Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway.
Neonatology. 2011;99(4):250-7. doi: 10.1159/000320332. Epub 2010 Nov 18.
The global neonatal mortality of 28/1,000 live births is unacceptably high. Furthermore, the huge difference in mortality between high- and low-income countries and regions is presently one of the most burning human rights issues. The decline in neonatal mortality has been slow and is a main reason the Millennium Development Goal 4 does not seem to have been reached.
Several countries have shown it is possible to reduce neonatal mortality quickly and dramatically without much cost.
It is important to learn from the successful countries and focus on the 3-4 major causes of neonatal death: asphyxia, infection, low birth weight/prematurity and congenital malformations.
A reasonable short-term goal is to reduce global neonatal mortality to 15/1,000 which can be achieved without introduction of high technology medicine. A further reduction of mortality to 5/1,000 should be the next global goal. Reaching this would reduce the present 3.8 million annual deaths by 3 million. In order to do this, regionalization of health care should be implemented. Maternal health should be the focus, with free antenatal care and centralized deliveries with health personnel attending the birth. Education of girls is perhaps the best way to prevent perinatal and neonatal deaths. Ten simple recommendations are given to reduce neonatal mortality. One of these is that each newborn baby in the world should have free access to essential drugs.
It is possible to reduce newborn mortality in all countries and regions. Most important to achieve these goals is, however, political will.
全球每千例活产儿的新生儿死亡率为 28，这一数值高得令人无法接受。此外，高收入和低收入国家及地区之间死亡率的巨大差异目前是最紧迫的人权问题之一。新生儿死亡率的下降速度缓慢，是千年发展目标 4 似乎无法实现的主要原因之一。
有几个国家已经证明，在不增加太多成本的情况下，快速而显著地降低新生儿死亡率是可能的。
重要的是要从成功的国家中吸取经验教训，并将重点放在导致新生儿死亡的 3-4 个主要原因上：窒息、感染、低出生体重/早产和先天性畸形。
一个合理的短期目标是将全球新生儿死亡率降低到 15/1000，而无需引入高科技医学。进一步将死亡率降低到 5/1000 应该是下一个全球目标。这将使目前每年 380 万例死亡人数减少 300 万。为此，应实施医疗保健的区域化。孕产妇保健应是重点，提供免费产前护理，并由卫生人员集中分娩。对女孩进行教育可能是预防围产期和新生儿死亡的最佳途径。文中提出了 10 条降低新生儿死亡率的建议。其中之一是，世界上每一个新生儿都应该能够免费获得基本药物。
所有国家和地区都有可能降低新生儿死亡率。然而，实现这些目标最重要的是政治意愿。
