EFFECT OF IMPROVED
PERINATAL CARE ON NEONATAL MORTALITY: A MULTINATIONAL EXPERIENCE
Vidyasagar,
D
University
of Illinois at Chicago Medical Center, Chicago, Illinois, USA
Globally infant
mortality (IMR) is a major cause of all deaths. Further, out of 11 Million deaths in children under 5
years in the developing countries, 5 Million were due to neonatal and
perinatal causes. A comparison
of industrialized (INDUST), developing (DEV) least developed countries
(LDEV) during 1960-1996 (WHO: 1998) are given below. During these 15 years significant
reduction
|
|
1960
|
1996
|
|
|
|
IMR/1000 LB
|
IMR/1000 LB
|
Reductions %
|
|
INDUST.
DEV.
L.DEV.
|
31
137
171
|
6
66
109
|
75%
50%
30%
|
|
WORLD
|
123
|
60
|
50%
|
(75%) was seen in Indust. countries
and in DEV. Countries (50%) but only 30% in Least Dev. countries. Reduction
in IMR in dev. countries was mainly due to large reduction in neonatal and
perinatal mortality. Programs
that made a major impact on reduction in NMR/PMR are; improved, 1) access
to perinatal care; 2) perinatal surveillance and 3) neonatal care. There is ample data to support that
access to perinatal care through
regionalization improves neonatal outcome. It assures care to all high
risk mothers and infants at a specialized tertiary care center (level
III). Fetal surveillance,
perinatal interventions, management of preterm labor and antenatal steroid
therapy are some of the major advances in perinatal care. These approaches have lead to
delivery of ¡°Better Babies.¡±
In one study 30% of improvement in NMR was ascribed to delivery of
¡°Better Babies.¡± Finally,
improved care of the preterm and term newborn infant: (better
resuscitation, surfactant therapy, and ventilator care) have all
significantly reduced NMR.
Whereas the industrialized countries have enjoyed the benefits of
these advances since the 1970¡¯s, the developing countries are showing
progress within the last decade, by adopting the Regionalization concept
(Poland, Lithuania, India).
Maternal & Child Health Programs in least developed countries have serious deficiencies. A programmatic approach to
regionalize perinatal services may be a solution to improve perinatal
outcomes.