Dr. Long Chelsea98.com Huizhou Education_Millions of Dragons Health
Editor-in-chief summary: This article begins with a brief description of the overview and status quo of neonatal deaths in the "Top Ten Killers in the World", analyzes the causes of neonatal deaths, and presents the situation in China, the United States and Canada, where the Chinese population is the most. Finally, through in-depth research, the author made a professional explanation on how to avoid neonatal death strategies, peeling onions layer by layer. Enjoy your reading! If you have any questions, please contact Chelsea98.com.
The newborn is the starting point of a new life. According to UNICEF, an estimated 392,000 "New Year babies" will be born on January 1, 2020. The estimate of the number of babies born on January 1, 2020 draws on data from the latest revision of the UN's 2019 World Population Outlook report. Based on these data, the World Data Lab used a specific algorithm to predict the number of births per day in each country. The countries with the largest number of births on the first three New Years’ days are: 1. India—67,385; 2. China—46,299; 3. Nigeria—26,039. There are 10,452 "New Year babies" in the United States, and 1,004 "New Year babies" in Canada.
In 2020, so far, the total number of newborns worldwide is 143 million. However, the first day of life of a newborn is the most dangerous time for both pregnant women and babies, and the neonatal period (the first month after birth) is a critical period for child survival. From birth to 15th birthday, the neonatal period has the greatest risk of death. Among the deaths of children under 15 years of age, about 40% occurred within the first month after birth. At present, more than 300,000 women die from pregnancy and childbirth worldwide each year, and 2.7 million newborns die within 28 days after birth (that is, about 7,000 newborns die every day, of which about 100 die on the first day of life. Million, the death toll in the next 6 days is close to 1 million), and 2.6 million babies are still born.
The top three countries with the highest neonatal mortality:
1. Pakistan: 1/22
2. Central African Republic: 1/24
3. Afghanistan: 1/25
The top three countries with the lowest neonatal mortality rate:
1. Japan: 1/1111
2. Iceland: 1/1000
3. Singapore: 1/909
World Health Organization spokesperson Ian Askew pointed out at a press conference in Geneva on August 16, 2020 that official reports generally underestimate the number of maternal and child deaths by as much as 30% globally, and as high as 30% in some countries. 70%. The report shows that globally, in low-income countries, the average neonatal mortality rate is 27‰. In high-income countries, this ratio is only 3‰. The mortality rate of newborns born in the most dangerous areas is 50 times higher than in the safest areas. This situation is not conducive to understanding the causes of these deaths and effective prevention. Progress in reducing neonatal mortality is slower than progress in reducing mortality among older children. Therefore, the number of neonatal deaths has increased as a proportion of the total number of deaths of children under 5 years of age.
In February 2018, UNICEF launched the "Every Child ALIVE" global campaign, which aims to call for the introduction and implementation of effective measures for newborns around the world. Through this activity, UNICEF urgently appeals to governments, health care service providers, donors, the private sector, families and businesses to ensure the survival and healthy growth of newborns through the following methods.
Analysis of the causes of neonatal death
Using the perinatal mortality rate (perinatal mortality rate, PMR) can assess pregnancy outcome and monitor the quality of care during the perinatal period (fetal period and neonatal period). PMR includes fetal mortality in late pregnancy and early neonatal mortality (neonatal mortality rate, NMR).
The use of standard terminology facilitates the comparison of PMR in various countries. A 2016 clinical report of the American Academy of Pediatrics (American Academy of Pediatrics, AAP) Fetal and Neonatal Committee established standard terms for fetal death, infant death, and perinatal death, based on WHO and the CDC National Center for Health Statistics ( National Center for Health Statistics, NCHS) established standards.
Live birth — Live birth is defined as a human pregnancy product that is completely delivered or taken out of the mother's body and shows vital signs (ie, heartbeat, umbilical cord pulsation, respiratory muscle or voluntary muscle movement), regardless of the length of pregnancy, whether the umbilical cord has been broken, or whether the placenta is still attached In the uterus. Heartbeat should be distinguished from transient heart contractions, and breathing should be distinguished from brief breathing effort or gasping.
Fetal death (stillbirth) — Fetus is defined as the fetus that exists in the uterus from a few weeks to full term after intrauterine conception. Fetal death occurs before it is completely delivered or removed from the mother, regardless of the length of pregnancy, except for induction of labor. The absence of any vital signs after delivery (such as heartbeat, umbilical cord pulsation, respiratory muscles or voluntary muscle movements) indicates that the fetus has died. Heartbeat should be distinguished from transient cardiac contractions, and breathing should be distinguished from brief breathing effort or gasping.
NCHS records fetal deaths that occur at gestational age ≥ 20 weeks, also known as "stillbirth". For statistical purposes, NCHS further subdivides stillbirths into "early" (gestational age 20-27 weeks) or "late" (gestational age ≥ 28 weeks). The WHO limits stillbirth to fetal death at 28 weeks of pregnancy and beyond. Any fetal death before 20 weeks of gestation is classified as abortion.
World Health Organization spokesperson Ian Askew said: “Stillbirths and neonatal deaths may be caused by complications during childbirth and may be related to mothers’ infections, especially infections in pregnant women with diabetes and high blood pressure. It may be due to the problem of the fetus itself. But because there is no record of newborn deaths, it is difficult to know what caused the death, and the lack of such records makes it difficult for countries to know how to prevent it."
one of the reasons:
Premature delivery (referring to delivery between 28 weeks of gestation and less than 37 weeks of pregnancy), birth-related complications (birth suffocation or no breathing at birth), sepsis and other infections and birth defects (that is, "congenital malformations" in popular terms, refers to Abnormalities in body structure, function or metabolism that occur before the baby is born are the cause of most newborn deaths. The main causes of neonatal death in developing countries include: infectious diseases, birth asphyxia, birth defects, sequelae related to preterm birth, intrauterine growth restriction, etc.; in China, infection, birth defects, respiratory distress syndrome, neonatal asphyxia and Pulmonary hemorrhage is the main cause of neonatal death.
From the end of the newborn period to the age of 5, the main causes of death were pneumonia, diarrhea, birth defects and malaria. Maternal and infant malnutrition (including overnutrition) is a potential contributing factor that makes newborns more susceptible to serious diseases. The vast majority of neonatal deaths occur in low- and middle-income countries.
Sudden infant death syndrome (Sudden infant death syndrome, SIDS) (related information provided by Canadian Children's Hospital). SIDS refers to the sudden and unexpected death of infants less than one year old, and the cause cannot be found after a thorough autopsy and research. SIDS is sometimes referred to as "cradle death" because many SIDS infant patients die in the cradle. However, it has not been found that the cause of sudden infant death syndrome is the crib.
In the mid-1990s, international and national advocacy organizations recommended that parents let their babies sleep on their backs, thereby reducing the chance of SIDS by 50%. The chance of SIDS is very low when the baby is born, but it rises rapidly after the baby is one month old. Babies who die due to SIDS are usually only 2-4 months old. All SIDS deaths of 90% occurred when the baby was 6 months old. Boys are more likely to suffer from SIDS than girls.
In the first few days of birth and the first few days after birth, the lack of skilled nursing and treatment of related diseases is obviously related; the death of newborns in the first 28 days of life is significantly related to the lack of quality care in the newborn period. Women who receive continuous care provided by professional midwives who understand and comply with international standards will have a lower probability of losing a baby by 16% and a lower probability of preterm birth by 24%.
Continuous care of newborns includes: standardization and proficiency of a series of actions such as light, noise, vibration, dermatitis, eczema, sleep, exercise, spitting up, hiccups, nasal congestion, bathing, umbilical cord care, diaper changing, etc.
In developing countries, nearly half of mothers and newborns do not receive skilled care during and immediately after delivery. If known and effective hygiene measures can be provided during delivery and during the first week of life, it is possible to prevent nearly two-thirds of newborn deaths. The vast majority of neonatal deaths occur in developing countries where access to health care services is low. Most of these newborns died at home due to lack of skilled care. Skilled care can greatly improve their chances of survival.
Let's take a look at the newborn situation in China, the United States, and Canada.
According to the "Report on the Development of China's Maternal and Child Health Career (2019)": Before 1949, the capacity of maternal and child health services was lacking, the vast rural and remote areas lacked medical care and medicine, the maternal mortality rate was as high as 1500/100,000, and the infant mortality rate was as high as 200. ‰, the average life expectancy is only 35 years. After 1949, by 2018, the national maternal mortality rate dropped to 18.3 per 100,000, the infant mortality rate dropped to 6.1‰, and the average life expectancy reached 77.0 years, which was better than the average level of middle- and high-income countries. The neonatal mortality rate, infant mortality rate and mortality rate of children under 5 years of age decreased from 33.1‰, 50.2‰, and 61.0‰ in 1991 to 3.9‰, 6.1‰, and 8.4‰ in 2018, respectively, a decrease of 88.2% and 87.81 respectively. TP1T and 86.2%.
The gap between urban and rural areas has narrowed significantly. In 2018, the mortality rate of children under 5 in rural and urban areas was 10.2‰ and 4.4‰, respectively, a decrease of 85.7% and 78.9% from 1991. In 1991, the ratio of the mortality rate of children under 5 in urban and rural areas was 1:3.4, and in 2018 it was reduced to 1:2.3. The regional gap continues to narrow. In 2018, the mortality rate of children under 5 years old in the eastern, central and western regions was 4.2‰, 7.2‰ and 12.7‰, respectively, which were 87.5%, 89.1% and 87.3% lower than in 1991. The difference in mortality among children under 5 in the east and west has narrowed from 66.5‰ in 1991 to 8.5‰ in 2018.
The United Nations Millennium Development Goals require that by 2015, the mortality rate of children under 5 years old should be reduced by two-thirds from 1990. China achieved this goal eight years ahead of schedule in 2007. The decline in the mortality rate of children under 5 years of age has made an important contribution to the increase in life expectancy per capita in my country. According to estimates, among the 4.9 years of life expectancy increase in China between 2000 and 2015, 23.51 TP1T was attributed to the decline in under-five mortality.
At present, the main causes of neonatal death in China are pneumonia, birth injury asphyxia, congenital malformations and premature delivery. The imbalance in the sex ratio of infants and young children in China is due to the low mortality rate of 0-year-old boys and the high mortality rate of 0-year-old girls. Whether in cities, towns and villages, it is surprisingly consistent that the mortality rate of female infants is higher than that of male infants. The use of B-ultrasound in private clinics, or the abuse of B-ultrasound by medical staff in some public hospitals, has resulted in more girls than boys in abortion. But whether this data will be counted in the neonatal mortality rate, we do not know. However, miscarriage can lead to an increase in neonatal mortality after a woman becomes pregnant again. Because the first child has undergone an artificial abortion, it is prone to insufficiency of the cervix after the second pregnancy, causing premature or late abortion. Studies have shown that women who have had an artificial abortion before have significantly higher rates of threatened abortion and spontaneous abortion than normal people. Other problems include fetal mortality, neonatal hemolysis and so on. In 2018, the National Health Commission issued the "Regulations on Contraceptive Services after Induced Abortion (2018 Edition)". The National Health Commission introduced: In recent years, the number of abortions in China has been large, with more than 9 million cases per year.
A latest report on neonatal mortality provided by Save the Children in the United States shows that the neonatal mortality rate in the United States remains high (7.07‰). Approximately 11,300 babies die on the day of birth each year, which is more than the sum of other industrial countries. 50%. The US ranks behind 68 other countries, including Mexico, Saudi Arabia and Kuwait.
Among the 186 countries ranked, Somalia has the highest first-day mortality rate for newborns. 18 out of 1,000 babies die on the day of birth. The countries with the lowest mortality rates are Luxembourg, Singapore, and Sweden, with only 0.5 babies died on the day of birth. In the United States, the first-day mortality rate for newborns is 2.6 per 1,000.
In 2018, a study by the PLoS Medicine in the United States reported that for every 5,000 babies born at term, 11 babies died before their first birthday. Studies have shown that the mortality rate of full-term infants varies from state to state, but all states have a higher mortality rate than many European countries. Previous studies have found that babies are more likely to die in the United States than in other developed and wealthy countries, but the current study provides new evidence, even for babies who should have a high survival rate at full-term birth. The same is true, and throughout the United States, the infant mortality rate for full-term births is 50% to 200% higher than Austria, Denmark, Finland, Norway, Sweden and Switzerland.
One of the authors of the study, Neha Bairoliya of the Center for Population and Development Studies of Harvard University in Cambridge, Massachusetts, said that the two main reasons for the high infant mortality rate in the United States are: congenital malformations, in addition to ensuring that it is carried out during pregnancy. In addition to adequate screening, parents have no other effective methods; the risk of sudden infant death is high, and such accidents are mainly prevented through appropriate sleep arrangements. Overall, more than 7,000 full-term infants die each year in the United States. Researchers predict that if all states can minimize the death rate of these two causes of death, the country's infant mortality rate may be reduced by about 4,000 people. According to this research analysis, the mortality rate of full-term infants in every state in the United States is higher than that of the above-mentioned six European countries. About 6 out of 5,000 full-term newborns in these countries die.
Researchers found that birth defects or congenital malformations accounted for 31% of infant deaths in the United States, so-called perinatal complications or medical problems that occurred shortly after birth accounted for 13%. The biggest cause is Sudden Infant Death (SUID), which includes sleep-related deaths, accounting for 43% of infant deaths.
Niha said via email: “Although we don’t have data on actual sleep arrangements, other data shows that a large number of babies are still sleeping on their parents’ stomachs. We have also found that a large number of babies have died of suffocation, which indicates that parents are not safe to use. It’s safest to sleep in an adult’s bed.” According to a report from the American Academy of Pediatrics, it’s safest for babies to sleep in their own crib, and there should be no pillows, toys, blankets or other loose bedding around. . If the baby sleeps on the parent’s bed, the parent should use a firm mattress, remove soft objects such as pillows, and move the bed away from the wall.
In the United States, Sudden Infant Death Syndrome (SIDS) is still the main cause of the death of babies more than one month old. Black babies and Indian babies are one to two times more likely to develop SIDS than other babies. SIDS is more likely to cause SIDS in winter than in summer. Premature babies, babies with low birth weight, and babies born to underage mothers are more likely to develop SIDS.
"Daily Health" senior writer, Rachel Leitner wrote the analysis reason: the high premature birth rate is an important reason for the high neonatal mortality in this country. The United States has the highest rate of premature births among industrialized countries, with 1 in 8 newborns being premature babies, which is twice the rate in countries such as Finland, Japan, Norway and Sweden. Save the Children stated that 35% neonatal deaths across the United States were caused by complications of premature birth. The report shows that premature babies (or babies whose gestation period is less than 37 weeks) generally face the risk of death caused by factors such as loss of body temperature, inability to take in sufficient nutrients, difficulty breathing, and vulnerability to infection. Another important factor that affects neonatal mortality and also affects the premature birth rate is the excessively high teenage birth rate in the United States.
In the United States, teenage mothers have worse financial conditions, lower education levels, and fewer prenatal care than older mothers. The report points out that these factors, in turn, will lead to an increase in the rate of premature birth and premature mortality. Save the Children stated that despite the decline in teenage birth rates in recent years, the United States still has the highest rate of premature birth among industrialized countries.
According to a report from Children First Canada and O'Brien Public Health Agency: From high infant mortality to alarming statistics about abuse, the physical and mental health of Canadian children is very worrying . The report examines Canadian child mortality, physical and mental health, and social determinants of health, such as poverty, food insecurity and abuse. The report is based on data from various organizations such as Statistics Canada, the Canadian Institute of Health Information Research and Health Canada.
"Wikipedia·World Infant Mortality List" shows that Canada's infant mortality rate is 5.30‰, which is lower than China and the United States. The reports of Children First Canada and O'Brien Public Health Agency show that the infant mortality rate is 4.2‰. The report found that Canada has one of the highest infant mortality rates among the Organization for Economic Cooperation and Development (OECD) countries. Canada ranks 30th among 36 member states, with a mortality rate of 4.7 infants under one year of age per 1,000 live births. In contrast, Iceland has the lowest infant mortality rate at 0.7, while India has the highest mortality rate of 37.9 per 1,000 live births.
In Canada, British Columbia has the lowest infant mortality rate at 3.4, and the highest rate is Nunavut at 17.7, which is more than twice that of other provinces. Sara Austin, founder and director of Children First Canada, said: A quarter of Canadian children do not receive diphtheria, pertussis and tetanus vaccines before the age of two. Ms. Janet Smylie, a physician in the Department of Family and Community Medicine at St. Michael’s Hospital in Toronto, said that in the past 10 years, the country’s infant mortality rate in the first year after birth was an average of nearly 5 deaths per 1,000 babies. The infant mortality rate among the inhabitants is relatively high, and the infant mortality rate among some indigenous people is even four times the national average. In terms of factors such as premature birth, complications, infections, and hospital care, the country has not equally allocated medical and social resources to different groups of people at the medical level. In addition to the country’s regional characteristics, some indigenous people living in remote northern areas need Enjoying normal maternal and child care, often driving or travelling by car for dozens or even hundreds of kilometers makes the life of the aborigines whose poverty rate is higher than the average level even more difficult and further aggravates this social inequality. The Canadian Consultative Bureau (CBC) also pointed out in a 2012 infant mortality report that advances in medical care for multiple births will also bring greater risks, which will push up the overall infant mortality rate in the country.
In January 2020, the Canadian CBC radio news survey program "FIFTH ESTATE" (FIFTH ESTATE) survey found that the phenomenon of birth tourism brings tension and pressure to the Canadian medical system, which is worrying. Since babies born in Canada can automatically obtain Canadian citizenship, more and more pregnant women come to Canada to give birth. Non-residents who come to Canadian hospitals on tourist visas to have children are called birth tourists. According to data from the Canadian Institute for Health Information and a number of Quebec hospitals, about 5,000 non-resident babies were born in Canada in 2018, an increase of nearly 15% over the previous year. Since the nutritional and health status of pregnant women is unknown, this may be a factor leading to infant death. Among them, many people have their children born prematurely due to visa or travel reasons, which will also increase the mortality rate.
Key strategies to avoid neonatal death
1, Popularize and improve the basic nursing of newborns
The vast majority of neonatal deaths occur in low- and middle-income countries. By popularizing high-quality prenatal care, skilled childbirth care, postpartum care for mothers and babies, and care for thin and sick newborns, the survival and health of newborns can be improved and preventable stillbirths can be terminated.
In an environment with a well-functioning midwife program, providing continuous care led by a midwife can reduce the preterm birth rate by as much as 24%. Continuous care led by a midwife is a mode of care in which a midwife or a team of support birth attendants is responsible for providing care to the same woman during pregnancy, childbirth and postpartum, and seeking medical support when necessary.
With the increase in delivery rates in facilities (approximately 80% worldwide), there is an excellent opportunity to provide basic newborn care and identify and manage high-risk newborns. However, very few mothers and newborns stay in the facility for 24 hours as recommended after delivery (this is the most critical period for complications). In addition, too many newborns died at home due to premature discharge, difficult access to services and delays in treatment. It is recommended to conduct four postpartum care in a health facility or through home visits. This can play a key role in providing services to these newborns and their families.
Twenty basic nursing principles for newborns (omitted)
2To reduce premature birth and sick infant mortality
In January 2019, according to statistics reported by a global alliance including UNICEF and the World Health Organization, nearly 30 million babies are born too early, too young or sick every year, and they need special care to survive. . This is the main content of a new report released today by a global coalition including UNICEF and the World Health Organization. The coalition called for better care and stronger legislation to save newborn babies on the brink of death. To accelerate progress to improve newborn survival rates and promote health and well-being, there is a need to improve the quality of care and ensure quality health services for thin and sick newborns.
The report is entitled "Survival and Growth: Changing the Care of Every Little Baby and Sick Baby." The report pointed out that among newborns, those who are at the highest risk of death and disability are those who are born prematurely, have brain damage during childbirth, have complications such as severe bacterial infections or jaundice, and those who are affected by congenital diseases. In addition, the economic and psychological shocks suffered by their families will adversely affect their cognitive, language and emotional development.
Soumya Swaminathan, Deputy Director-General of the World Health Organization in charge of the project, said: “For every mother and baby, health from pregnancy to delivery and the first few months after birth is of paramount importance. Universal medical insurance It can ensure that everyone, including newborns, can get the medical services they need without facing financial difficulties. Progress in newborn health care is a win-win situation. It saves lives and is vital to early childhood development. This affects the family, society and future generations."
According to the report, if there is no special treatment, many at-risk newborns will not survive the first month after birth. In 2017, about 2.5 million newborns died, most of which were due to preventable causes. Almost two-thirds of babies who die are premature babies. But even if they survive, many babies will face chronic diseases or developmental delays. In addition, it is estimated that one million newborns who were small and sick at birth have survived but face long-term disability.
12 measures to prevent premature birth (omitted)
3, To prevent sudden infant death syndrome (SIDS)
Although the probability of sudden infant death syndrome (SIDS) in newborns is not high, it is a big concern for older babies, so necessary preventive measures must be taken from the birth of the baby. Although the exact cause of SIDS is still unclear, many risk factors have been found, such as sleeping on the stomach, secondhand smoke, overheating, premature birth, low birth weight, and underage mothers.
Prevent infant SIDSSuggestion
(1) In the first 6 months of life, it is best for babies to sleep on their backs: Most studies have pointed out that letting babies sleep on their stomachs can easily cause SIDS. Therefore, the American Academy of Pediatrics issued a statement in 1992 that babies should sleep on their backs. Infants sleeping on their backs have the lowest SIDS probability, followed by sleeping on their sides, and sleeping on their stomachs the highest. One problem with babies sleeping on their sides is that they can easily roll over to sleep on their stomachs. Some parents worry that letting babies sleep on their backs will increase the risk of choking or spitting up milk, while some parents are convinced that babies sleeping on their backs are not easy to choke.
Studies have shown that babies who usually sleep on their backs but occasionally sleep on their stomachs are even more likely to suffer from this disease than those who usually sleep on their stomachs. This shows that even if you keep the baby sleeping on its back, the babysitter decides to let the baby sleep on its stomach. Babies are more susceptible to contraction. Make sure that all caregivers and babysitters realize that they must sleep on their backs. Not only sleep at night, but also naps.
(2) Do not use soft mattresses, bedding and pillows: Soft mattresses, couches and water beds are not good for babies to sleep. Soft beds and soft pillows can block the baby’s nose and mouth, hinder the baby’s breathing, and cause SIDS. It is especially dangerous to let a baby sleep face down and on a soft bed. Do not padded soft objects, such as quilts, scarves or sheepskin jackets, when the baby is sleeping. Do not give babies sleep pillows, stuffed toys or other soft objects. Do not use rubber pads and soft bedding. Use a hard baby mattress with close-fitting sheets. If using a blanket, roll the blanket around the baby mattress and do not let the blanket cover the baby's face.
(3) Do not smoke: Smoking during pregnancy will increase the risk of SIDS in babies. Babies after birth are also prone to SIDS if they smoke secondhand smoke. Letting babies enjoy a smoke-free environment is directly related to the health of their lungs when they grow up.
(4) Avoid overheating: Overheating will increase the risk of SIDS. Don't let the baby get too hot. Wear lighter clothes for the baby when sleeping. Make sure that the temperature in the baby's room is appropriate and that it is comfortable for adults to wear light clothes. Don't let the baby feel too hot and unwilling to be touched by others.
(5) Put your baby in your room: Studies have pointed out that if parents or other caring adults sleep with the baby in the same room but on different beds, the chance of SIDS will decrease by 50%. Most infant SIDS occurs in infants who sleep in a room alone. Putting a baby in a room with other children does not reduce the chance of SIDS.
(6) Premature babies and low birth weight babies: Despite the promotion of "sleeping on their backs", many health workers in the hospital nursery continue to let premature babies and low birth weight babies sleep on their stomachs or on their sides. This is because babies in this sleeping position are easier to control, and the chances of SIDS in babies at birth are relatively low. In addition, these babies are usually connected to a monitor, so medical staff can quickly detect problems. However, parents are likely to learn from the practice of medical staff and continue to let the baby sleep on his stomach or on his side after returning home. Most pediatric medical associations recommend that all babies who are hospitalized or at home sleep on their backs as much as possible, including premature babies and babies with low birth weight.
(7) Time to sleep on the stomach: Sleeping on the back of a baby may sometimes cause the baby's head to be flat. To reduce this chance, let the baby lie down for more than 5 minutes every day when the baby wakes up, and hold the baby upright when the baby wakes up. In addition, try to change the baby's head position every time you put the baby to sleep.
(8) Responding to infant SIDS: There is no sign when infant SIDS patients die, and it is currently unexplained in medicine. Therefore, while the parents are facing the unbearable pain of losing their children, they also have great guilt in their hearts. Not only do they blame themselves, they sometimes blame people close to them. If your baby dies from SIDS, try not to blame yourself or others. Try to understand that although it can reduce the chance of SIDS, SIDS in infants can still occur, and the cause is not clear.
4, Home visits can improve newborn survival
Newborn deaths accounted for 45% of the total deaths of children under 5 years of age. The vast majority of neonatal deaths (75%) occur in the first week of life, and 25%-45% occur within the first 24 hours of life. Providing skilled health care services during pregnancy, childbirth and the postpartum period (immediately after childbirth) can prevent complications from the mother and newborn, and can detect and manage various problems early.
The WHO and UNICEF recommend that skilled health workers visit homes during the first week of the baby’s life to improve the survival rate of newborns. Newborns with special circumstances, such as low-birth-weight babies, babies whose mothers are HIV-positive, or sick babies, require additional medical care and should be taken to the hospital.
If effective health measures can be provided by skilled health workers during delivery and during the first week of life, nearly two-thirds of neonatal deaths may be avoided. Skilled health workers make home visits to women immediately after giving birth, which is a health strategy that can improve newborn survival. This strategy has shown positive effects in environments with high mortality, reducing neonatal mortality and improving primary neonatal care practices.
Childbirth at home is an extremely common phenomenon in developing countries. Only women with 13% in these countries can receive care within 24 hours after delivery. Many mothers who give birth in health facilities cannot go home for post-natal care due to economic, social or other obstacles. The first few days of life are the most important for the survival of a newborn.
Comfort treatment and abandonment of active treatment constitute a relatively high proportion of children who die, and are related to gestational age and weight at birth; preterm infants are the main group of deaths, especially extremely/ultra-premature infants and extremely/ultra-low birth weight infants; newborns; Infant respiratory distress syndrome and severe asphyxia at birth are the first direct causes of death in premature and full-term infants, respectively.
5, Health management of pregnancy, pregnant women, parturients and newborns
(1) Physical examination of pregnant couple:
Pre-pregnancy physical examination items for women include:
* Oral examination. Inspection contents: tooth, periodontal, dentition, oral mucosa. Inspection purpose: The oral health of pregnant women directly affects the oral health of infants and young children. If oral problems occur during pregnancy, considering the effects of treatment methods and medication on the fetus, treatment is limited, and it is the pregnant mother who suffers;
* TORCH test. Check content: Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex. Inspection purpose: When pregnant women are infected with the above diseases, the pathogens can be transmitted vertically through the placenta, leading to cessation of embryo development, miscarriage, stillbirth, premature delivery, congenital malformations, etc., and even affect the intellectual development of infants and young children after birth, causing lifelong sequelae. Among them, the rubella virus infection rate is very high, reaching 60%-70%. The baby’s "rare lips" are caused by rubella virus infection; women who have pets such as cats and dogs at home should pay special attention to toxoplasmosis infection;
* Reproductive hormones. Check content: FSH, estradiol E2, progesterone P. Inspection purpose: health inspection of ovarian function and hormone levels in women;
* Color B ultrasound. Check content: uterus, accessories. Inspection purpose: whether there are gynecological diseases such as uterine fibroids, ovarian tumors, endometriosis, etc., which are all important factors that cause ectopic pregnancy.
Male pre-pregnancy physical examination items include:
* Reproductive hormones. Check content: testosterone T. Inspection purpose: to detect whether the hormone levels in men are normal;
* Semen. Check content: semen routine. Inspection purpose: check sperm density and total number, sperm shape and mobility, etc. Figures show that sperm motility in men has dropped by half compared with 50 years ago. Male sperm are affected by many factors, such as alcohol, lead, mercury and other chemicals and many drugs will have an adverse effect on the male's reproductive function and sperm quality, and severely cause neonatal defects.
(2) Pregnant couple 3-6Month pregnancy plan:
* Avoid tobacco and alcohol, avoid excessive irritating foods (coffee, tea, spicy, high sugar, cold drinks, etc.);
* Avoid refined foods: refined rice noodles, refined oils, refined sweets, foods containing harmful artificial food additives, etc.;
* Avoid food with excessive pesticide and fertilizer residues, sulfur fumigated food, dry goods, medicinal materials, supplements, etc.;
* Avoid all kinds of Chinese and Western medicines, unhealthy nutrients, unhealthy supplements, and foods from unknown sources;
* It is forbidden to stay up late, ensure regular work and rest, and get rid of bad habits;
* 1-3 days of short trips, city tours, appropriate aerobic exercise and stretching exercises (including swimming, cycling, running, yoga, Tai Chi), etc., strenuous exercise or anaerobic exercise is not recommended ；
* Music, dance, piano, chess, calligraphy and painting, reading and writing, etc., are beneficial to physical and mental health and improve intelligence. You can also read books to increase pregnancy knowledge and common knowledge of infant health care;
* Supplementary functional nutritional preparations: reduce harmful fats, improve uterine environment, improve cardiovascular and antioxidant capacity, and improve sperm and egg activity: calcium, magnesium, zinc, VB, VC, VE, seal oil, coenzyme Q10, proanthocyanidins, multidimensional pregnant women, folic acid , Curcumin and so on. For specific dosage and formula, please consult the author of this article;
* It is recommended to participate in the "Canadian Boss Dragon Detoxification Body Sculpting Immune Repair Course and Training" to build a brand new healthy body in 3 months, especially in terms of pregnancy.
(3) Calculation of female ovulation time
* Women's ovulation time is roughly 14-16 days back in the next menstrual cycle, and the ovulation time can be roughly calculated by combining the number of days in the menstrual cycle;
* Basal Body Temperature measurement (BBT): Women's questions during ovulation will be about 0.5 degrees higher than usual. This method is a bit cumbersome. During that period, it needs to be measured daily to grasp temperature changes, sometimes Possible cold and fever impact assessment;
* Apply ovulation test strips: This method is economical, easy to implement, and suitable for most people.
* Vaginal B-ultrasound monitoring follicular development: This method needs to be monitored in the hospital, and the accuracy is relatively good.
Normal women only ovulate one egg per cycle, and the egg usually survives for about 24 hours after the egg is released, and the sperm survives in the body for about 72 hours. Therefore, the chance of conception is only when the same room is before and after ovulation.
Scientifically calculating the ovulation period, although it helps to increase the probability of conception, may increase the tension of the couple. Therefore, for healthy pregnant couples, it is recommended to have intercourse every 3-4 days. Generally, you will not miss the ovulation period. During pregnancy, intercourse should not be too frequent or too long. The frequency of intercourse for more than 3 days or less than 7 days will affect sperm quality. If the couple cannot arrange the same sex regularly due to work or physical reasons, the above scientific methods can be used to calculate the ovulation period to arrange the time of the same sex.
(4) Nutrition and exercise plan for pregnant women for 10 months: (omitted)
(5) The progressive start mode of prenatal education and fetal health management: (omitted)
(6) The choice of normal delivery and caesarean section
* Judging by the size of the pelvis: The size of the pelvis has an important influence on the choice of delivery methods. The larger the pelvis, the higher the probability of having a smooth delivery. So if you want to know whether you are suitable for a smooth delivery, you can measure the size of the pelvis. Measuring the pelvis refers to measuring the length of the diameters at the entrance of the pelvis. All diameters are normal is a prerequisite for a smooth delivery, because it means that the road to the fetus is smooth. .
* Judging by the size of the fetus: It is not the mother whose pelvis size is suitable for the normal delivery. The weight and head circumference of the fetus also play a key role in the choice of delivery method. Estimating the size of the fetus requires the double parietal diameter and femur Data such as length and abdominal circumference are evaluated together. If the fetus is too large, it is usually recommended to have a C-section.
* Judgment according to uterine contraction force: uterine contraction force cannot fully and accurately determine whether a pregnant woman can give birth before delivery. Generally, it needs to be adjusted in time based on the phenomenon during the delivery process. If the delivery time is too long, it means that the uterine contraction force is not enough At this time, it is necessary to switch to C-section.
* It is recommended to choose a caesarean section:
-Senior primiparous women over 35 years old;
-Occurrence of threatened uterine rupture, prenatal hemorrhage, etc.;
— Suffer from pregnancy complicated with heart disease, diabetes, kidney disease and other serious pregnancy complications or complications;
— Obviously narrow or even deformed pelvis, or deformed genitals;
— Have done genital fistula repair or old third degree perineum tear repair;
-Special lesions or even deformities in the vagina, soft birth canal, cervix, pelvis, etc.;
-Abnormal fetal position such as transverse and breech position.
(7) Health restoration and body contouring plan for normal delivery and caesarean section: (omitted)
(8) Nutritional structure and nutritional collocation of confinement meal: (omitted)
(9) Nutrition management and health management of newborns: (omitted)
New life is a new hope, but many people are not fully prepared for the new life. The report of UNICEF pointed out: Now that medicine is so advanced, the global neonatal mortality rate is still alarmingly high. In addition to training, maintaining and managing a sufficient number of doctors, nurses and midwives with professional knowledge of maternal and newborn care; ensuring that every mother and baby has access to clean and fully functional sanitation facilities and electricity; giving priority to every mother In addition to providing necessary medicines and equipment with babies, the health management of fetuses, newborns and pregnant women is particularly important. Among them, the core is the popular maternity education system of families and hospitals.
If you have any questions or worry about the pregnancy status of yourself or your relatives and friends, please feel free to contact Dr. Long from Huizhou Smart Education. For more professional health blog posts, please refer to https://www. Chelsea98.com/blog
China Maternal and Child Health Development Report (2019)
*** Every article has been carefully written, edited and checked by Huizhou experts. Please trust the experts’ opinions and suggestions.If you have any questions, please email firstname.lastname@example.org ***
Chelsea98.com--Wise Week Million Dragon's Great Health Project Dr. Kyle Long, registered dietitian, registered health manager, from Smart Week Smart Financial Education Group-Sincere, clear and efficient personalized FAH financial quotient and health quotient education