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. 2022 Jul 21;17(7):e0271662.
doi: 10.1371/journal.pone.0271662. eCollection 2022.

Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network

Elizabeth Quincer  1 , Rebecca Philipsborn  1   2 , Diane Morof  3 , Navit T Salzberg  4 , Pio Vitorino  5 , Sara Ajanovic  5 , Dickens Onyango  6 , Ikechukwu Ogbuanu  7 , Nega Assefa  8 , Samba O Sow  9 , Portia Mutevedzi  10 , Shams El Arifeen  11 , Beth A Tippet Barr  12 , J Anthony G Scott  13 , Inacio Mandomando  5   14 , Karen L Kotloff  15 , Amara Jambai  16 , Victor Akelo  12 , Carrie Jo Cain  17 , Atique Iqbal Chowdhury  11 , Tadesse Gure  8 , Kitiezo Aggrey Igunza  18 , Farzana Islam  11 , Adama Mamby Keita  9 , Lola Madrid  8   13 , Sana Mahtab  10 , Ashka Mehta  15 , Paul K Mitei  19 , Constance Ntuli  10 , Julius Ojulong  20 , Afruna Rahman  11 , Solomon Samura  17 , Diakaridia Sidibe  9 , Bukiwe Nana Thwala  21 , Rosauro Varo  5   22 , Shabir A Madhi  10 , Quique Bassat  5   22   23   24   25 , Emily S Gurley  11   26 , Dianna M Blau  27 , Cynthia G Whitney  2
Affiliations

Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network

Elizabeth Quincer et al. PLoS One. .

Abstract

Introduction: The high burden of stillbirths and neonatal deaths is driving global initiatives to improve birth outcomes. Discerning stillbirths from neonatal deaths can be difficult in some settings, yet this distinction is critical for understanding causes of perinatal deaths and improving resuscitation practices for live born babies.

Methods: We evaluated data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network to compare the accuracy of determining stillbirths versus neonatal deaths from different data sources and to evaluate evidence of resuscitation at delivery in accordance with World Health Organization (WHO) guidelines. CHAMPS works to identify causes of stillbirth and death in children <5 years of age in Bangladesh and 6 countries in sub-Saharan Africa. Using CHAMPS data, we compared the final classification of a case as a stillbirth or neonatal death as certified by the CHAMPS Determining Cause of Death (DeCoDe) panel to both the initial report of the case by the family member or healthcare worker at CHAMPS enrollment and the birth outcome as stillbirth or livebirth documented in the maternal health record.

Results: Of 1967 deaths ultimately classified as stillbirth, only 28 (1.4%) were initially reported as livebirths. Of 845 cases classified as very early neonatal death, 33 (4%) were initially reported as stillbirth. Of 367 cases with post-mortem examination showing delivery weight >1000g and no maceration, the maternal clinical record documented that resuscitation was not performed in 161 cases (44%), performed in 14 (3%), and unknown or data missing for 192 (52%).

Conclusion: This analysis found that CHAMPS cases assigned as stillbirth or neonatal death after DeCoDe expert panel review were generally consistent with the initial report of the case as a stillbirth or neonatal death. Our findings suggest that more frequent use of resuscitation at delivery and improvements in documentation around events at birth could help improve perinatal outcomes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Availability and indication of signs of life from clinical health record abstractions and the verbal autopsy for stillbirths and very early neonatal deaths at facilities in the Child Health and Mortality Prevention Surveillance (CHAMPS) network.
a. Stillbirths delivered in a facility (N = 1753). b. Very early neonatal deaths at a facility (N = 692).
See this image and copyright information in PMC

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