Causes Of Death In Childhood

As can be seen from Table 1.1, the greatest mortality during childhood occurs in the first year of life with the highest death rate of all happening in the first month.

Table 1.1. Number of deaths by age group

Number of deaths (rate)

Age group

1991 (E&W)

1998 (E&W)

1998 (Australia)

0-28 days

3052 (4-4)

24189 (3-8)

842 (5-02)

4-52 weeks

2106 (3-0)

1207 (1-9)

410

1-4 years

993 (36)

722 (28)

347

5-14 years

1165 (19)

897 (13)

376

1-14 years

2158 (24)

1619 (17)

723 (19-7)

The rate for under ones is per 1 000 population and for over ones per 100 000 population England and Wales, 1991 and 1998 Office of National Statistics (ONS) Australia 1998

The rate for under ones is per 1 000 population and for over ones per 100 000 population England and Wales, 1991 and 1998 Office of National Statistics (ONS) Australia 1998

The causes of death vary with age as shown in Table 1.2. In the newborn period the most common causes are congenital abnormalities and factors associated with prematurity, such as respiratory immaturity, cerebral haemorrhage, and infection due to immaturity of the immune response.

From 1 month to 1 year of age the condition known as "cot death" is the most common cause of death. Some victims of this condition have previously unrecognised respiratory or metabolic disease, but some have no specific cause of death found at detailed postmortem examination. This latter group is described as suffering from the sudden infant death syndrome. There has been a striking reduction in the incidence of the sudden infant death syndrome over the last few years in the UK, Holland, Australia and New Zealand. In England and Wales the decrease has been from 1597 in 1988 to 454 in 1994 and to 239 in 1998. The reduction has followed national campaigns to inform parents of known risk factors such as the prone sleeping position in the infant and parental smoking. The next most common causes in this age group are congenital abnormalities and infections (Table 1.2).

Table 1.2 Common causes of death by age group

Cause

Number of deaths* at 4-52 weeks 1-4 years

5-14 years

Cot death

239 (20)

0 (0)

0 (0)

Congenital abnormality

285 (24)

102 (14)

66 (7)

Infection

228 (19)

69 (10)

35 (4)

Trauma

53 (4)

143 (20)

219 (25)

Neoplasms

22 (2)

94 (13)

232 (25)

England and Wales, 1998, ONS. *Numbers in parentheses are the percentage.

After 1 year of age trauma is the most frequent cause of death, and remains so until well into adult life. Deaths from trauma have been described as falling into three groups. In the first group there is overwhelming damage at the time of trauma, and the injury caused is incompatible with life; children with such massive injuries will die within minutes whatever is done. Those in the second group die because of progressive respiratory failure, circulatory insufficiency, or raised intracranial pressure secondary to the effects of injury; death occurs within a few hours if no treatment is administered, but may be avoided if treatment is prompt and effective. The final group consists of late deaths due to raised intracranial pressure, infection or multiple organ failure. Appropriate management in the first few hours will decrease mortality in this group also. The trimodal distribution of trauma deaths is illustrated in Figure 1.1.

Mortality Multiple Trauma

Minutes Hours Days

Figure 1.1. Trimodal distribution of deaths from trauma

Minutes Hours Days

Figure 1.1. Trimodal distribution of deaths from trauma

Only a minority of childhood deaths, such as those due to unresponsive end-stage neoplastic disease, are expected and "managed". Most children with potentially fatal diseases such as complex congenital heart disease, inborn errors of metabolism, or cystic fibrosis are treated or "cured" by operation, diet, transplant or, soon, even gene therapy. The approach to these children is to treat vigorously incidental illnesses (such as respiratory infections) to which many are especially prone. Therefore, some children presenting to hospital with serious life-threatening acute illness also have an underlying chronic disease.

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