The Change of Perinatal Mortality Over Three Decades in a Reference Centre in the Aegean Region: Neonatal Mortality has decreased but Foetal Mortality Remains Unchanged

Yıl 2017, Cilt: 34 Sayı: 6, 553 - 558, 01.11.2017

Nilgün Kültürsay Niyazi Aşkar Demet Terek Ahmet Özgür Yeniel Özge Altun Köroğlu Mehmet Yalaz Ferda Özkınay Mete Akısü

Öz

Background: Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area. Aims: Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population. Study Design: Cross-sectional retrospective study. Methods: The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point) and 1988-1989 (2nd time point) were compared with the year 2008 (3rd time point). The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated. Results: Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades. Conclusion: Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for high risk pregnancies are needed.

Anahtar Kelimeler

Perinatal mortality, neonatal mortality, foetal mortality, premature birth

Kaynakça

• 1. World Health Organization. Neonatal and Perinatal Mortality: Country, Regional and Global Estimates, 2006.
• 2. King JF, Warren RA. The role of reviews of perinatal dieaths. Semin Fetal Neonatal Med 2006;11:79-87.
• 3. Zacharias N. Perinatal mortality. https://www.update.com/contents/ perinatal-mortality
• 4. MacDorman MF, Gregory ECW. Fetal and Perinatal Mortality: United States, 2013. National Vital Statistics Reports, Vol. 64, No. 8, 2015 https:// www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr6408.pdf
• 5. The UN Inter-agency Group for Child Mortality Estimation: Levels & Trends in Child Mortality: Report 2014. New York: UNICEF; 2014.
• 6. Wardlaw T, You D, Hug L, Amouzou A, Newby H. UNICEF Report: enormous progress in child survival but greater focus on newborns urgently needed. Reprod Health 2014;11:82.
• 7. Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 2011;16;377:1319-30.
• 8. Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L. Diagnosis of neonatal sepsis: A clinical and laboratory challenge. Clin Chem 2004;50:279-87.
• 9. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update. Neonatology 2010;97:402-17.
• 10. MacLennan A. A template for defining a casual relation between acute intrapartum events and cerebral palsy. İnternational consensus statement. BMJ 1999;319:1054-9.
• 11. Hey EN, Lloyd DJ, Wigglesworth JS. Classifying perinatal death: fetal and neonatal factors. Br J Obstet Gynaecol 1986;93:1213-23.
• 12. Erdem G, Önderoğlu L, Yurdakök M. Hacettepe Üniversitesi Hastanesi’nde 1994 yılı perinatal mortalite ve morbiditesi. Çocuk Sağlığı ve Hastalıkları Dergisi 1996;39:703-13.
• 13. Korkmaz A, Akçören Z, Alanay Y, Özyüncü Ö, Yiğit Ş, Deren Ö, ve ark. Perinatal mortality analysis from 2001-2006 at Hacettepe University Hospital. Çocuk Sağlığı ve Hastalıkları Dergisi 2010;53:175-88.
• 14. Aygün C, Tosum M, Aydın O, Tanyeri B, Oğur G, Çetinkaya M, et al. Perinatal Mortality in Ondokuz Mayıs University Faculty of Medicine Between 2004-2006. OMÜ Tıp Dergisi 2007;24:131-6.
• 15. Ecevit A, Oguz SS, Tarcan A, Yazici C, Dilmen U. The changing pattern of perinatal mortality and causes of death in central Anatolian region of Turkey. J Matern Fetal Neonatal Med 2012;25:1738-41.
• 16. Hacettepe University Perinatal Mortality Study Group. Perinatal Mortality in 1998 in Hacettepe University. Çocuk Sağlığı ve Hastalıkları Dergisi 1999;42:315-27.
• 17. Perinatal Mortality Study Group. Perinatal mortality rate: hospital based study during 1998-2001 at Hacettepe University. J Perinat Med 2003;31:435-40.
• 18. Akman İ, İmir G, Özek E, Ceyhan N. Perinatal and neonatal mortality rates and causes of death at Marmara University Hospital. Marmara Med J 2001;14:169-72.