No Cry at Birth: Global Estimates of Intrapartum Stillbirths and Intrapartum-Related Neonatal Deaths
Joy E. Lawn, Kenji Shibuya. Saving Newborn Lives, Save the Children, USA, Washington, DC; International Perinatal Care Unit, Institute of Child Health, London, United Kingdom; Cape Town, South Africa; World Health Organization, Geneva, Switzerland.
BACKGROUND: Of 4 million annual neonatal deaths, < 3% occur in countries with complete vital registration (VR). Reducing neonatal deaths is essential to meet the Millennium Development Goal-4 for child survival. Lack of cause-specific information limits action. Estimates of asphyxia-related neonatal deaths vary from 0.7 to 1.2 million with no published methods. Estimates for intrapartum stillbirths are not available.
OBJECTIVE: To estimate for the year 2000 the numbers of intrapartum stillbirths and neonatal deaths related to acute intrapartum events.
DESIGN/METHODS: For intrapartum-related neonatal deaths data inputs included a new analysis of vital registration (VR) data from countries with full (>90%) coverage (48 countries, N=97,297) and literature identified from systematic searches (>4000 abstracts) and meeting inclusion criteria (46 populations, 30 countries, N=12,355). For countries with full VR data, the reported numbers of intrapartum-related neonatal deaths were used. For the remaining countries a multiple regression model was fitted to the VR and literature cause-specific proportionate mortality data. Predicted cause-specific proportions were applied to the WHO estimated number of neonatal deaths by country, and these estimates summed to a global total. Intrapartum stillbirths were estimated using median cause-specific mortality rate by country from published and unpublished datasets meeting inclusion criteria (73 populations, 52 countries, N=46,779) or the subregional median in the absence of country data.
RESULTS: Intrapartum-related neonatal deaths were estimated at 0.94 million [uncertainty 0.66 to 1.17], 23% of the global total of 4 million neonatal deaths. Country level predictions agreed well with unpublished, population-based data for 4 countries. An estimated 1.02 million intrapartum stillbirths [0.66 to 1.48 million] occur annually comprising 26% of estimated global stillbirths.
CONCLUSIONS: Intrapartum-related stillbirths and neonatal deaths are a huge and often invisible problem. 99% of these deaths are in low/middle income countries. Lack of data and consistency in case definitions complicates measurement.
PAS 2005: 57: 2411
Tuesday, May 17, 2005 10:45 am, Washington Convention Center - Room 207 A
Platform Session: Global Perspectives on Birth Asphyxia, Part II (10:30 AM - 12:30 PM)
Course Number: 7350