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Determining risk factors and scientific argumentation of a new approach of analyzing deaths of term newborns


Author: Carauş Tatiana
Degree:doctor of medicine
Speciality: 14.00.09 - Pediatrics
Year:2017
Scientific adviser: Petru Stratulat (decedat)
doctor habilitat, professor, Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care
Institution: Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care

Status

The thesis was presented on the 6 April, 2017
Approved by NCAA on the 31 May, 2017

Abstract

Adobe PDF document – 1.94 Mb / in romanian

Thesis

CZU 16-053.31/32-037:615.99.036.8

Adobe PDF document 4.33 Mb / in romanian
144 pages

Keywords

infant mortality, perinatal mortality, early neonatal mortality, perinatal risk factors, perinatal audit, confidential inquiry, standard, verbal autopsy

Summary

Thesis structure: introduction, four chapters, conclusions and practical recommendations, 183 bibliography sources, 7 annexes, 115 pages of basic text, 39 figures and 38 tables. The obtained results of this thesis are published in 19 scientific articles.

Domain of the study: Medicine.

Aim of the study: Assessment of risk factors and death causes, volume and quality of health care provided to term newborns by scientific optimization and argumentation of the neonatal deaths analysis approach.

Objectives of the study: Assessment of medico-biological and social risk factors, as well as those associated with health care when early neonatal deaths occur. Evaluation of clinical, laboratory and morphopathological particularities of deceased newborn and those survived in the first week of life. Comparison of the volume and quality of health care provided to mothers and deceased term newborns with their survived peers by adopting confidential inquiry methodology to identify healthcare areas for improvement. Evaluation of mothers/families perception versus the quality and volume of health care provided.

Scientific novelty and originality: There was scientifically substantiated a new approach of analyzing deaths in term babies during the early neonatal period, highlighting the main causes and circumstances that contributed to death, which allowed to systematize actions of different categories of factors.

The solved important scientific problem consists in estimating and substantiating the impact of various risk factors and causes of death in the group of normal birth weight term infants. The system of assessing the volume and quality of medical care provided to term newborns has been developed and implemented. Given the high rate of death in term newborns, the principles of confidential audit have been developed nationwide.

Theoretical significance. The role of various categories of risk factors for the death of newborns by periods of exposure to these adversities has been assessed for the first time for our space. A new classification of causes of early neonatal death has been proposed. The paper has substantiated the need to objectify the results of mother/family interview, which is presented in the formulation of a new verbal autopsy instrument.

Applicative value of the paper: The volume and quality of health care provided to mothers and term newborns have been assessed with the elaboration of practical recommendations for professionals in the primary health care and from republic maternities.

Implementation of results: The study results have been tested and implemented via recommendations and proposals elaborated within the activity if obstetrical and neonatal units from level I maternities, as well as from level II and III Perinatal Centers.