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Spa: Las mortalidades maternas, neonatales tardías y perinatales son por lo regular evitables, se ha reportado que la máxima expresión de desnivel en salud de la población que se ve primeramente afectada son las maternas y sus hijos por las dificultades sociodemográficas. Este proyecto de grado tiene como objetivo principal describir los eventos de mortalidad materna, neonatal tardía y perinatal en Colombia entre los años 2011 y 2019. Para ello, se plantean tres objetivos específicos: En primer lugar, se busca realizar una caracterización sociodemográfica de las personas que presentaron estos eventos. En segundo lugar, se pretende determinar la razón de los eventos de mortalidad materna en Colombia durante el período de estudio. Por último, se busca identificar las causas de mortalidad materna en Colombia entre los años 2011 y 2019. Por consiguiente, el motivo de esta investigación fue analizar los casos presentados de las muertes maternas, muertes neonatales tardías y perinatales en los 32 departamentos de Colombia por un periodo de 9 años del 2011 al 2019, el comportamiento de estos eventos se realizó a través de un estudio observacional descriptivo de corte transversal en el cual se determina análisis de las características sociodemográficas reportadas al SIVIGILA de los casos de maternas y neonatos que fallecieron durante este periodo, también se logró mostrar cuales fueron las causas básicas de estas defunciones en Colombia. Los resultados indican que la falta de acceso a la atención médica adecuada durante el embarazo, el parto y el posparto es un factor determinante para la prevención y reducción de la mortalidad materna y neonatal tardía y perinatal en Colombia. Los resultados también resaltan la importancia de priorizar a las maternas y neonatos más vulnerables, como aquellos pertenecientes a grupos étnicos y estratos socioeconómicos bajos., Ing: Maternal, late neonatal, and perinatal mortalities are typically preventable, and it has been reported that the highest level of health disparity among affected populations is among mothers and their children due to sociodemographic difficulties. The main objective of this thesis is to describe the events of maternal mortality, late neonatal mortality, and perinatal mortality in Colombia from 2011 to 2019. To achieve this, three specific objectives are proposed: Firstly, to carry out a sociodemographic characterization of the individuals who experienced these events. Secondly, to determine the reason for maternal mortality events in Colombia during the study period. Lastly, to identify the causes of maternal mortality in Colombia from 2011 to 2019. Therefore, the purpose of this research was to analyze the represented cases of maternal deaths, late neonatal deaths, and perinatal deaths in the 32 departments of Colombia over a period of 9 years from 2011 to 2019. The behavior of these events was studied through a cross-sectional descriptive observational study, in which an analysis was made of the sociodemographic characteristics reported to SIVIGILA of maternal and neonatal cases that died during this period. The basic causes of these deaths in Colombia were also identified. The results indicate that lack of access to adequate medical care during pregnancy, childbirth, and postpartum is a determining factor in the prevention and reduction of maternal, late neonatal, and perinatal mortality in Colombia. The results also highlight the importance of prioritizing the most vulnerable mothers and neonates, such as those belonging to ethnic groups and lower socioeconomic strata., Pregrado, Instrumentador Quirúrgico, Pág. Introducción 19 Planteamiento del Problema 20 Justificación 23 Objetivos 25 Objetivos General 25 Objetivos Específicos 25 Marco Teórico 26 Antecedentes 26 Estado del Arte 29 Marco Legal 33 Marco Contextual 37 Metodología 38 Diseño de la Investigación 38 Enfoque de la Investigación 38 Población 38 Técnicas de Investigación 38 Instrumentos de Recolección de Datos 38 Paso a Paso Ingreso a Cubos SISPRO 38 Paso a Paso Creación de Tabla Dinámica 40 Cuadro de Variables 41 Plan de Análisis 12 Aspectos Éticos 13 Resultados 14 Mortalidad Materna 14 Mortalidad Materna Según Área de Residencia 15 Mortalidad Materna Según el Estrato 15 Mortalidad Materna Según Etnia 16 Mortalidad Materna Según Ocupación de la Madre 17 Mortalidad Materna Según el Régimen de Afiliación de Salud 18 Mortalidad Materna Según Población 19 Causas Directas e Indirectas de Mortalidad Materna 19 Mortalidad Neonatal Tardía y Perinatal 12 Mortalidad Neonatal Tardía y Perinatal Según el Área de Residencia 13 Mortalidad Neonatal Tardía y Perinatal Según Estrato Socioeconómico 14 Mortalidad Neonatal Tardía y Perinatal Según su Etnia 14 Mortalidad Neonatal Tardía y Mortalidad Perinatal Según Población 15 Tendencia de Casos de Mortalidad Materna, Mortalidad Neonatal Tardía y Perinatal 16 Discusión 19 Conclusión 22 Referencias Bibliográficas 24

Background: Neonatal mortality is a major public health problem. Its reduction is one of the targets of the objectives for sustainable development. Objectives: To determine the frequency of late neonatal mortality, to determine the causes of death and to identify the factors associated with late neonatal mortality at Brazzaville University Hospital. Patients and methods: This was a descriptive and analytical study conducted in the neonatal department of the Brazzaville University Hospital from 1 January to 30 June 2018. It concerned all newborns admitted to the service and died between 7th and 28th day of life. The variables studied were epidemiological, clinical and evolutionary. For the study of the factors associated with late mortality, we compared the deceased newborns with those hospitalized in the service whose stay was at least seven days. The materiality threshold was 5%. Results: During the study period, 697 newborns were admitted to the service, 286 (41%) died, 79 (27.6%) on the seventh day or beyond. The median age at admission was one hour. These were male (44.3%) and female (55.7%) newborns. The causes of death were prematurity (50.7%), neonatal infection (36.7%), perinatal asphyxia (6.3%) and others (6.3%). The mean age at death was 13.5 ± 6.4 days (range: 7 and 28 days). Prematurity OR = 3.62 (95% CI: 1.2 - 10.6) is the factor associated with late mortality. Conclusion: Reducing late neonatal mortality requires the implementation of measures to improve the human and material capacities of the service.

Resumo Objetivo: Caracterizar a mortalidade neonatal precoce e tardia no estado do Rio Grande do Norte de 2008 a 2017. Metodologia: Estudo epidemiológico descritivo, temporal de abordagem quantitativa retrospectiva, com dados do Departamento de Informática do Sistema Único de Saúde (DATASUS) sobre os óbitos neonatais ocorridos entre janeiro de 2008 e dezembro de 2017 no estado do Rio Grande do Norte por local de moradia. Resultados: A amostra foi composta de um total de 4.531 óbitos, sendo mais prevalente óbito neonatal precoce (79,65 %), sexo masculino (54,71 %), gestação inferior a 27 semanas (34,05 %), parto do tipo vaginal (49,93 %), recém-nascidos com peso menor que 2.500 g (68,57 %) e mães com escolaridade entre 8 e 11 anos de estudo. Entre 2008, ano inicial de coleta, e 2017, ano final, a mortalidade neonatal apresentou redução de 23,83 %. A mortalidade masculina se apresentou maior que a feminina em todos os anos, com variação entre 0,09 e 0,08 respectivamente. O teste de qui-quadrado de independência mostrou que existe associação entre o tipo de parto e a mortalidade neonatal p < 0,001. Conclusão: Os dados da pesquisa evidenciam a redução da mortalidade neonatal no estado, ao mesmo tempo que aponta para a necessidade do fortalecimento de ações no período gestacional a fim de evitar condições favoráveis à mortalidade infantil, como a prematuridade e a desnutrição. Outro dado comprovado refere-se ao preenchimento das declarações de nascido vivo e óbito, visto que muitas variáveis apresentaram o item "ignorado" referente ao preenchimento incorreto ou não preenchimento da informação. Resumen Objetivo: Caracterizar la mortalidad neonatal temprana y tardía en el estado de Rio Grande do Norte (Brasil) en el periodo 2008-2017. Metodología: Estudio epidemiológico descriptivo temporal de enfoque cuantitativo retrospectivo, con datos del Departamento de Informática do Sistema Único de Saúde (DATASUS) sobre muertes neonatales ocurridas entre enero de 2008 y diciembre de 2017 en el estado de Rio Grande do Norte por lugar de residencia. Resultados: La muestra consideró un total de 4.531 muertes, siendo las más frecuentes: muerte neonatal temprana (79,65 %), sexo masculino (54,71 %), embarazo de menos de 27 semanas (34,05 %), parto vaginal (49,93 %), recién nacidos con menos de 2,500 g de peso (68,57 %) y madres con 8 a 11 años de escolaridad. Entre 2008, el año inicial de recolección, y 2017, el año final, la mortalidad neonatal disminuyó en 23,83 %. La mortalidad masculina fue mayor que la femenina en todos los años, oscilando entre 0,09 y 0,08, respectivamente. La prueba de independencia de chi-cuadrado mostró una asociación entre el tipo de parto y la mortalidad neonatal p < 0,001. Conclusión: Los datos de la investigación muestran una reducción de la mortalidad neonatal en la región de estudio, al tiempo que señalan la necesidad de fortalecer algunas acciones en el período gestacional para evitar condiciones que favorezcan la mortalidad infantil, como el nacimiento prematuro y la desnutrición. Otros datos se refieren al diligenciamiento de declaraciones de neonatos vivos y defunciones, debido a que muchas variables presentaron el ítem "ignorado", refiriéndose al suministro de información incorrecta o incompleta. Abstract Objective: To characterize early and late neonatal mortality in the state of Rio Grande do Norte (Brazil) from 2008 to 2017. Methodology: Descriptive, temporal epidemiological study under a retrospective quantitative approach, with data from the sus Department of Informatics (DATASUS) on neonatal deaths occurred between January 2008 and December 2017 in the state of Rio Grande do Norte by place of residence. Results: The sample consisted of a total of 4,531 deaths, the most prevalent being: early neonatal death (79.65 %), male gender (54.71 %), pregnancy of less than 27 weeks (34.05 %), childbirth type (49.93 %), newborns weighing less than 2,500g (68.57 %), and mothers with 8 to 11 years of schooling. Between 2008, the initial year of collection, and 2017, the final year, neonatal mortality decreased by 23.83 %. Male mortality was higher than female in all years, ranging between 0.09 and 0.08, respectively. The chi-square independence test showed an association between type of delivery and neonatal mortality of p < 0.001. Conclusion: Research data show a reduction of neonatal mortality in the RN state, while pointing the need to strengthen actions during the gestational period in order to avoid conditions favorable to infant mortality such as prematurity and malnutrition. Other proven data refers to the filing of "live birth" or "death" statements, where several variables presented the item "ignored," referring to incorrect or non-filling information.

Objectives: to estimate the population attributable fraction of preventable infant mortality rates due to changes in breastfeeding (BF) indicators attributable to the Baby Friendly Hospital Initiative (BFHI). Methods: an estimate on the impact of BFHI in reducing infant mortality with an inferential level of plausibility, using secondary data from the II Breastfeeding Prevalence Survey of 2008. Initially, the effect of BFHI on breastfeeding in the first hour of life, exclusive breastfeeding, and any breastfeeding based on the prevalence of the outcomes among infants born in BFHI or non-BFHI was calculated. Second, the population attributable fraction of nonbreastfeeding was estimated for late neonatal mortality, mortality by all causes and infant mortality by infections, for BFHI and non-BFHI, and the number of potentially avoidable deaths if all children were born in BFH. Results: reduction of 4.2% of late neonatal deaths due to the increase in BF prevalence in the first hour, as provided by BFHI. BFHI potentially contributed with 3.5% of all-cause deaths and 4.2% of deaths from infection by BF promotion in infants below 6 months. Conclusions: the reduction of mortality in children between 7 and 180 days in 2008 potentially attributable to BFHI through the promotion of BF indicators reinforces the importance of strengthening and expanding this initiative in Brazil to ultimately enhance child survival.

BackgroundTo determine the gender differences in neonatal mortality, stillbirths, and perinatal mortality in south Asia using the Global Network data from the Maternal Newborn Health Registry.MethodsThis study is a secondary analysis of prospectively collected data from the three south Asian sites of the Global Network. The maternal and neonatal demographic, clinical characteristics, rates of stillbirths, early neonatal mortality (1–7 days), late neonatal mortality (8–28 days), mortality between 29–42 days and the number of infants hospitalized after birth were compared between the male and female infants.ResultsBetween 2010 and 2018, 297,509 births [154,790 males (52.03%) and 142,719 females (47.97%)] from two Indian sites and one Pakistani site were included in the analysis [288,859 live births (97.1%) and 8,648 stillbirths (2.9%)]. The neonatal mortality rate was significantly higher in male infants (33.2/1,000 live births) compared to their female counterparts (27.4/1,000, p ConclusionThe risks of stillbirths, and early neonatal mortality were higher among male infants than their female counterparts. However, there was no gender difference in mortality after 7 days of age. Our results highlight the importance of stratifying neonatal mortality into early and late neonatal period to better understand the impact of gender on neonatal mortality. The information from this study will help in developing strategies and identifying measures that can reduce differences in sex-specific mortality.

Objetivos: Descrever uma tendência da saúde materno-infantil e dos seus componentes entre 2007 e 2016, destacando-se as características da saúde materna, neonatal e perinatal. Métodos: Para os cálculos das taxas de mortalidade materna, neonatal e perinatal, de seus componentes e as variáveis ​​foram utilizadas no Sistema de Informações sobre Mortalidade (Sinasc) e sobre os óbitos infantis do Sistema de Informações sobre Mortalidade (SIM). para os anos de 2007 a 2016, fazendo um médio entre os períodos. A gravidez precoce, a gravidez na adolescência, taxas de mortalidade materna, neonatal e perinatal, peso ao nascer e causas das mortalidades materno-infantis. Resultados: Observou-se um taxa de natalidade que de 1,01 filhos por mulher entre 2007 e 2016. A taxa de mortalidade neonatal tardia de 2,27 anos por mil nascidos vivos nos anos de 2007 a 2016, enquanto na taxa neonatal anterior foi de 7,25 por mil nascidos vivos no período de 2007 a 2016. Conclusão: "Por que nascemos vivos no período de 2007 a 2016"? The objective of the main health health - infantil. Objetivos: Descrever a tendência da saúde materno-infantil e dos seus componentes entre 2007 e 2016, destacando as características da saúde materna, neonatais e perinatais. Métodos: Para os cálculos das taxas de mortalidade materna, neonatal e perinatal, de seus componentes e suas causas foram utilizados os dados sobre nascimentos do Sistema de Informações sobre Nascidos Vivos (Sinasc) e sobre óbitos infantis do Sistema de Informações sobre Mortalidade (SIM) para os anos de 2007 a 2016, fazendo a média entre os períodos. Foram analisados a prematuridade, gravidez na adolescência, taxas de mortalidade materna, neonatal e perinatal, peso ao nascer e causas das mortalidades materno-infantis. Resultados: Observou-se a taxa de natalidade que de 1,01 filhos por mulher entre 2007 e 2016. A taxa de mortalidade neonatal tardia de 2,27 óbitos por mil nascidos vivos nos anos de 2007 a 2016, enquanto na taxa neonatal precoce foi de 7,25 por mil nascidos vivos no período de 2007 a 2016. Conclusão: Através do presente estudo foi possível observar uma significativa queda das taxas de natalidade fato determinante na estrutura populacional, bem como a queda nas taxas de mortalidade neonatal, e perinatal o que demonstrou um avanço significativo nos programas de assistência à saúde materna e de seus descendentes, que por sua vez promoveu uma melhora na saúde materno - infantil.

Objective: To determine the causes of neonatal mortality and its epidemiological characteristics in our institution, 2015and 2016. Materials and methods: Retrospective, descriptive and observational study, we reviewed the clinical records ofpatients who died in the neonatal department of the INMP during 2015 and 2016. Objetivo: Determinar las causas de mortalidad neonatal y sus características epidemiológicas en nuestra Institución, 2015y 2016. Materiales y métodos: Estudio retrospectivo, descriptivo y observacional, se revisaron las historias clínicas depacientes fallecidos en el departamento de neonatología del INMP durante 2015 y 2016.

IntroductionAlthough past studies have established that iron-supplements and anti-malaria drugs taken by mothers during pregnancy reduce the risk of neonatal deaths in high prone malaria areas, little is known about their impact on mortality risks in neonatal age segments in Kenya. The study objective was to analyse variations in neonatal age segments mortality rates by uptake of these two antenatal care services and determine their effects on the age segments mortality in Kenya’s malaria zones.Data and methodsThis study used data from the 2014 Kenya Demographic and Health Survey (KDHS). Survival status information for 20,794 children born less than 60 months prior to interview date and reported mothers’ uptake of iron-supplements and anti-malaria drugs during last pregnancy was analysed. Life table method was used to estimate mortality rates and Poisson multivariate regression models were fitted to determine relative risks of death for the study variables.ResultsThe results show that variations in neonatal age segments mortality in Kenya’s malaria zones are statistically insignificant. The contributions of early neonatal (0 to 7 days) to neonatal mortality rate are 80% and 100% in low and high malaria zones, respectively. Combined high community uptake of iron-supplements and anti-malaria drugs during pregnancy reduce significantly mortality risk in late neonatal (8 days to less than one month) in all malaria zones when effects of other risk factors are controlled for.ConclusionsThe findings suggest that future decline in neonatal mortality in all Kenya’s malaria zones depend mainly on reduction of early neonatal mortality. High community uptake of iron-supplements and anti-malaria drugs during pregnancy has significant reduction effect on late neonatal mortality in all malaria zones. This study recommends improvement of future KDHS data quality, especially on care for small and sick neonates.

To ascertain the national neonatal mortality rate in Qatar during the first quarter of 2011 (1 January-31 March), we carried out a prospective pilot national epidemiologic study. Nationwide birth and neonatal mortality data were collected using predesigned, structured questionnaires. To analyse trends over the previous 4 years (2008-2011) we used neonatal mortality data for 2008-2010 from the database of the neonatal unit at the Women's Hospital, annual reports of Hamad Medical Corporation, and published neonatal mortality data for 2010 for comparative analysis. A total of 4909 live births and 21 neonatal deaths were recorded during the study period. The neonatal mortality rate was 4.28/1000 live births (corrected neonatal mortality rate 2.85/1000). The early neonatal mortality rate was 1.84/1000 and the late neonatal mortality rate was 2.44/1000 live births. Fifteen of the 21 neonatal deaths were in non-Qatari babies, reflecting the ethnic distribution in the population. Neonatal mortality rates in Qatar declined very little between 2008 and the first quarter of 2011.

Objective: To prospectively ascertain Qatar's national Neonatal Mortality Rate (NMR), Early Neonatal Mortality Rate (ENMR), and Late Neonatal Mortality Rate (LNMR) during 2011, compare it with recent data from high-income countries, and analyze trends in Qatar's NMR's between 1975 and 2011 using historic data. Study Design: A National prospective cohort-study. Materials and Methods: National data on live births and neonatal mortality was collected from all public and private maternity facilities in Qatar (1 st January-December 31 st 2011) and compared with historical neonatal mortality data (1975-2010) ascertained from the database of maternity and neonatal units of Women's Hospital and annual reports of Hamad Medical Corporation. For inter country comparison, country data of 2009 was extracted from World Health Statistics 2011 (WHO) and the European Perinatal Health report (2008). Results: A total of 20583 live births were recorded during the study period. Qatar's national NMR during 2011 was 4.95, ENMR 2.7, LNMR 2.2, and cNMR 3.33. Between 1975 and 2011, Qatar's population increased by 10-fold, number of deliveries by 7.2 folds while relative risk of NMR decreased by 87% (RR 0.13, 95% CI 0.10-0.18, P>0.001), ENMR by 91% (RR 0.09, 95% CI 0.06-0.12, P

Dans le cadre du systeme d’information actif mis en place par le service d’epidemiologie sur la mortalite hospitaliere au CHU de Blida (Algerie), une etude a ete realisee pour apprecier l’importance et l’evolution de la mortalite neonatale enregistree au CHU au cours des annees 1999–2006, ainsi que celles des causes du deces neonatal. La Classification internationale des maladies (CIM-9) a ete utilisee pour coder la nature de la maladie causale. Les operations de saisie, de controle et d’analyse ont ete effectuees par l’utilisation du logiciel EpiInfo™ dans sa sixieme version. Au total, 2 167 deces neonatals ont ete enregistres au CHU pendant la periode d’etude, soit une mortalite proportionnelle de 25,4 %. La mortalite neonatale precoce (0–6 jours) a represente 83,4 % de l’ensemble de la mortalite neonatale. Pres des deux tiers des deces neonatals precoces sont intervenus dans les trois premiers jours de vie. L’evolution mensuelle du nombre de deces neonatals precoces a dessine une tendance significativement a la hausse au cours de la periode d’etude (p < 0,05) sans mise en evidence d’effet saisonnier. Le rapport de masculinite etait pratiquement le meme pour la mortalite neonatale precoce et tardive, respectivement 1,4 et 1,5. La prematurite a represente 42,1 % des causes de deces de lamortalite neonatale precoce, suivie par le syndrome de detresse respiratoire et les infections; respectivement 17 et 14,4 %. Les infections ont represente, avec une frequence relative de 36,2 %, la cause la plus frequente pour la mortalite neonatale tardive. Le taux de mortalite neonatale precoce au cours de la periode d’etude, lorsque celui-ci admet pour denominateur le nombre de nouveau-nes admis en neonatalogie pour exprimer la mortalite de service, etait de 15,6 %. Pendant toute la periode d’etude, le taux de mortalite neonatale precoce, en deduisant les deces survenus parmi les nouveau-nes transferes, pouvait etre estime a 19,2 pour 1 000 naissances vivantes, tandis que le taux de mortalite neonatale globale pouvait etre estime a 22,3 pour 1 000 naissances vivantes. Aucune tendance temporelle significative n’a ete mise en exergue. Le CHU de Blida ne se caracterise pas par un risque inferieur de mortalite neonatale par rapport a celui enregistre a l’echelle nationale. Les donnees du CHU de Blida contribuent a mesurer le degre d’atteinte d’objectifs fixes par le Programme national sur la perinatalite.

This study aimed to investigate the perinatal mortality rate with 37 864 deliveries which occured in two different periods in a single center, to compare the components of perinatal mortality and affecting factors with the results of the study related with perinatal mortality which we conducted in 1999 and to emphasize the precautions directed to reduce mortality rates.All live births and stillbirths which occurred in Bakırköy Obstetrics and Pediatrics Training and Research Hospital between January 2007 and December 2007 were evaluated. The results were compared with the results of the study conducted in 1999. Newborns with a weight above five hundred grams and a gestational age above 22 weeks were enrolled in the study. The stillbirth rate, early neonatal mortality rate, late neonatal mortality rate, perinatal mortality rate and corrected perinatal mortality rate were calculated. Modified Wigglesworth Classification was used for evaluating the perinatal mortality and the subjects were examined in 7 groups. The characteristics belonging to the years of 2007 and 1999 were examined, the differences were recorded and the results were discussed. When the two periods were compared, it was observed that the perinatal mortality rate increased from 23.5‰ to 26‰.When the causes were investigated, it was observed that the stillbirth rate was increased in 2007 (84%) and especially congenital anomalies had an important role in this increment. The early neonatal mortality rate declined from 0.8% in 1999 to 0.4% in 2007. It was found that especially the premature mortality rate (Group 3) and the mortality rate related with perinatal asphyxia (Group 4) were significantly decreased.The decrease in early neonatal mortality rate could be best explained by productive operation of the new neonatal intensive care unit which had been established after 2002.

To determine risk factors associated to neonatal mortality(NM) Hospital Universitario Ramón Gonzalez Valencia (HURGV) atBucaramanga in 2000. Methods: The cases were all the neonatesborn at HURGV during 2000, weighing 1000 gm or more and/or 28or more gestational age, and dead the first 28 days of life. Earlyneonatal death (END) was defined as death before the 7th day of lifeand late neonatal death (LND) as death among 7 and 28 day of life.For each case were randomly selected three controls among theneonates born at the hospital during the same month and were notdead. Babies and mothers´ clinical records were assessed for socialdemographics variables, and pregnancy and neonatal outcome.Results: 91 cases and 268 controls were analyzed. A statisticallysignificant association with NM was found with lower mothers´scholarship level, occupation, previous death birth delivery,premature rupture of membranes, labor < 24 hours, cesareansection, emergency cesarean section and find meconium in amnioticfluid. In the neonates, were significant weight < 2.500 gm, risingthe risk by lowering the weight. Also, APGAR score < 7 in first 5minutes, gestational age < 37 week and low height. The logisticsregress confirmed significant association with lower mothers´scholarship level (OR = 0.569, IC 95% 0.341 - 0.947, p = 0.030),occupation at home (OR = 9.19, IC 95% 1.626 - 52.039, p = 0.012 number of pregnancy medical visits (OR = 0.844, IC 95% 0.718 -0.991, p = 0.039), previous stillborn (OR = 16.705 for each one, IC95% 4.22 - 66.10, p = 0.000), newborn weight (OR = 0.998 pereach grame < 600, IC 95% 0.997 - 0.998, p = 0.000) and oneminuteApgar score (OR = 0.408 per each point, IC 95% 0.305 -0.547, p = 0.000).Discussion: The rate of NM was 17.03 for 1000 live born children; theENM was 12.5 for 1000 live born children, whereas LNM was 4.49.The risk factors found in this study agree with the reported in theliterature, and are useful specific to perform follow-up studies in pregnantwomen care and to evaluate the quality of prenatal control in ourcommunity. The findings can be inferred to III and IV complexity levelinstitutions with a similar population from the assessed in this study.

Maternal mortality rate (MMR): Qatar’s MMR dropped from 49/100,000 in 1990 to 9.02% in 2012. Qatar’s MMR had been zero for several years between 1995 and 2000; for the rest of the years, it had been between 7 and 11/100,000. Qatar’s MMR over the last decade has not only been significantly low, as compared to the global MMR of 260/100,000 and regional MMR of 320/100,000 in Eastern Mediterranean Region as given, it is also comparable to the MMR of many high income countries, both from the West and East. Qatar’s antenatal coverage is 94%. Qatar’s reproductive health system is based on 99.45% hospital deliveries. During 2011, the State of Qatar had a 25% national C section rate. The relative risk of neonatal mortality was significantly higher among C section deliveries, particularly in emergency C Section deliveries. Neonatal mortality and perinatal mortality rates: The Relative Risk of Neonatal Mortality in Qatar decreased by 87% between 1975 and 2011, though the population increased by 10 fold and number of deliveries by 7.2 folds. This is a superb achievement; which encompasses both early and late neonatal mortality. Qatar’s neonatal mortality rate corrected for lethal congenital anomalies and futility (cNMR) was 3.26/1000 during 2011. Qatar’s 2011 NMR (4.9/1000) and cNMR (3.26/1000) are comparable to selected high income countries; both from the west and east.

SummaryCongenital abnormalities are the leading cause of perinatal and late neonatal mortality at the National Guard King Khalid Hospital in Saudi Arabia. This paper analyses the lethal congenital abnormalities that caused perinatal and late neonatal deaths during the seven years from 1987 to 1993. A total of 119 (103 perinatal and 16 late neonatal) deaths had lethal congenital abnormalities during the 7 years, including two sets of twins. The commonest congenital abnormalities affected the central nervous system (32 per cent) followed by abnormalities in the cardiovascular system (13 per cent) and the renal system (11 per cent).

Summary. Recent evidence concerning time trends in infant mortality rates suggests faster falls in early compared with late deaths. This may be due to rapid advances in neonatal care. This study was undertaken to examine the timing of neonatal death in Ontario between 1979 and 1987. Trends with time, gestational age and type of birth hospital were examined. Evidence suggests that, controlling for level of birth hospital and gestational age, there was a time trend of an increasing proportion of late neonatal deaths. This suggests that early neonatal mortality was decreasing more rapidly than late neonatal mortality. Controlling for year of birth and gestational age, it was observed that the proportion of late neonatal deaths was higher for those born in a tertiary rather than community hospital. In combination, these findings suggest that, due to advances in neonatal care, a disproportionately high number of early neonatal deaths are increasingly being prevented. The findings have implications for the interpretation of routinely available mortality markers. The authors conclude that early neonatal death rate may be becoming a less useful marker and that a measure of perinatal mortality which includes late neonatal deaths would be a useful addition to the currently collected mortality markers.

Summary. The conventional partition of infant mortality into neonatal and postneonatal deaths, with the 28th day postpartum as the dividing line, has lost much of its epidemiological rationale in countries with low infant death rates. Infant deaths are concentrated increasingly at the start of the neonatal period: one out of three infant deaths in the United States occurs during the first 24 hours. Circumstances of early neonatal deaths differ considerably from those of later neonatal deaths. Failure to monitor separately early and late neonatal mortality can compromise the recognition of distinct epidemiological patterns. Racial disparities in the US tend to be larger for first day deaths than for any other infant deaths. Total US infant mortality declined rapidly in the 1950s and 1960s but first day deaths rose at a steady pace. Surveillance of infant mortality, whether on the national or the community level, should encompass first day, first month and first year death rates.

OBJETIVOS: determinar a incidência de malformações congênitas em recém-nascidos assistidos em uma maternidade-escola de Recife e avaliar o impacto destas malformações na mortalidade perinatal e neonatal. MÉTODOS: realizou-se um estudo longitudinal durante os meses de setembro de 2004 a maio de 2005, analisando-se todos os partos assistidos no Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Determinou-se a freqüência e o tipo de malformações congênitas e foram calculados os coeficientes de mortalidade fetal, mortalidade perinatal, mortalidade neonatal precoce e tardia. RESULTADOS: a freqüência de malformações foi de 2,8% (em 4043 nascimentos). O percentual de malformações entre os nativivos foi de 2,7%, e entre os natimortos foi de 6,7%. Dentre as malformações, as mais freqüentes foram as do sistema nervoso central (principalmente hidrocefalia e meningomielocele), as do sistema osteomuscular e as cardiopatias. Não houve associação entre malformações e sexo, porém a freqüência de prematuridade e baixo peso foi maior entre os casos de malformações. Constatou-se, entre os malformados, mortalidade neonatal precoce de 32,7% e tardia de 10,6%. Os casos de malformações representaram 6,7% dos natimortos, 24,2% das mortes neonatais precoces e 25,8% do total de mortes neonatais. CONCLUSÕES: a freqüência de malformações correspondeu a 2,8% dos nascimentos. As malformações representaram a segunda causa mais freqüente de mortes neonatais, depois da prematuridade. OBJECTIVES: to determine the incidence of congenital malformations in newborns in a university maternity hospital in Recife and assess the impact of malformation in perinatal and neonatal mortality. METHODS: a longitudinal study was performed from September 2004 to May 2005 with all deliveries at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP analyzed. The type and incidence of congenital malformations were determined, and fetal mortality, perinatal mortality, early and late neonatal mortality coefficients were calculated. RESULTS: malformation incidence was of 2.8% (in 4.043 births). Malformation percentages among live births was of 2.7% and among stillbirths of 6.7%. The most frequent malformations involved the central nervous system (principally hydrocephaly and meningomyelocele), the skeletal and muscular system and cardiopathies. There was no association between malformation and gender, but prematurity and low birthweight were more frequent among the malformation cases. It was determined that among malformed infants early neonatal mortality was of 32.7% and late neonatal mortality was of 10.6%. Malformation cases were 6.7% of stillborn babies, 24.2% of early neonatal deaths and 25.8% the total of neonatal deaths. CONCLUSIONS: malformation incidence corresponded to 2.8% of the births. Malformation was the second more frequent neonatal death cause following prematurity.

OBJECTIVEThe aim of this study was to identify spatial patterns of distribution of overall, early, and late neonatal mortality rates in São Paulo state.METHODSAn ecological and exploratory study was carried in micro-regions of São Paulo sate. Mortality rates per 1,000 live births (LB) were calculated using data on overall, early, and late neonatal mortality in São Paulo between 2006 and 2010; these data were obtained from Information System and Information Technology Department of the Brazilian National Healthcare System (DATASUS). The global Moran's indices (I) were calculated for rates and thematic maps were built with these rates. Micro-regions with a high priority for intervention were identified by the box map. The software TerraView 4.2.1 was used for spatial analysis.RESULTSThe rates of early and late neonatal mortality were 6.2 per thousand LB and 2.5 per thousand LB, respectively. The global Moran's indexes (I) were I=0.13, I=0.15, and I=0.26 for overall, early, and late neonatal mortality rates, respectively; all global Moran's indices showed P-values

The interest in congenital malformations increases when the infant mortality rate declines. When the preventable cases decline and form only a small part of the total infant mortality, attention is directed towards the remaining hard-core of infant mortality. At this stage, congenital malformations (CM), which are still to a certain degree a terra incognita, gain in importance and are rated at high priority. Infant mortality in Israel declined from 51 -7 per 1,000 live births in 1949 to 23-7 in 1964. During these 16 years, the mortality in the second half of infancy (infants aged 6-11 months) diminished to about one-fifth of the 1949 figure; the mortality at the ages 1-5 months declined to less than one-third; even the late neonatal mortality (1-3 weeks) decreased to less than half; but in the first week of life the decrease amounted to only 16-4 per cent. This is the period in which intra-uterine developments influence the mortality rather more than environmental circum stances. Most causes of death showed a more or less regular tendency to decline. But the share of CM in the total infant mortality increased from 9 8 per cent, in 1950 to 21 -3 per cent, in 1963 and 20 0 per cent, in 1964. Further improvement in the infant mortality will depend on understanding the bio logical processes underlying congenital malforma tions.

Background Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0–2) and later neonatal mortality (day 3–28). Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children’s Health’s Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas. Results We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22). Conclusions Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated. Trial registration ClinicalTrials.gov NCT01073475