Neonatal Mortality

Each year, 814,000 neonatal deaths and 1.02 million stillbirths result from intrapartum-related causes, such as intrauterine hypoxia. Almost all of these deaths are in low- and middle-income countries, where women frequently lack access to quality perinatal care and may delay care-seeking. Approximately 60 million annual births occur outside of health facilities, and most of these childbirths are without a skilled birth attendant. Conditions that increase the risk of intrauterine hypoxia--such as pre-eclampsia/eclampsia, obstructed labor, and low birth weight--are often more prevalent in low resource settings. Intrapartum-related neonatal deaths can be averted by a range of interventions that prevent intrapartum complications (eg, prevention and management of pre-eclampsia), detect and manage intrapartum problems (eg, monitoring progress of labor with access to emergency obstetrical care), and identify and assist the nonbreathing newborn (eg, stimulation and bag-mask ventilation). Simple, affordable, and effective approaches are available for low-resource settings, including community-based strategies to increase skilled birth attendance, partograph use by frontline health workers linked to emergency obstetrical care services, task shifting to increase access to Cesarean delivery, and simplified neonatal resuscitation training (Helping Babies Breathe(SM)). Coverage of effective interventions is low, however, and many opportunities are missed to provide quality care within existing health systems. In sub-Saharan Africa, recent health services assessments found only 15% of hospitals equipped to provide basic neonatal resuscitation. In the short term, intrapartum-related neonatal deaths can be substantially reduced by improving the quality of services for all childbirths that occur in health facilities, identifying and addressing the missed opportunities to provide effective interventions to those who seek facility-based care. For example, providing neonatal resuscitation for 90% of deliveries currently taking place in health facilities would save more than 93,000 newborn lives each year. Longer-term strategies must address the gaps in coverage of institutional delivery, skilled birth attendance, and quality by strengthening health systems, increasing demand for care, and improving community-based services. Both short- and long-term strategies to reduce intrapartum-related mortality should focus on reducing inequities in coverage and quality of obstetrical and perinatal care.

Most maternal and newborn recommended practices are acceptable to both the community and to health service providers. However, health system and community barriers were prevalent and will need to be overcome for better neonatal outcomes. Pregnant women did not ...

Preeclampsia is a leading cause of maternal and fetal/neonatal mortality and morbidity worldwide. The early identification of patients with an increased risk for preeclampsia is therefore one of the most important goals in obstetrics. The availability of highly sensitive and specific physiologic and biochemical markers would allow not only the detection of patients at risk but also permit a close surveillance, an exact diagnosis, timely intervention (e.g. lung maturation), as well as simplified recruitment for future studies looking at therapeutic medications and additional prospective markers. Today, several markers may offer the potential to be used, most likely in a combinatory analysis, as predictors or diagnostic tools. We present here the current knowledge on the biology of preeclampsia and review several biochemical markers which may be used to monitor preeclampsia in a future, that, we hope, is not to distant from today.

Neonatal mortality is an important global health indicator of a country. Nigeria has one of the highest neonatal mortality rates in the world. Rural portions of the country have higher rates of neonatal mortality, compared to urban areas. Problems related to asphyxiation result because resuscitation training is not targeted to the correct provider. Neonatal resuscitation training was given in three clinical sites in rural Nigeria, from October 23, 2015 to October 28, 2015. Seventy (70) participants aged 19-60 completed a 17-item questionnaire about neonatal knowledge and completed a 38-item hands-on skills checklist to measure their neonatal skill abilities. Training was given to community health extension workers (CHEWs), auxiliary nurses, traditional birth attendants (TBAs), nurse midwives, student nurse midwives, and nursing officers. To compare the mean scores between a pre-test and a post-test for both the knowledge questionnaire and the skills test, a dependent samples t-test was performed. For knowledge, the average score on the pre-test was 12.43±2.98, p<.0001 and the average score on the post-test was 14.74 ±2.16, p<.0001, meaning that the average knowledge score increased by 2.31 points, after the training. For skill, the average score on the pre-test was 21.87±6.58, p<.0001 and the average score on the post-test was 34.67±4.50, p<.0001, meaning that the average skills score increased by 12.8 points, after the training. The implementation of a neonatal resuscitation training program in rural Nigeria, can improve neonatal resuscitation knowledge and neonatal resuscitation skill ability amongst TBAs and other birth attendants. This has the potential to reduce the high neonatal mortality rates in rural communities.