Journal of Kerman University of Medical Sciences

Assessment of Maternal Risk Factors Associated with Mortality in Preterm Infants

Authors

Hassan Boskabadi 1
Maryam Zakerihamidi 2

1 Department of Pediatrics, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Ph.D. in Reproductive Health, Department of Midwifery, School of Medicine, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran

Abstract
Background & Aims: Detection of maternal risk factors associated with neonatal mortality helps to identify high-risk infants and prevent neonatal death. It can also contribute to the design more effective prenatal care. This study was performed aiming to evaluate the maternal risk factors associated with mortality in preterm infants in Mashhad Ghaem Hospital, Iran, during 2009-2014. Methods: This cross-sectional study was performed on 335 dead infants (23 to 40 weeks of gestation). The infants were divided into two groups, according to the history of maternal risk factors: 185 cases (55.20%) with a previous history of normal pregnancy and 150 infants (44.80%) with a history of maternal risk factors. The researcher-made questionnaire containing maternal information, neonatal characteristics, and maternal risk factors was completed. The causes of infants' death were confirmed by the hospital mortality technical committee. Data were analyzed using t and chi-square test via SPSS19.5 software. P-value less than 0.05 was considered statistically significant. Results: There was a statistically significant difference between the two groups in terms of age, weight, height, head circumference, length of hospital stay, being a twin, gestational age, maternal age, and mode of delivery (P < 0.05 for all). There was history of maternal risk factors in 45% of cases. The most common maternal disease was preeclampsia (14%). Asphyxia in infants with previous history of maternal risk factors, and congenital anomalies in infants with normal pregnancy, were the most common causes of death. Conclusion: As the results indicated, maternal risk factors including preeclampsia, diabetes and placental abruption were involved in neonatal mortality. Maternal risk factors were identified in about half of the infants, who had died within the first week after the birth. Therefore, when these factors are identified during pregnancy, caring of infants during the first week after delivery is recommended.

Keywords

Congenital abnormalities
Infant death
Pregnancy complications
Diabetes Mellitus
preeclampsia
  1. Stoll BJ. Infections in the neonatal infant. In: Kliegman R, Behrman RE, Jenson HB, Editors. Nelson textbook of pediatrics. 18th ed. Philadelphia, PA: Elsevier Saunders; 2007.
  2. Mirzarahimi M, Abedi A, Shahnazi F, Saadati H, Enteshari A. Causes and rate of mortality among the newborns in NICU and Newborns Unit at Imam Khomeini and Alavi Hospitals in Ardabil from September 2006 to September 2007. J Ardabil Univ Med Sci 2009; 8(4): 424-30. [In Persian].
  3. World Health Organization. The World Health Report 2005 - make every mother and child count [Online]. [cited 2005]; Available from: URL: World Health Organization
  4. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet 2005; 365(9462): 891-900.
  5. Ashworth A, Waterlow JC. Infant mortality in developing countries. Arch Dis Child 1982; 57(11): 882-4.
  6. Moss W, Darmstadt GL, Marsh DR, Black RE, Santosham M. Research priorities for the reduction of perinatal and neonatal morbidity and mortality in developing country communities. J Perinatol 2002; 22(6): 484-95.
  7. Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, et al. Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bull World Health Organ 2009; 87(2): 130-8.
  8. Jehan I, McClure EM, Salat S, Rizvi S, Pasha O, Harris H, et al. Stillbirths in an urban community in Pakistan. Am J Obstet Gynecol 2007; 197(3): 257-8.
  9. From Wikipedia tfe. List of countries by infant mortality rate [Online]. [cited 2011]; Available from: URL: http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
  10. Kliegman R, Behrman R, Jenson HB. Nelson textbook of pediatrics. Philadelphia, PA: Saunders; 2004.
  11. Logan S. Epidemiology of childhood diseases [Online]. [cited 2008]; Available from: URL: http://www.forfarandarneil.com/pdfs/10002.pdf
  12. Bapat U, Alcock G, Shah More N, Das S, Joshi W, Osrin D. Stillbirths and newborn deaths in slum settlements in Mumbai, India: a prospective verbal autopsy study. BMC Pregnancy and Childbirth 2012; 12: 39.
  13. Diallo AH, Meda N, Ouédraogo WT, Cousens S, Tylleskar T. A prospective study on neonatal mortality and its predictors in a rural area in Burkina Faso: Can MDG-4 be met by 2015? J Perinatol 2011; 31(10): 656-63.
  14. Clarence W, Gowen J. Fetal and neonatal medicine. In: Kliegman R, Editor. Nelson essentials of pediatrics. 5th ed. Philadelphia, PA: Elsevier Saunders; 2006.
  15. Greenwood AM, Greenwood BM, Bradley AK, Williams K, Shenton FC, Tulloch S, et al. A prospective survey of the outcome of pregnancy in a rural area of the Gambia. Bull World Health Organ 1987; 65(5): 635-43.
  16. Bahman-Bijari B, Niknafs P, Maddahiyan S. Causes of neonatal mortality in Kerman province in (2008-2009). Urmia Med J 2012; 22(6): 501-6. [In Persian].
  17. Sareshtedari M, Shahamat H, Sadeghi T. Causes and related factors of neonatal mortality in Qazvin NICU, 2010. Hakim Res J 2012; 14(4): 227-32. [In Persian].
  18. Sankaran K, Chien LY, Walker R, Seshia M, Ohlsson A. Variations in mortality rates among Canadian neonatal intensive care units. CMAJ 2002; 166(2): 173-8.
  19. Chowdhury ME, Akhter HH, Chongsuvivatwong V, Geater AF. Neonatal mortality in rural Bangladesh: an exploratory study. J Health Popul Nutr 2005; 23(1): 16-24.
  20. Tariq P, Kundi Z. Determinants of neonatal mortality. J Pak Med Assoc 1999; 49(3): 56-60.
  21. Boskabad H, Moudi A, Parvini Z, Barati T. Evaluation of the cause and related factors of neonatal mortality in Qaem hospital 2008-2009. Iran J Obstet Gynecol Infertil 2012; 14(7): 21-6. [In Persian].
  22. Kirby RS. Neonatal and postneonatal mortality: useful constructs or outdated concepts? J Perinatol 1993; 13(6): 433-41.
  23. Scott CL, Iyasu S, Rowley D, Atrash HK. Postneonatal mortality surveillance--United States, 1980-1994. MMWR CDC Surveill Summ 1998; 47(2): 15-30.
  24. Simpson LL. Maternal medical disease: risk of antepartum fetal death. Semin Perinatol 2002; 26(1): 42-50.
  25. Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics 1963; 32: 793-800.
  26. Burrows RF, Andrew M. Neonatal thrombocytopenia in the hypertensive disorders of pregnancy. Obstet Gynecol 1990; 76(2): 234-8.
  27. Mouzinho A, Rosenfeld CR, Sanchez PJ, Risser R. Effect of maternal hypertension on neonatal neutropenia and risk of nosocomial infection. Pediatrics 1992; 90(3): 430-5.
  28. Hansen AR, Barnes CM, Folkman J, McElrath TF. Maternal preeclampsia predicts the development of bronchopulmonary dysplasia. J Pediatr 2010; 156(4): 532-6.
  29. Cheng SW, Chou HC, Tsou KI, Fang LJ, Tsao PN. Delivery before 32 weeks of gestation for maternal pre-eclampsia: neonatal outcome and 2-year developmental outcome. Early Hum Dev 2004; 76(1): 39-46.
  30. Simmons R. Developmental origins of adult disease. Pediatr Clin North Am 2009; 56(3): 449.
  31. Mitanchez D. Foetal and neonatal complications in gestational diabetes: perinatal mortality, congenital malformations, macrosomia, shoulder dystocia, birth injuries, neonatal complications. Diabetes Metab 2010; 36(6 Pt 2): 617-27.
  32. Kicklighter S. Infants of diabetic mothers? Emedicine 2001; 51(3): 619-37.
  33. Meberg A, Lindberg H, Thaulow E. Congenital heart defects: the patients who die. Acta Paediatr 2005; 94(8): 1060-5.
  34. Pourarian S, Vafafar A, Zareh Z. The incidence of prematurity in the hospital of Shiraz University of Medical Sciences and health services, 1999. Razi j Med Sci 2002; 9(28): 19-25. [In Persian].
  35. Ngoc NT, Merialdi M, Abdel-Aleem H, Carroli G, Purwar M, Zavaleta N, et al. Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries. Bull World Health Organ 2006; 84(9): 699-705.
  36. Kayode GA, Adekanmbi VT, Uthman OA. Risk factors and a predictive model for under-five mortality in Nigeria: evidence from Nigeria demographic and health survey. BMC Pregnancy Childbirth 2012; 12: 10.
  37. Martines J, Paul VK, Bhutta ZA, Koblinsky M, Soucat A, Walker N, et al. Neonatal survival: a call for action. Lancet 2005; 365(9465): 1189-97.


Journal of Kerman University of Medical Sciences
Volume 22, Issue 5
2015
Pages 639-649

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