Abstract

PIP: In developing countries, child mortality declined during the 1980s, but neonatal mortality did not improve. Ministries of Health do not consider reduction of early neonatal mortality to be a priority. Underreporting of perinatal deaths is common (e.g., at least 40% of perinatal deaths). Researchers sometimes categorize perinatal deaths as other causes of infant mortality. Many people believe too technological or costly interventions are needed to reduce perinatal mortality, but simple, low-cost principles of newborn care do exist: keep the newborn warm, feed often, avoid infection, and keep the newborn close to the mother. A study in Zimbabwe shows that asphyxia, a preventable condition, occurred in 76% of cases. Prenatal care; education; improved treatment of syphilis, hypertension, diabetes, and amniotic fluid infection; closer monitoring of the fetal condition during labor; and proper management of abnormal labor would reduce perinatal deaths. Premature infants are at greater risk of death than are intrauterine growth retarded infants. Research is needed to learn more about the epidemiology, causes,, and sequelae of asphyxia as well as the most cost-effective interventions. 38% of newborns at a hospital in Kathmandu had mild or moderate hypoglycemia, 44% of whom experienced at least 3 hypoglycemic episodes in the first 2 days. Known hypoglycemic risk factors are low birth weight and hypothermia. Possible hypoglycemic risk factors are prelactal feeds and a delay in beginning breast feeding. Effective perinatal health care in developing countries requires a tired system of referral and a motivated community health worker trained to manage safe delivery and newborn care. Unfriendly staff and user charges are obstacles to primary perinatal health care, however. UNICEF's Baby Friendly Hospital initiative aims to stop distribution of free infant formula in maternity wards and to improve perinatal care.