Risk factors for neonatal mortality due to birth asphyxia in southern Nepal: A prospective, community-based cohort study
Risk factors for neonatal mortality due to birth asphyxia in southern Nepal: A prospective, community-based cohort study
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DOI：
10.1542/peds.2007-1966
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发表时间：
2008-05-01
期刊：
影响因子：
8
通讯作者：
Darmstadt, Gary L.
中科院分区：
文献类型：
--
作者：
Lee, Anne C. C.;Mullany, Luke C.;Darmstadt, Gary L.
客观的。我们的目标是在尼泊尔南部农村、资源匮乏、以人群为基础的队列中确定产前、产中和婴儿出生窒息死亡率的危险因素。患者和方法。在尼泊尔萨拉希进行的一项整群随机、基于社区的试验中前瞻性收集了数据，该试验评估了新生儿皮肤和脐带清洁对新生儿死亡率和发病率的影响。 2002 年 9 月至 2006 年 1 月期间，共有 23 662 名新生儿入组。采用多变量回归模型来确定产前、产时和婴儿危险因素的出生窒息死亡率的调整相对风险估计。结果。出生窒息死亡（9.7/1000.0活产）占新生儿死亡率的30%。出生窒息死亡的产前危险因素包括父亲教育程度低、马德什族裔和初产。设施交付；产妇发烧；产妇脸部、手或脚肿胀；多胞胎是产时窒息死亡的重要危险因素。早产儿（< 37 周）的风险较高，与无发热母亲的足月婴儿相比，母亲发烧和早产的结合导致出生窒息死亡的风险增加 7 倍。结论。在资源匮乏的社区环境中，孕产妇感染、早产和多胎是出生窒息死亡的重要危险因素。社会经济地位低下与出生窒息高度相关，导致死亡的机制需要阐明。孕产妇感染与早产之间的相互作用可能是未来社区干预措施的一个重要目标，以减少出生窒息对新生儿死亡率的全球影响。
OBJECTIVE. Our goal was to identify antepartum, intrapartum, and infant risk factors for birth asphyxia mortality in a rural, low-resource, population-based cohort in southern Nepal.PATIENTS AND METHODS. Data were collected prospectively during a cluster-randomized, community-based trial evaluating the impact of newborn skin and umbilical cord cleansing on neonatal mortality and morbidity in Sarlahi, Nepal. A total of 23 662 newborn infants were enrolled between September 2002 and January 2006. Multivariable regression modeling was performed to determine adjusted relative risk estimates of birth asphyxia mortality for antepartum, intrapartum, and infant risk factors.RESULTS. Birth asphyxia deaths (9.7/1000.0 live births) accounted for 30% of neonatal mortality. Antepartum risk factors for birth asphyxia mortality included low paternal education, Madeshi ethnicity, and primiparity. Facility delivery; maternal fever; maternal swelling of the face, hands, or feet; and multiple births were significant intrapartum risk factors for birth asphyxia mortality. Premature infants (< 37 weeks) were at higher risk, and the combination of maternal fever and prematurity resulted in a 7-fold elevation in risk for birth asphyxia mortality compared to term infants of afebrile mothers.CONCLUSIONS. Maternal infections, prematurity, and multiple births are important risk factors for birth asphyxia mortality in the low-resource, community-based setting. Low socioeconomic status is highly associated with birth asphyxia, and the mechanisms leading to mortality need to be elucidated. The interaction between maternal infections and prematurity may be an important target for future community-based interventions to reduce the global impact of birth asphyxia on neonatal mortality.