Birth asphyxia is under‐rated as a cause of preterm neonatal mortality in low‐ and middle‐income countries: A prospective, observational study from PURPOSe

Goldenberg, Robert L.; Dhaded, Sangappa; Saleem, Sarah; Goudar, Shivaprasad S.; Tikmani, Shiyam Sunder; Trotta, Marissa; Kay, Hwang Jackson,; Guruprasad, Gowder; Kulkarni, Vardendra; Kumar, Sanjiv; Uddin, Zeesham; Reza, Sayyeda; Raza, Jamal; Yasmin, Haleema; Yogeshkumar, S; Somannavar, Manjunath S; Aceituno, Anna; Parlberg, Lindsay; Silver, Robert M.; McClure, Elizabeth M

doi:10.1111/1471-0528.17220

Cited by 10 publications

(9 citation statements)

References 34 publications

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“…In separate analyses, we compared the cause of death determined by the NICU physicians compared with the cause of death determined by the panels 28 . The panel had access to the entire obstetric history, the placental histological data and placental weight, the internal organ histology and the PCR results, in addition to the clinical course of the neonate.…”

Section: Resultsmentioning

confidence: 99%

“…In separate analyses, we compared the cause of death determined by the NICU physicians compared with the cause of death determined by the panels. 28 The panel had access to the entire obstetric history, the placental histological data and placental weight, the internal organ histology and the PCR results, in addition to the clinical course of the neonate. The major difference was the frequent diagnosis of RDS by the physicians, whereas the panels, with much more data, far more often cited the cause of death to be birth asphyxia.…”

Section: Preterm Neonatal Deathmentioning

confidence: 99%

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The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review

Goldenberg,

Saleem,

Goudar

et al. 2023

BJOG

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The PURPOSe study was a prospective, observational study conducted in India and Pakistan to determine the cause of death for stillbirths and preterm neonatal deaths, using clinical data together with minimally invasive tissue sampling (MITS) and the histologic and polymerase chain reaction (PCR) evaluation of fetal/neonatal tissues and the placenta. After evaluating all available data, an independent panel chose a maternal, a placental and a fetal/neonatal cause of death. Here, we summarise the major results. Among the most important findings were that most stillbirths were caused by fetal asphyxia, often preceded by placental malperfusion, and clinically associated with pre‐eclampsia, placental abruption and a small‐for‐gestational‐age fetus. The preterm neonatal deaths were primarily caused by birth asphyxia, followed by various infections. An important finding was that many of the preterm neonatal deaths were caused by a nosocomial infection acquired after neonatal intensive care (NICU) admission; the most common organisms were Acinetobacter baumannii, followed by Klebsiella pneumoniae, Escherichia coli/Shigella and Haemophilus influenzae. Group B streptococcus was less commonly present in the placentas or internal organs of the neonatal deaths.

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Section: Resultsmentioning

confidence: 99%

Section: Preterm Neonatal Deathmentioning

confidence: 99%

The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review

Goldenberg,

Saleem,

Goudar

et al. 2023

BJOG

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“…Similar to CHAMPS findings, WHO figures state that 75% of neonatal deaths occur in the first-week of life (82% in CHAMPS), and preterm births, perinatal asphyxia, infections, and congenital defects are recognized as being the leading causes of neonatal deaths [ 1 , 2 ]. Likewise, modeling by IHME estimates that preterm birth, encephalopathy due to birth asphyxia and trauma, and sepsis and other infections caused about three-fourths of disability adjusted life years lost among neonatal deaths in 2019 [ 23 ] and in recent publication it has been mentioned that birth asphyxia is under rated in LMICs [ 24 ]. CHAMPS methods add to existing reports by showing the full causal chain of events in newborns that lead to death, in addition to maternal factors, providing a clearer picture of the complexities involved in these deaths than studies or estimates that apply a single, underlying cause.…”

Section: Discussionmentioning

confidence: 99%

Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 –December 2021

Mahtab

Madhi²,

Baillie³

et al. 2023

PLOS Glob Public Health

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Each year, 2.4 million children die within their first month of life. Child Health and Mortality Prevention Surveillance (CHAMPS) established in 7 countries aims to generate accurate data on why such deaths occur and inform prevention strategies. Neonatal deaths that occurred between December 2016 and December 2021 were investigated with MITS within 24–72 hours of death. Testing included blood, cerebrospinal fluid and lung cultures, multi-pathogen PCR on blood, CSF, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver and brain. Data collection included clinical record review and family interview using standardized verbal autopsy. The full set of data was reviewed by local experts using a standardized process (Determination of Cause of Death) to identify all relevant conditions leading to death (causal chain), per WHO recommendations. For analysis we stratified neonatal death into 24-hours of birth, early (1-<7 days) and late (7-<28 days) neonatal deaths. We analyzed 1458 deaths, 41% occurring within 24-hours, 41% early and 18% late neonatal deaths. Leading underlying causes of death were complications of intrapartum events (31%), complications of prematurity (28%), infections (17%), respiratory disorders (11%), and congenital malformations (8%). In addition to the underlying cause, 62% of deaths had additional conditions and 14% had ≥3 other conditions in the causal chain. The most common causes considering the whole causal chain were infection (40%), prematurity (32%) and respiratory distress syndrome (28%). Common maternal conditions linked to neonatal death were maternal hypertension (10%), labour and delivery complications (8%), multiple gestation (7%), placental complications (6%) obstructed labour and chorioamnionitis (5%, each). CHAMPS’ findings showing the full causal chain of events that lead to death, in addition to maternal factors, highlights the complexities involved in each death along with the multiple opportunities for prevention. Highlighting improvements to prenatal and obstetric care and infection prevention are urgently needed in high-mortality settings.

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“…That birth asphyxia was more common than RDS as a cause of death in this population focusing on twins is consistent with our prior findings. 21,22 The much higher mortality in live-born preterm twins than in live-born singletons may be due to an increased risk of death for twins of similar gestation age or birthweight or may be due to the fact that twins are far more likely to be born preterm or have a low birthweight. In this study, although there were small differences in mortality between twins and singletons of similar birthweight and GA, that twins were far more likely to be born preterm explains most of the difference in preterm neonatal mortality between singleton and twin preterm live births.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in preterm multiple gestations: Results from a prospective study in India and Pakistan (PURPOSe)

Guruprasad¹,

Raghoji²,

Dhaded

et al. 2023

BJOG

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ObjectiveTo evaluate perinatal outcomes in preterm multiple compared with singleton pregnancies in India and Pakistan.DesignProspective, observational study.SettingsStudy hospitals in India and Pakistan.PopulationWe evaluated 3897 preterm pregnancies. These mothers gave birth to 3615 (92.8%) singleton infants, 267 (6.8%) sets of twins, 14 (0.4%) sets of triplets and one set of quadruplets.Main outcome measuresNeonatal mortality, stillbirth, cause of death.ResultsOf the singleton infants, 691 (19.1%) were stillborn and 2924 (80.9%) live born. Of the 534 infants from twin pregnancies, 41 (7.7%) were stillborn and 493 (92.3%) were live born. Of the 267 sets of twins, in 14 cases (5.2%) both were stillborn, in 13 cases (4.8%) one was stillborn and one live born, and in 240 cases (90.0%) both were live born. In both preterm twins and preterm singletons, the three most common causes of death were intrauterine hypoxia, infections acquired prior to birth and infections acquired at or after birth. The preterm twins appeared less likely to have died from intrauterine hypoxia but more likely to have died from infections acquired at or after birth. Respiratory distress syndrome (RDS) was less likely considered by the panel to be the primary cause of death in either the twins (9.6%) or singletons (9.7%). Congenital anomalies were also not often judged to be the cause of death in either the preterm twins 2 (2.4%) or singletons 27 (5.3%).ConclusionIn the PURPOSe study, neonatal mortality rates in preterm twins compared with singletons when evaluated by sex, GA, birthweight and SGA, were generally similar to rates of preterm singleton neonatal mortality in those groups. Thus, the higher rate of mortality in live‐born twin infants is related to the fact that these infants were more likely to be born earlier rather than to any inherent characteristics of the babies themselves.

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Birth asphyxia is under‐rated as a cause of preterm neonatal mortality in low‐ and middle‐income countries: A prospective, observational study from PURPOSe

Cited by 10 publications

References 34 publications

The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review

The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review

Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 –December 2021

Pregnancy outcomes in preterm multiple gestations: Results from a prospective study in India and Pakistan (PURPOSe)

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