BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter VI. Neonatal Mortality
101
intrapartum asphyxia; for those born alive
low birth weight is common and the chances
of hypoxic complications are higher than
under normal circumstances. The diagnosis
of toxemia without or with convulsions
(celampsia) was based on clinical findings
of hypertension, edema, proteinuria, and
on the statement of such diagnosis in the
records.
Neonatal death rates for toxemia as
underlying cause varied between 156.2 per
100,000 live births in Kingston-St. Andrew
and 20.1 in the California project (Table
43). In addition to the 334 neonatal deaths
from toxemia as underlying cause in all 15
projects, 94 were found in which these conditions
were assigned as associated causes
(Table 44).
Maternal Antepartum and Intrapartumn
Infection (763)
This category includes infections of the
genitourinary tract (pyelitis and pyclonephritis),
chorio-ainnionitis, and various
other infections arising during pregnancy
and childbirth,
In addition to the 133 neonatal deaths in
which these conditions were found as underlying
causes in all projects, in 207 others
they acted as associated causes, usually as
consequences of premature rupture of memebranes.
In the Chilean project, for instance,
there were 37 deaths in which antepartum
and intrapartum infections were assigned
as underlying causes and 62 in which they
were assigned as associated causes.
Relationship between Immaturity and
Maternal Conditions
The association between the maternal
conditions just discussed and immaturity is
extremely close, as can be seen in Table 43
and Figure 48, where neonatal deaths from
maternal conditions per 100,000 live births
are shown to the left and deaths with immaturity
as associated cause to the right. In
those instances in which a specific infection
(syphilis, toxoplasmosis, etc.) was found in
the neonate, the assignment was made to
the infectious disease; and if the infant was
born immature, this condition was considered
contributory and not a consequence of
the infectious disease. In other words, only
when the morbid condition was assigned to
the mother was the immaturity considered
a consequence.
Very few neonatal deaths from maternal
conditions as underlying causes occurred
after the first week of life, as can be seen
in Table 40.
W1'hen neonatal deaths due to maternal
conditions as underlying causes are distributed
by birth-weight groups, interesting
differences are observed (Table 45). Even
though a certain number of babies (lying
from these causes in the neonatal period did
not have birth weights recorded an(d the
total numbers were small, the differences in
percentages in some projects are worthy of
note. Thus, while in Monterrey 37.7 per
cent of these deaths occurred in neonates
with birth weights above 2,500 grams and
13.2 per cent occurred in tho.se weighing
1,000 grams or less, the percentages for the
California project were 10.0 and 40.0 or
almost the reverse. The explanation for
these differences is not clear. Apart from
the completeness of information on deaths
of babies of low birth weight, factors such
as quality of medical attention and incidence
of diseases such as maternal diabetes
could be responsible and these possibilities
warrant clarification, through the recording
of accurate basic data on birth weight and
on condition of the product at birth and in
succeeding days.