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Changing patterns of perinatal death, 1982-2000: a retrospective cohort study

Lookup NU author(s): Dr Ruth Bell, Dr Svetlana Glinyanaya, Professor Judith Rankin, Dr Christopher Wright, Professor Mark Pearce, Professor Louise Parker

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Abstract

OBJECTIVE: To describe trends in cause specific stillbirth and neonatal mortality. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 686,860 births in 1982-2000, to mothers resident in the Northern Region of England. MAIN OUTCOME MEASURES: Cause specific stillbirth and neonatal mortality; rate ratios (RR) and 95% confidence intervals (CI) in 1991-2000 compared with 1982-1990. RESULTS: In singletons, rates of stillbirth and neonatal mortality declined over time (RR stillbirths, 0.81 (95% CI 0.76 to 0.87); RR neonatal mortality, 0.76 (95% CI 0.70 to 0.82)). Death from congenital anomalies declined substantially for both stillbirths (RR 0.52; 95% CI 0.40 to 0.68) and neonatal mortality (RR 0.58; 95% CI 0.51 to 0.67). Mortality due to intrapartum hypoxia also fell, by nearly 50% for stillbirths and 30% for neonatal deaths. There was no reduction in stillbirths due to antepartum hypoxia in babies weighing > or = 2500 g, or in mortality attributed to infection. In multiples, the risk of death was higher (RR stillbirths, 4.13 (95% CI 3.68 to 4.64); RR neonatal death, 7.82 (95% CI 7.13 to 8.58)). Stillbirth rates declined significantly (RR 0.71; 95% CI 0.57 to 0.89) but neonatal mortality did not (RR 0.91; 95% CI 0.77 to 1.08). There was no reduction in neonatal mortality resulting from prematurity, or in mortality from congenital anomalies. CONCLUSIONS: There is considerable overlap in the causes of stillbirth and neonatal mortality. Future progress in reducing perinatal mortality requires better understanding of the aetiology of antepartum stillbirth, of the excess risks of prematurity facing multiple births, particularly in the light of their increasing incidence, and of strategies to prevent perinatal infection.


Publication metadata

Author(s): Bell R, Glinianaia SV, Rankin J, Wright C, Pearce MS, Parker L

Publication type: Article

Publication status: Published

Journal: Archives of Disease in Childhood: Fetal & Neonatal Edition

Year: 2004

Volume: 89

Issue: 6

Pages: F531-F536

Print publication date: 01/11/2004

ISSN (print): 1359-2998

ISSN (electronic): 1468-2052

Publisher: BMJ Group

URL: http://dx.doi.org/10.1136/adc.2003.038414

DOI: 10.1136/adc.2003.038414

PubMed id: 15499149


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