Perinatal Care Project, Bangladesh Diabetic Samity, BIRDEM, 122 Kazi Nazrul Islam Ave, Shahbagh, Dhaka-1000, Bangladesh.
Pediatrics. 2011 May;127(5):e1182-90. doi: 10.1542/peds.2010-0842. Epub 2011 Apr 18.
Using a low-cost community surveillance system, we aimed to estimate intrapartum stillbirth and intrapartum-related neonatal death rates for a low-income community setting.
From 2005 to 2008, information on all deliveries in 18 unions of 3 districts of Bangladesh was ascertained by using traditional birth attendants as key informants. Outcomes were measured using a structured interview with families 6 weeks after delivery.
We ascertained information on 31 967 deliveries, of which 26 173 (82%) occurred at home. For home deliveries, the mean cluster-adjusted stillbirth rate was 26 (95% confidence interval [CI[: 24-28) per 1000 births, and the perinatal mortality rate was 51 per 1000 births (95% CI: 47-55). The NMR was 33 per 1000 live births (95% CI: 30-37). There were 3186 (12.5%) home-born infants who did not breathe immediately. Of these, 53% underwent some form of resuscitation. Of 1435 infants who were in poor condition at 5 minutes (5% of all deliveries), 286 (20%) died; 35% of all causes of neonatal mortality. Of 201 fresh stillbirths, 40 (14%) of the infants had major congenital abnormalities. Our estimate of the intrapartum-related crude mortality rate among home-born infants is 17 in 1000 (95% CI: 16-19), 6 in 1000 stillborn and 11 in 1000 neonatal deaths after difficulties at birth.
Difficulty initiating respiration among infants born at home in rural Bangladesh is common, and resuscitation is frequently attempted. Newborns who remain in poor condition at 5 minutes have a 20% mortality rate. Evaluation of resuscitation methods, early intervention trials including antibiotic regimes, and follow-up studies of survivors of community-based resuscitation are needed.
利用低成本的社区监测系统，我们旨在为低收入社区环境估算分娩期死胎和与分娩相关的新生儿死亡率。
从 2005 年到 2008 年，通过传统的接生员作为主要信息提供者，在孟加拉国的 3 个区 18 个联盟中确定所有分娩的信息。结果通过在分娩后 6 周与家庭进行结构化访谈来测量。
我们确定了 31967 次分娩的信息，其中 26173 次（82%）在家中进行。对于家庭分娩，经过聚类调整的平均死胎率为 26（95%置信区间[CI]：24-28）/每 1000 例活产，围产期死亡率为 51/每 1000 例活产（95%CI：47-55）。新生儿死亡率为 33/每 1000 例活产（95%CI：30-37）。有 3186 名（12.5%）在家中出生的婴儿没有立即呼吸。其中，53%接受了某种形式的复苏。在 5 分钟时状况不佳的 1435 名婴儿中，有 286 名（20%）死亡；占所有新生儿死亡的 35%。在 201 例新鲜死胎中，有 40 例（14%）婴儿有重大先天性异常。我们对在家中分娩的婴儿中与分娩相关的粗死亡率的估计为每 1000 例 17（95%CI：16-19），每 1000 例死产 6 例，每 1000 例新生儿死亡 11 例，这些婴儿在分娩时出现困难。
在孟加拉国农村地区在家中分娩的婴儿中，呼吸开始困难很常见，并且经常尝试复苏。在 5 分钟时仍状况不佳的新生儿死亡率为 20%。需要评估复苏方法，包括抗生素方案的早期干预试验，以及对社区复苏后幸存者的随访研究。
