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Perinatal mortality related to low birth weight

Ariadne Malarnitsi-Puchner Department of Neonatology Uniuersity and Stare Hospital ‘Alexandra : Athens, Greece

Low birth weight (< 2500 gl is the major con- tributor to perinatal mortality. We compared the data concerning fetal, neonatal and perinatal mortality in two perinatal centers and a network of hospitals providing also level III perinatal care. These centers are: (A) The Medical Center Hos- pital, San Antonio, Texas, and the survey refers to the years 1978-1982. (B) The University of Illinois, Perinatal Network Hospitals and the sur- vey refers to the years 1982-1984; and (C) The ‘Alexandra’ University and State Hospital, Athens, Greece, and the survey refers to the years 1987-1989 (Table I>. Center C has the highest mortality rates although the study refers to much more recent years than in the other two centers. The reasons for the high mortality rate in the Alexandra Hospital are the following: (1) The low socioeconomic level of the population the Hospital cares for. Destitute Greeks, gypsies and refugees from Eastern Europe, Middle East and Asia deliver almost exclusively in the ‘Alexandra’ Hospital. (21 Lack of prenatal care. The forementioned population groups very rarely seek prenatal care, which has been recognized as one of the most important parameters for lowering perinatal mor- tality. Thus these groups presented many compli- cations of pregnancy and the higher percentage of fetal deaths. (3) No resuscitation and no intensive care pro- vided to infants < 25-26 gestational weeks. It is a fact that no precise definition of infant viability in relation to gestational age exists. In the ‘Alexandra’ Hospital terminated pregnancies un- der 26 and more recently under 25 weeks were considered in the rule as abortions. (4) Timidity in the performance of cesarean sec- tions for estimated very low and extremely low birth weight infants, even for breech presenta-

tions. In the ‘Alexandra’ Hospital perinatal as- phyxia and intracranial hemorrhage were in 86% of cases the cause of death of very low and extremely low birth weight infants delivered in the rule by the vaginal route. (5) Perinatal infections. Septicemia caused mainly by gram-negative (E. coli etc.) but also gram-posi- tive bacteria (Staphylococcus aureus and epider- midis) accounts also for the high mortality rates even for infants weighing more than 1500 g. (6) Insufficient nursing personnel and monitoring devices in the neonatal intensive care unit. Thus preventable complications of mechanical ventila- tion aggrevate the impaired health of many low birth weight infants and lead them often to death. The proportion of nursing personnel to patients

TABLE I

Fetal, neonatal and perinatal mortality (%) in three level If1

care centers related to BW

500-1000 g 1001-1500 g 1501-2000 g 200-2500 g

Fetal A 30.27 13.23 6.49 1.48 B 21.85 10.28 4.47 1.90

C 38.22 19.70 11.74 4.92

Neonatal A 64.29 17.37 5.10 1.44

B 57.81 14.69 4.11 1.22

c 64.95 19.50 8.26 2.07

Perinatal A 75.10 28.31 11.26 2.89

B 67.03 23.47 8.41 3.10

C 78.34 35.35 19.03 6.89

A: Medical Center Hospital, San Antonio, Texas (1978-1982).

B: University of Illinois Perinatal Network Hospitals (1982-

1984).

C: ‘Alexandra’ State & University Hospital, Athens (1987-

1989).

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in the ‘Alexandra’ NICU is only exceptionally 1: 1, rarely 1: 2, usually 1: 3 and in the nights 1: 5. Monitoring devices are not as many as they should be in the NICU, and neonates in the intermediate care are not monitored. (7) Finally, medical assistance for neonates with surgical or cardiovascular problems is not possi- ble in the same hospital and neonates have to be transferred to other hospitals.

We believe that amelioration of many of the above-mentioned conditions will significantly re-

duce the high perinatal mortality rate in the ‘Alexandra’ Hospital.

References

1 Brans YW, Escobedo MB, Hayashi RH, Huff RW, Kagan- Hallet KS, Ramamurthy RS. Perinatal mortality in a large perinatal center: five-year review of 31000 births. Am J Obstet Gynecol 1984;148:284-289.

2 Vasa R, Vidyasagar D, Winegar A, Peterson P, Spellacy WN. Perinatal factors influencing the outcome of 501- to 1000-g newborns. Clin Perinatol 1986;13:267-284.