Early neonatal death Health Dictionary

An old name for PLAGUE.... black death

See SUDDEN INFANT DEATH SYNDROME (SIDS).... cot death

The proportion of deaths in a specified population. The death rate is calculated by dividing the number of deaths in a population in a year by the midyear resident population. Death rates are often expressed as the number of deaths per 100 000 persons. The rate may be restricted to deaths in specific age, race, sex, or geographic groups or deaths from specific causes of death (specific rate), or it may be related to the entire population (crude rate).... death rate

“Death is often, at the start, in a particular organ, i.e. local. If the part can be saved in time life may be preserved. At the approach of death the value of a particular organ strikes one forcibly. There may be no need for constitutional medication. The one suffering part may be the whole case. In many chronic cases certain organs claim and must have special attention.” (Dr J. Compton Burnet)

Most important of such organs are the heart, which can be sustained by a few grains of Cayenne; the brain (Ginkgo, Skullcap, Kola); stomach (Peppermint); liver (Dandelion); spleen (New Jersey tea). See: LIFE DROPS.

When all desire for food has ceased, sips of honey-water or Balm tea sweetened with honey offer a comforting and sustaining support. ... death

In 2000, more than 12,000 people died in or as a result of accidents in the UK, nearly half occurring at home and around a third in motor vehicle incidents. Many of these deaths would have been preventable, had appropriate safety measures been taken. A high proportion of deaths from accidents occur in males between ?ve and 34 years of age; alcohol is a signi?cant factor. Since the introduction of compulsory use of car seatbelts in the UK in the 1980s, the incidence of deaths from driving has fallen. With employers more aware of the risks of injury and death in the work place – with legislation reinforcing education – the number of such incidents has fallen over the past 50 years or more: this group now accounts for less than 2 per cent of all accidental deaths. Accidental deaths in the elderly are mainly caused by falls, mostly at home. In infants, choking is a signi?cant cause of accidental death, with food and small objects presenting the main hazards. Poisoning (often from drug overdose) and drowning are notable causes between the mid-20s and mid-40s.

See www.rospa.com... accidental death

The irreversible cessation of all functions of the brain, including the brainstem. (See also death.)... brain death

The sudden, unexpected death of an infant that cannot be explained.

Possible risk factors include: laying the baby face-down to sleep; overheating; parental smoking after the birth; prematurity and low birth weight; and poor socioeconomic background.

Preventive measures include: ensuring that the baby sleeps on its back at the foot of the cot; regulating the baby’s temperature (using the same amount of clothing and blankets that an adult would need); and stopping smoking.... sudden infant death syndrome

If deaths from accidents are excluded, this term means the unexpected death of an apparently healthy person. CARDIAC ARREST is the most common cause of sudden death. Older people (35 years or above) who suffer cardiac arrest commonly have coronary artery disease (see HEART, DISEASES OF) with restriction or stoppage of blood supply to part of the heart which causes INFARCTION (heart attack). Irregularity of the heartbeat (cardiac ARRHYTHMIA) is another cause. MYOCARDITIS, PNEUMONIA and STROKE can also result in sudden death, as can ASTHMA, anaphylactic shock (see ANAPHYLAXIS), ruptured aortic ANEURYSM and SUICIDE, the incidence of which is rising, especially among young people, and is over 4,000 a year in the UK.

Sudden death sometimes occurs in infants, usually in the ?rst year of life: this is called SUDDEN INFANT DEATH SYNDROME (SIDS) or, colloquially, cot death, the possible causes of which are an ongoing subject for research and debate.

When a person dies unexpectedly the event must be reported to a CORONER, who has the power to decide whether an AUTOPSY is necessary.... death, sudden

Fixed dilated pupils of the eyes

Absent CORNEAL REFLEX

Absent VESTIBULO-OCULAR REFLEX

No cranial motor response to somatic (physical) stimulation

Absent gag and cough re?exes

No respiratory e?ort in response to APNOEA despite adequate concentrations of CARBON DIOXIDE in the arterial blood.... b nosed. the test for brain-stem death are:

Brain damage, resulting in the irreversible loss of brain function, renders the individual incapable of life without the aid of a VENTILATOR. Criteria have been developed to recognise that ‘death’ has occurred and to allow ventilation to be stopped: in the UK, these criteria require the patient to be irreversibly unconscious and unable to regain the capacity to breathe spontaneously. (See also GLASGOW COMA SCALE and PERSISTENT VEGETATIVE STATE (PVS).)

All reversible pharmacological, metabolic, endocrine and physiological causes must be excluded, and there should be no doubt that irreversible brain damage has occurred. Two senior doctors carry out diagnostic tests to con?rm that brain-stem re?exes are absent. These tests must be repeated after a suitable interval before death can be declared. Imaging techniques are not required for death to be diag-... brain-stem death

For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate and using the international rules for selecting the underlying cause of death from the reported conditions. See “International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10)”.... cause of death

Cause-of-death ranking for adults is based on the List of 72 Selected Causes of Death, HIV Infection, and Alzheimer’s Disease. The List was adapted from one of the special lists for mortality tabulations recommended for use with the International Classification of Diseases, ninth revision. Two group titles – “Major cardiovascular diseases” and “Symptoms, signs, and ill-defined conditions” – are not ranked based on the list of 72 selected causes. In addition, category titles that begin with the words “other” and “all other” are not ranked. The remaining category titles are ranked according to number of deaths to determine the leading causes of death. When one of the titles that represents a subtotal is ranked (for example, unintentional injuries), its component parts are not ranked (in this case, motor vehicle crashes and all other unintentional injuries).... cause-of-death ranking

A certi?cate required by law to be signed by a medical practitioner stating the main and any contributary causes of a person’s death.... death certificate

(American) Daughter born prematurely

Earli, Earlie, Earley, Earlee, Earleigh, Earlea, Earleah... early

Action at an early stage of a disease or social process.... early intervention

Pertaining to the ?rst month of life.... neonatal

The provision of a dedicated unit with special facilities, including one-to-one nursing and appropriate technology, for caring for premature and seriously ill newborn babies. Paediatricians and neonatologists are involved in the running of such units. Not every maternity unit can provide intensive care: for example, the provision of arti?cial ventilation, other than as a holding procedure until a baby can be transferred to a better-equipped and better-serviced unit. Such hospitals tend to have special-care baby units, which are capable of looking after the needs of most, but not all, premature or ill babies.... neonatal intensive care

Death Cap or other poisoning by fungi. Fungus contains toxic amanitines.

Symptoms: vomiting, nausea, abdominal pain. Leads to rapid liver degeneration.

Tinctures. Formula. Echinacea 3; Goldenseal 1; Myrrh 1. Dose: 30-60 drops every 2 hours. Practitioner. Stomach irrigation. 50mg ampoules of Silymarin (Madaus) injected by a physician. ... death cap

The ?nal cause of death is usually the failure of the vital centres in the brain that control the beating of the heart and the act of breathing. The important practical question, however, is what disease, injury or other agent has led to this failure. Sometimes the cause may be obvious – for example, pneumonia, coronary thrombosis, or brain damage in a road accident. Often, however, the cause can be uncertain, in which case a POST-MORTEM EXAMINATION is necessary.

The two most common causes of death in the UK are diseases of the circulatory system (including strokes and heart disease) and cancer.

Overall annual death rates among women in the UK at the start of the 21st century were

7.98 per 1,000 population, and among men,

5.58 per 1,000. Comparable ?gures at the start of the 20th century were 16.3 for women and

18.4 for men. The death rates in 1900 among infants up to the age of four were 47.9 per 1,000 females and 57 per 1,000 males. By 2003 these numbers had fallen to 5.0 and 5.8 respectively. All these ?gures give a crude indication of how the health of Britain’s population has improved in the past century.

Death rates and ?gures on the causes of deaths are essential statistics in the study of EPIDEMIOLOGY which, along with information on the incidence of illnesses and injuries, provides a temporal and geographical map of changing health patterns in communities. Such information is valuable in planning preventive health measures (see PUBLIC HEALTH) and in identifying the natural history of diseases – knowledge that often contributes to the development of preventive measures and treatments for those diseases.... death, causes of

There are some minor signs, such as: relaxation of the facial muscles (which produces the staring eye and gaping mouth of the ‘Hippocratic countenance’), as well as a loss of the curves of the back, which becomes ?at by contact with the bed or table; discoloration of the skin, which takes on a wax-yellow hue and loses its pink transparency at the ?nger-webs; absence of blistering and redness if the skin is burned (Christison’s sign); and failure of a ligature tied round the ?nger to produce, after its removal, the usual change of a white ring, which, after a few seconds, becomes redder than the surrounding skin in a living person.

The only certain sign of death, however, is that the heart has stopped beating. To ensure that this is permanent, it is necessary to listen over the heart with a stethoscope, or directly with the ear, for at least ?ve minutes. Permanent stoppage of breathing should also be con?rmed by observing that a mirror held before the mouth shows no haze, or that a feather placed on the upper lip does not ?utter.

In the vast majority of cases there is no dif?culty in ensuring that death has occurred. The introduction of organ transplantation, however, and of more e?ective mechanical means of resuscitation, such as ventilators, whereby an individual’s heart can be kept beating almost inde?nitely, has raised diffculties in a minority of cases. To solve the problem in these cases the concept of ‘brain death’ has been introduced. In this context it has to be borne in mind that there is no legal de?nition of death. Death has traditionally been diagnosed by the irreversible cessation of respiration and heartbeat. In the Code of Practice drawn up in 1983 by a Working Party of the Health Departments of Great Britain and Northern Ireland, however, it is stated that ‘death can also be diagnosed by the irreversible cessation of brain-stem function’. This is described as ‘brain death’. The brain stem consists of the mid-brain, pons and medulla oblongata which contain the centres controlling the vital processes of the body such as consciousness, breathing and the beating of the heart (see BRAIN). This new concept of death, which has been widely accepted in medical and legal circles throughout the world, means that it is now legitimate to equate brain death with death; that the essential component of brain death is death of the brain stem; and that a dead brain stem can be reliably diagnosed at the bedside. (See GLASGOW COMA SCALE.)

Four points are important in determining the time that has elapsed since death. HYPOSTASIS, or congestion, begins to appear as livid spots on the back, often mistaken for bruises, three hours or more after death. This is due to the blood running into the vessels in the lowest parts. Loss of heat begins at once after death, and the body has become as cold as the surrounding air after 12 hours – although this is delayed by hot weather, death from ASPHYXIA, and some other causes. Rigidity, or rigor mortis, begins in six hours, takes another six to become fully established, remains for 12 hours and passes o? during the succeeding 12 hours. It comes on quickly when extreme exertion has been indulged in immediately before death; conversely it is slow in onset and slight in death from wasting diseases, and slight or absent in children. It begins in the small muscles of the eyelid and jaw and then spreads over the body. PUTREFACTION is variable in time of onset, but usually begins in 2–3 days, as a greenish tint over the abdomen.... death, signs of

See sudden infant death syndrome (SIDS).... death, sudden infant

See death, sudden.... sudden death

A very common, harmless skin condition, also known as erythema neonatorum or toxic erythema, that affects newborn infants. A blotchy rash, in which raised white or yellow lumps are surrounded by illdefined red areas of inflammation, forms, mainly affecting the face, chest, arms, and thighs. The cause of neonatal urticaria is unknown. The rash usually clears up without treatment.... urticaria, neonatal

(EWS) a system to detect deteriorating patients on the ward. Certain physical parameters are accorded scores: the higher the scores for individual patients, the greater the deterioration in their condition. Parameters scored include blood pressure, respiratory rate, pulse rate, blood oxygen saturation, and level of consciousness. Adjustments can be made for increased age.... early warning system

Neonatal mortality is the mortality of infants under one month of age. In England and Wales this has fallen markedly in recent decades: from more than 28 per 1,000 live births in 1939 to 3.6 in 2002. This improvement can be attributed to various factors: better antenatal supervision of expectant mothers; care to ensure that expectant mothers receive adequate nourishing food; improvements in the management of the complications of pregnancy and of labour; and more skilled resuscitation at birth for those who need it.

Nearly three-quarters of neonatal deaths occur during the ?rst week of life. For this reason, increasing emphasis is being laid on this initial period of life. In Britain, in the last four decades of the 20th century, the number of deaths in the ?rst week of life fell dramatically from 13.2 to just over 2.7 per 1,000 live births. The chief causes of deaths in this period are extreme prematurity (less than 28 weeks’ gestation), birth asphyxia with oxygen lack to the brain, and congenital abnormalities. After the ?rst week the commonest cause is infection.... neonatal mortality

Sudden infant death syndrome, or cot death, refers to the unexpected death – usually during sleep – of an apparently healthy baby. Well over 1,500 such cases are thought to have occurred in the United Kingdom each year until 1992, when government advice was issued about laying babies on their backs. The ?gure was 192 in 2002 and continues to fall. Boys are affected more than girls, and over half of these deaths occur at the age of 2–6 months. More common in lower social classes, the incidence is highest in the winter; most of the infants have been bottle-fed (see also INFANT FEEDING).

Causes These are unknown, with possible multiple aetiology. Prematurity and low birth-weight may play a role. The sleeping position of a baby and an over-warm environment may be major factors, since deaths have fallen sharply since mothers were o?cially advised to place babies on their backs and not to overheat them. Some deaths are probably the result of respiratory infections, usually viral, which may stop breathing in at-risk infants, while others may result from the infant becoming smothered in a soft pillow. Faults in the baby’s central breathing control system (central APNOEA) may be a factor. Other possible factors include poor socioeconomic environment; vitamin E de?ciency; or smoking, drug addiction or anaemia in the mother. Help and advice may be obtained from the Foundation for the Study of Infant Deaths and the Cot Death Society.... sudden infant death syndrome (sids)

death of a fetus in the uterus after 24 weeks of gestation. See stillbirth.... intrauterine fetal death

death of a baby between 7 and 27 completed days of life.... late neonatal death

deaths of women while pregnant or within 42 days of the end of the pregnancy from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes. These deaths can be subdivided into four main categories: (1) direct deaths: directly related to pregnancy; (2) indirect deaths: due to pre-existing maternal disease aggravated by pregnancy; (3) coincidental: unrelated to pregnancy; (4) late deaths: occurring between six weeks and one year following delivery. See also maternal mortality rate.... maternal death

an assessment tool for newborn babies, consisting of a chart in which a combination of *vital signs, neurological involvement, observation of blue skin and lips, and level of behavioural response indicate the appropriate level of concern. It is colour-coordinated from red to green to enable standardized escalation of concerns about the sick baby.... neonatal early warning score

see infant mortality rate.... neonatal mortality rate

*screening tests carried out on newborn babies to detect diseases that appear in the neonatal period, such as phenylketonuria (see Guthrie test). If these diseases are detected early enough, treatment may be instigated before any irreversible damage occurs to the baby.... neonatal screening

Yellowing of the skin and whites of the eyes in newborn babies, due to accumulation of bilirubin in the blood. It usually results from the liver being immature and unable to excrete bilirubin efficiently. This form of jaundice is usually harmless and disappears within a week. Rarely, severe or persistent neonatal jaundice is caused by haemolytic disease of the newborn, G6PD deficiency, hepatitis, hypothyroidism, biliary atresia, or infection.

Jaundiced babies usually require extra fluids and may be treated with phototherapy.

Exchange transfusion (see blood transfusion) may be needed in severe cases.

If severe neonatal jaundice is not treated promptly, kernicterus may occur.... jaundice, neonatal

a legal document, signed by a doctor, stating (in Part 1) the immediate cause of a person’s death followed by diseases underlying the condition. For example, if the immediate cause of death was a myocardial infarction, the underlying disease might have been ischaemic heart disease or hypertension. Other diseases, which were not directly linked with the immediate cause of death but may have contributed to the patient’s overall condition, are mentioned in Part 2 of the certificate. The document usually states the decedent’s gender and date and place of death; other details, such as occupation, may also be included. The death certificate forms a vital record in most countries throughout the world; without a death certificate, there can be no funeral. For England and Wales, this information is held at the General Register Office, which is now in Southport. In Scotland death certificates are kept at the National Records of Scotland, and in Northern Ireland at the General Register Office for Northern Ireland. Following the case of the serial killer Dr Harold Shipman and the subsequent public enquiry, legislation has introduced greater checks on, and scrutiny of, death certification by doctors.... death certificate

(NAS) symptoms and signs exhibited by a newborn baby (neonate) due to drug withdrawal (see dependence). This results when the fetus has been exposed to addictive drugs through maternal substance abuse or misuse. Symptoms tend to occur in the first few days of life (in the case of methadone, which is a long-acting opioid, symptom onset may be delayed). They include tremors and jerking, high-pitched crying, sneezing, sucking of fists, feeding difficulties, shortened periods of sleep between feeds, rapid breathing, sweating, loose stools, nasal stuffiness, and frequent yawning. Treatment includes swaddling or snugly wrapping in a blanket, as babies with NAS are often difficult to comfort. Other nonpharmacological measures include frequent small feeds using high-calorie formula and intravenous fluids if babies become dehydrated. Drug therapy may be used for seizures and withdrawal symptoms.... neonatal abstinence syndrome

teeth that emerge through the gingiva (gums) during the first month of life.... neonatal teeth

see erythema.... neonatal urticaria

(SUDEP) the sudden unexpected nontraumatic death of a person with *epilepsy, with or without evidence of a seizure and with no obvious cause found at post mortem.... sudden unexpected death in epilepsy