Every Newborn: progress, priorities, and potential beyond survival
Every Newborn: progress, priorities, and potential beyond survival
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DOI：
10.1016/s0140-6736(14)60496-7
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发表时间：
2014-07-12
期刊：
影响因子：
168.9
通讯作者：
Cousens, Simon N.
中科院分区：
文献类型：
--
作者：
Lawn, Joy E.;Blencowe, Hannah;Cousens, Simon N.
在本系列论文中，我们回顾了自 2005 年《柳叶刀》新生儿生存系列以来的趋势，为 2015 年后新生儿健康的加速进展提供信息。在多国分析和多方利益相关者磋商的基础上，我们提出了到2035年每1000名活产儿中死产数不超过10例、每1000名活产儿中新生儿死亡数不超过10例的国家目标，这与每1000名活产儿中5岁以下儿童死亡率不超过20例的目标相一致。我们还给出了2030年的目标。新生儿死亡率的降低速度慢于孕产妇和儿童（1-59个月）死亡率的降低速度，在负担最重的国家中最慢，尤其是在非洲，死产率的降低速度更慢。出生是风险最高的时期，每年有超过 40% 的孕产妇死亡（总计约 29 万人）以及死产或新生儿死亡（550 万人）发生在这个时期。这些死亡发生得很快，需要医护人员迅速做出反应。全球每年 290 万新生儿死亡可归因于三个主要原因：感染（60 万）、产时疾病（70 万）和早产并发症（100 万）。男孩新生儿死亡的生物学风险较高，但女孩的社会风险通常较高。由于早产或小于胎龄 (SGA) 或两者兼而有之，出生时体形较小是 80% 以上新生儿死亡的最大风险因素，并增加了新生儿后死亡率、生长障碍和成人发病非传染性疾病的风险。南亚的 SGA 率最高，撒哈拉以南非洲的早产率最高。足月 SGA 低出生体重婴儿（这些地区有 1040 万）面临发育迟缓和成年后发病的代谢疾病的风险。 1500 万早产儿，尤其是妊娠 32 周以下的早产儿，新生儿死亡风险最高，存在持续的新生儿后死亡风险，以及长期神经发育障碍、发育迟缓和非传染性疾病的重要风险。每年有 400 万新生儿患有其他危及生命或致残的疾病，包括产时相关的脑损伤、严重细菌感染或病理性黄疸。世界上一半的新生儿没有出生证明，大多数新生儿死亡和几乎所有死产都没有死亡证明。统计死亡人数对于改变死亡人数至关重要。如果到 2035 年未能改善出生结果，预计将导致 1.16 亿人死亡、9900 万名幸存者残疾或丧失发展潜力，以及数百万成年人在低出生体重后患非传染性疾病的风险增加。在2015年后的时代，儿童生存、发展和人力资本的改善取决于确保每个新生婴儿——未来的公民和劳动力——有一个健康的开端。
In this Series paper, we review trends since the 2005 Lancet Series on Neonatal Survival to inform acceleration of progress for newborn health post-2015. On the basis of multicountry analyses and multi-stakeholder consultations, we propose national targets for 2035 of no more than 10 stillbirths per 1000 total births, and no more than 10 neonatal deaths per 1000 livebirths, compatible with the under-5 mortality targets of no more than 20 per 1000 livebirths. We also give targets for 2030. Reduction of neonatal mortality has been slower than that for maternal and child (1-59 months) mortality, slowest in the highest burden countries, especially in Africa, and reduction is even slower for stillbirth rates. Birth is the time of highest risk, when more than 40% of maternal deaths (total about 290 000) and stillbirths or neonatal deaths (5.5 million) occur every year. These deaths happen rapidly, needing a rapid response by health-care workers. The 2.9 million annual neonatal deaths worldwide are attributable to three main causes: infections (0.6 million), intrapartum conditions (0.7 million), and preterm birth complications (1.0 million). Boys have a higher biological risk of neonatal death, but girls often have a higher social risk. Small size at birth-due to preterm birth or small-for-gestational-age (SGA), or both-is the biggest risk factor for more than 80% of neonatal deaths and increases risk of post-neonatal mortality, growth failure, and adult-onset non-communicable diseases. South Asia has the highest SGA rates and sub-Saharan Africa has the highest preterm birth rates. Babies who are term SGA low birthweight (10.4 million in these regions) are at risk of stunting and adult-onset metabolic conditions. 15 million preterm births, especially of those younger than 32 weeks' gestation, are at the highest risk of neonatal death, with ongoing post-neonatal mortality risk, and important risk of long-term neurodevelopmental impairment, stunting, and non-communicable conditions. 4 million neonates annually have other life-threatening or disabling conditions including intrapartum-related brain injury, severe bacterial infections, or pathological jaundice. Half of the world's newborn babies do not get a birth certificate, and most neonatal deaths and almost all stillbirths have no death certificate. To count deaths is crucial to change them. Failure to improve birth outcomes by 2035 will result in an estimated 116 million deaths, 99 million survivors with disability or lost development potential, and millions of adults at increased risk of non-communicable diseases after low birthweight. In the post-2015 era, improvements in child survival, development, and human capital depend on ensuring a healthy start for every newborn baby-the citizens and workforce of the future.