BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter VI
Neonatal Mortality
The neonatal age period encompasses the which in turn is determined by the infant's
first 28 days of life and thus includes the state of health and maturity, measured by
postnatal component (first seven days of the degree of growth and development at
life) of the perinatal period (which extends birth. A state of increased vulnerability
from the 28th week of gestation through the (i.e., low birth weight) may have been the
first week after birth). The context of neo- result of an abnormal maternal condition
natal morbidity and mortality is therefore during pregnancy or delivery, ani therehighly
complex, involving the action of fore such relationships should be estabmultiple
factors that may go back into preg- lished. On the other hand, infections, which
nancy and even earlier and have health im- commonly occur under unfavorable environplications
extending beyond the neonatal mental conditions, can develop during the
period, often through a lifetime,
prenatal period (or during delivery) by any
The health status of the mother before of the well-known mechanisms of intrauand
during pregnancy, as well as the risks terine infection.
of labor and delivery, are important de- The quality of information on causes of
terminants of the condition of the product neonatal deaths, particularly in relation to
of conception. Though normality is the the so-called "certain causes of perinatal
rule in the course of pregnancy and child- mortality," depends in large part on the
birth, the opportunities for hazards are nu- proportion of births occurring in hospitals
merous and varied. The intricacy of the and on the completeness of clinical records,
interrelationships of the mother's health which should include data on weight and
and that of the fetus or infant makes it condition of the infant at birth. Moreover,
necessary to adopt the multiple-cause ap- as was pointed out in Chapter II, failure
proach to the study of mortality, so as to to include all deaths in the first days of
establish the links between morbid condi- life may seriously interfere with measure­
tions in the mother and their effect on the ment of neonatal mortality and tile deternewborn,
and similarly, between complica- mination of its causes.
tions of delivery and their effects.
The proportions of infants dying in the
The role of external environment be- neonatal period anti known to have been
comes increasingly important and direct born in hospitals are shown in Table 37
from the moment of birth. The effect of and Figure 42. In six of the 15 projects
ecological factors on the newborn depends more than 90 per cent of deceased neonates
on the degree of vulnerability of the infant, had been born in hospitals, and in four
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