Intrapartum-Related Stillbirths and Neonatal Deaths in Rural Bangladesh: A Prospective, Community-Based Cohort Study
Intrapartum-Related Stillbirths and Neonatal Deaths in Rural Bangladesh: A Prospective, Community-Based Cohort Study
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DOI：
10.1542/peds.2010-0842
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发表时间：
2011-05-01
期刊：
影响因子：
8
通讯作者：
Barnett, Sarah
中科院分区：
文献类型：
--
作者：
Ellis, Matthew;Azad, Kishwar;Barnett, Sarah
目的：利用低成本的社区监测系统，估算低收入社区的产中死产和产中相关新生儿死亡率。方法：以传统助产士为主要信息源，对2005年至2008年孟加拉国3个区18个产区的所有分娩情况进行调查。结果：我们确定了31 967例分娩的信息，其中26 173例(82%)发生在家里。在家庭分娩方面，整群调整后的平均死产率为每1000名新生儿26人(95%可信区间：24-28)，围产儿死亡率为每1000名新生儿51人(95%可信区间：47-55)。核磁共振为每1000名活产儿33名(95%可信区间：30-37)。有3186名(12.5%)家庭出生的婴儿没有立即呼吸。在这些人中，53%经历了某种形式的复苏。在1435名在5分钟内状况不佳的婴儿中(占所有分娩的5%)，286名(20%)死亡；占新生儿死亡的所有原因的35%。在201例新鲜死产中，有40例(14%)有严重的先天畸形。我们对家庭出生婴儿产中相关粗死亡率的估计为千分之17(95%可信区间：16-19)，出生困难后死产婴儿为千分之六，新生儿死亡为千分之十一。结论：在孟加拉国农村，居家出生的婴儿呼吸困难是常见的，而且经常尝试复苏。新生儿如果在5分钟后仍处于较差的状态，其死亡率为20%。需要评估复苏方法、包括抗生素制度在内的早期干预试验以及对社区复苏幸存者的后续研究。儿科杂志2011；127：e1182-e1190
OBJECTIVE: Using a low-cost community surveillance system, we aimed to estimate intrapartum stillbirth and intrapartum-related neonatal death rates for a low-income community setting.PATIENTS AND METHODS: From 2005 to 2008, information on all deliveries in 18 unions of 3 districts of Bangladesh was ascertained by using traditional birth attendants as key informants. Outcomes were measured using a structured interview with families 6 weeks after delivery.RESULTS: We ascertained information on 31 967 deliveries, of which 26 173 (82%) occurred at home. For home deliveries, the mean cluster-adjusted stillbirth rate was 26 (95% confidence interval [CI[: 24-28) per 1000 births, and the perinatal mortality rate was 51 per 1000 births (95% CI: 47-55). The NMR was 33 per 1000 live births (95% CI: 30-37). There were 3186 (12.5%) home-born infants who did not breathe immediately. Of these, 53% underwent some form of resuscitation. Of 1435 infants who were in poor condition at 5 minutes (5% of all deliveries), 286 (20%) died; 35% of all causes of neonatal mortality. Of 201 fresh stillbirths, 40 (14%) of the infants had major congenital abnormalities. Our estimate of the intrapartum-related crude mortality rate among home-born infants is 17 in 1000 (95% CI: 16-19), 6 in 1000 stillborn and 11 in 1000 neonatal deaths after difficulties at birth.CONCLUSIONS: Difficulty initiating respiration among infants born at home in rural Bangladesh is common, and resuscitation is frequently attempted. Newborns who remain in poor condition at 5 minutes have a 20% mortality rate. Evaluation of resuscitation methods, early intervention trials including antibiotic regimes, and follow-up studies of survivors of community-based resuscitation are needed. Pediatrics 2011;127:e1182-e1190