaths

Describe the trends in perinatal and neonatal mortality rates in SL and the world

• Identify strategies that can be used in SL to reduce the NMR

What is neonatology?

A branch of medicine concerned with the care, development and disease of newborn infants.

Neonates come in different sizes and maturity

What is a neonate?

An infant from birth to 4 weeks (28 days of age) or 1 month

This period is known as the “neonatal period”

Remember that the “neonate” is an infant too – just a special infant.

Therefore all the things that happen in this period will be included in “infant” statistics. e.g. Neonatal death are included in infant deaths

Why are neonates special?

Neonates are different from older infants and children – this is not just a size difference

• This is a period where the newborn is getting adjusted from living inside the mother to living in the outside world

Also having an independent existence from being a total parasite on the mother

Risks during neonatal period

Because of the profound changes that are taking place the newborn is more at risk for certain insults than at any other period in life

e.g.

infection

hypoglycaemia

hypothermia

hyperbilirubunaemia

bleeding

Also, with improvements in medical care more and more babies are delivered preterm, at ages which where earlier considered as incompatible with life and are surviving • This group of babies contribute a large proportion of neonatal deaths and for later disability

Also most of the major congenital abnormalities, genetic syndromes, inborn errors of metabolism become apparent in the newborn period. • Therefore, this is a period of highest mortality during the entire life span of a human. • Majority of infant deaths occur during this period, a newborn has about 15 times greater risk of developing diseases and death than any other time before birth

KEY FACTS

Every year, nearly 41% of all under-five child deaths are among newborn infants.

Of the 8.2 million under-five child deaths per year, about 3.3 million occur during the neonatal period.

The majority - almost 3 million of these - die within one week and almost 2 million on their first day of life.

A child’s risk of death in the first four weeks of life is nearly 15 times greater than any other time before his or her first birthday.

• Three quarters of all newborn deaths occur in the first week of life.

• An additional 3.3 million are stillborn.

Virtually all (99%) newborn deaths occur in low- and middle-income countries. It is especially in Africa and South Asia that the least progress in reducing neonatal deaths has been made.

Up to two thirds of newborn deaths can be prevented if known, effective health measures are provided at birth and during the first week of life.

Almost 3 million of all the babies who die each year can be saved with low-tech, low-cost care interventions

Causes of deaths in children under 5 years

Most deaths at start of life and can be prevented

DEFINITIONS

Fetus - Fetus is a product of conception, irrespective of the duration of pregnancy, which is not completely expelled or extracted from its mother

Birth - Birth is the process of complete expulsion or extraction of a product of conception from its mother.

Live birth - A live birth is complete expulsion or extraction from its mother of a product of conception, irrespective of duration of pregnancy, which after separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movements of voluntary muscles. • This is irrespective of whether the umbilical cord has been cut or the placenta is attached. • Because of issues of viability a GA, weight or a CHL cutoff is used.This cutoff varies between centres

Fetal death - ‘‘Fetal death’’ is death of a fetus (product of conception) irrespective of the duration of pregnancy (at any gestational age) prior to the complete expulsion or extraction from its mother, which is not due to an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles

Still birth - The death of a baby before delivery. This baby shows no signs of life a birth. • For still births (like in life births but not fetal deaths) a gestational age or weight or CRL cutoff is used • This cutoff varies

WHO definition of life birth and still birth

A baby showing signs of life after birth with a birth weight >500 g or gestation >22 weeks or crown heel length >25 cm is considered a life birth

A baby having no signs of life after birth with a birth weight of >500 g or gestation >22 weeks or crown heel length >25 cm or more is a still birth.

Definitions based on birth weight

LOW BIRTH WEIGHT (LBW) Birth weight of less than 2500 g

• VERY LOW BIRTH WEIGHT (VLBW) Birth weight of less than 1500 g

EXTREMEY LOW BIRTH WEIGHT (ELBW) Birth weight of less than 1000 g

Definitions based on gestational age at birth

PRETERM Gestational age of less than 37 completed weeks (i.e. less than 259 days)

TERM Gestational age of 37 to less than 42 completed weeks (i.e. 259 to 293 days)

POST TERM

Gestational age of 42 completed weeks or more (i.e. 294 days or mo

Perinatal period

Commences from 22 weeks (154 days) of gestation (the time when the birth weight is 500 g), and ends at 7 completed days after birth.

Neonatal period

It refers to the period of less than 28 days after birth.

Early neonatal period refers to the period before 7 days of age.

Late neonatal period refers to the period from completion of 7 days up to 28 days of life.

COMMON MORTALITY RATES

Measuring mortality

Child mortality rates: definition

The cutoffs used to calculate the PNMR varies with the definitions used for life and still births.

• PNMR and an extended PNMR

Global trends in neonatal, post-neonatal and child mortality rate

Implementation of the National Feto Infant Mortality Surveillance System

The Ministry of Health together with the Family Health Bureau has initiated a process of collecting data on all feto-infant deaths that occur in the field and hospitals since 1st January 2016 as part of the Feto-Infant Mortality Surveillance. • All fetuses and infants weighing > 500g or > 22 weeks of POG at birth whether alive or dead at birth should be included in the surveillance