Assessment of the Recorded Causes of Neonatal Hospitalization and the Related Factors in Neonatal Wards and NICUs in Bojnord

Document Type: Original Article

Authors

1 Student Research Committee, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 North Khorasan University of Medical Sciences, Bojnord, Iran

3 School of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran

Abstract

Introduction: According to Millennium Development Goal (MDG) number 4, child mortality should be reduced by two thirds by 2015.  The focus has been on decreasing neonatal deaths in high-mortality countries. In this study, we assessed the recorded causes of neonatal hospitalization in the neonatal intensive care unit (NICU) and infant care wards.
Methods: The present cross-sectional study was carried out in two hospitals (Bentolhoda hospital and Emam Reza hospital) of North Khorasan University of Medical Sciences, Bojnord in 2011-2012. We assessed different variables such as maternal age at infant’s birth, gestational age, first and fifth minute Apgar scores, and hospitalization etiology. Chi-square and Kruskal-Wallis tests were used for the statistical analysis.
Results: In this study, the most common cause of neonatal admission was icterus. Most of the infants' birth weight was higher than 2,500 gr.There was a relationship between Apgar score in the first and fifth minutes and causes of hospitalization (P<0.001). Infants' gender and maternal mode of delivery had no significant relationship with the cause hospitalization (P<0.06). However, birth weight and gestational age were significantly related to the causes of admission in hospitals (P<0.0001).
Conclusion: Identifying the factors which influence the hospitalization of infants can help control these risk factors.It can also lead to the decrease of neonatal mortality, which is a reflection of nations’ socio-economic status.

Keywords


Introduction

Of the estimated 130 million infants born each year worldwide, 4 million die in the first 28 days of life (1). Neonatal mortality is used as a standard index of developing health care systems.  Also, neonatal morbidity and mortality rates reflect a country's socio-economic status, and the efficiency and effectiveness of health care services (2).  Mirza Rahimi et al (2009) showed that causes of neonatal mortality are HMD (hyaline membrane disease), sepsis, pneumonia, congenital anomalies, asphyxia and aspiration syndrome (3). Also, in a study by Nayeri et al (2007), results revealed that causes of neonatal death were preterm birth, RDS (respiratory distress syndrome), IVH (intraventri-cular hemorrhage), septicemia, and air leak syndrome (4). In the study by Fallahi et al (2009),

the most common causes of the infants’ deaths were RDS, sepsis, congenital anomaly, asphyxia, metabolic disorder, lung hemorrhage and necrotizing enterocolitis (5). Therefore, the first step to decrease neonatal mortality can be raising awareness regarding the causes of mortality (1).

United Nations Millennium Development Goal number 4 calls for the reduction of child mortality by two thirds by 2015. The focus has been on decreasing neonatal deaths in high-mortality countries (1, 4). Eighty seven percent of neonatal mortality worldwide is due to infection (36%), preterm birth (28%) and birth asphyxia (23%) (3, 4). In this study, we attempted to investigate the recorded causes of hospitalization and mortality of neonates in the NICU and infant care wards.

Materials and Methods

The present cross-sectional study was conducted between October 2011 and July 2012. The study was carried out in two hospitals of North Khorasan University of Medical Sciences. We assessed 260 out of 1,710 and 150 out of 1,569 medical records in the two hospitals, respectively. In total, the sample size was calculated as 415 infants who were admitted to the hospitals.

We used random sampling method and researcher-made checklists for gathering the data. The checklist consisted of the following variables: maternal age, parity, gravidity, maternal history of diseases, number of fetuses, gestational age, infant’s birth date, infant’s gender, time interval between birth and hospitalization, birth weight, first and fifth minute Apgar scores, time interval between amnion membrane rupture and infant’s birth, and hospitalization etiology.

 

 

Table 1. Maternal and neonates characteristics

Characteristics

Frequency

Percent

Valid percent

Maternal age, years (n=415)

 

 

 

<20

51

12.3

19.4

20-35

179

43.1

68.1

>35

33

8

12.5

Total

236

63.4

100

Missing system 

152

36.6

 

Mean(SD)

26.96(6.23)

 

 

Parity (n= 415)

 

 

 

1

62

14.9

50.4

2

30

7.2

24.4

3

19

4.6

15.4

>4

12

2.9

9.8

Total

123

29.6

100

Missing system

292

70.4

 

Mode delivery (n=415)

 

 

 

CS

124

29.9

47.1

NVD

139

33.5

52.9

Total

263

63.4

100

Missing system

152

36.6

 

Gestational age, weeks (n=415)

 

 

 

<35

39

9.4

15.4

35-37

33

8

13

>37

182

43.9

71.7

Total

254

61.2

100

Missing system

161

38.8

 

Mean(SD)

37.59(3.38)

 

 

Gender(n=415)

 

 

 

Male

225

54.2

56.3

Female

175

42.2

43.8

Total

400

96.4

100

Missing system

15

3.6

 

Birth weight, grams (n=415)

 

 

 

<1500

17

4.1

6.5

1500-2500

56

13.5

21.4

>2500

189

45.5

72.1

Total

262

63.1

100

Missing system

153

36.9

 

Mean(SD)

2858.01(776.03)

 

 

Preterm rupture of membrane, hours(n=415)

 

 

 

<12

230

55.4

89.8

12-24

18

4.3

7

>24

8

1.9

3.1

Total

256

61.7

100

Missing system

159

38.3

 

Mean(SD)

4.53(8.57)

 

 

Maternal history disease (n=415)

 

 

 

Yes

15

3.6

5.7

No

249

60

94.3

Total

264

63.6

100

Missing system

151

36.4

 

Apgar

 

 

 

1 minute(mean(SD))

7.72 (1.73)

 

 

5 minute(mean(SD))

8.81 (1.48)

 

 

 

SPSS (version 16) was utilized for entering and analyzing the data, and descriptive and analytic measures were used for data analysis. Statistical tests included chi-square and Kruskal-Wallis.

 

Results

The findings of the present study are presented in Table 1. The results showed the most common cause of admission was related to icterus (46.2%). The birth weight of most infants was more than 2500 gr, and in 89.8% of cases, the interval between membrane rupture and delivery was less than 12 hrs.

Most of the infants were born through normal vaginal delivery (52.9%). The mean of the gestational age in the two hospitals was 37.59±3.38 (range: 26-42 weeks). Also, the mean birth weight of hospitalized infants was calculated as 2851.14±791.46, with minimum of 720 gr and maximum of 4600 gr; eight percent of births were multiple gestations. 

Etiology of hospital admissions is presented in Tables 2 and 3, based on neonates’ birth weight. There was a relationship between the first and fifth minute Apgar scores and causes of hospitalization (P<0.001). Also, birth weight and gestational age were significantly related to causes of admission (P<0.001). 

However, there was no statistical relationship between causes of hospitalization and infant’s gender and mode of delivery (P<0.06). Moreover, we didn’t find any statistical relationship between causes of hospitalization and type of delivery (P<0.07).

 

Table 2. Hospitalization causes in neonates

Hospitalization causes

Frequency

Percent

Valid percent

Icter

HMD

Preterm

MAS

Sepsis

Asphyxia

Others

Total

Missing system

190

8

21

17

32

9

134

411

4

45.8

1.9

5.1

4.1

7.7

2.2

32.3

99

1

46.2

1.9

5.1

4.1

7.8

2.2

32.6

100

 

Table 3. Hospitalization causes based on birth weight

Hospitalization causes

N(%) birth weight<2500

N(%)Birth weight≥2500

Icter

HMD

Preterm

MAS

Sepsis

Asphyxia

Others

Total

8(10.5%)

8(100%)

18(94.7%)

0(0%)

4(22.2%)

1(11.1%)

39(33.6%)

78(29.8%)

68(89.5%)

0(0%)

1(5.3%)

16(100%)

14(77.8%)

8(88.9%)

77(66.4%)

184(70.2%)

Discussion

 In our study, the most common reasons for hospitalizing infants were icterus, sepsis, preterm birth, and meconium aspiration syndrome (MAS), while in the study by Mukasa (1992), the results showed that birth injuries and transient tachypnea of the newborn were common causes for hospitalization (6). Kasirye-Bainda et al (1992) also demonstrated that the major reasons for neonatal morbidity and mortality are immaturity, respiratory distress, infections and perinatal asphyxia (8), which are not similar to the findings of the present study.

In the studies by Okechukwu et al (2009), Udo et al (2008), Ahmed et al (2004), and Simiyu (2003, 2004), the results showed that the major reasons for the admission of neonates were as follows: low birth weight, neonatal sepsis (NNS), severe birth asphyxia (SBA), icterus, infections, low birth weight, very low birth weight, sepsis, pneumonia, omphalitis, dehydration, apnea attack and hypothermia, prematurity, respiratory distress, hyperbilirubinemia, respiratory distress, apnea attack, suspected sepsis, icterus, hypothermia and anemia, birth asphyxia, neonatal sepsis and prematurity (7, 9-13). In our study, the most common cause of hospitalization was to some extent similar to the aforementioned studies.

Khalili et al (2005) demonstrated that respiratory distress syndrome is more common than other causes of admissions (14); the results were similar to Simiyu’s study (2004) (12).

Hotrakitya et al (1993), in an evaluation regarding early neonatal mortality and causes of death in Ramathibodi Hospital in 1981-1990, showed that the most common causes of neonatal mortality were congenital malformation, immaturity, asphyxia, respiratory distress syndrome (RDS), and infection (15). In the present study, we couldn’t assess mortality etiologies of the neonates due to the unavailability of infants' death records in one of the hospitals. 

In the present study, male infants outnumbered the females, same as the studies by Mirza Rahimi et al (2009), Fallahi et al (2009) and Mukhtar-Yola (2007) (3, 5, 13). In the study by Fallahi et al, most of the deliveries were cesarean section (59%), however in our study, normal vaginal delivery was more frequent. In the mentioned study, in 63% of cases, the Apgar score was less than 7 and the majority of infants weighed 1000-1499 gr (50%) (5). However, in the present study, the birth weight of most of the infants was over 2500 gr (72.1%).

Conclusion

Immaturity is the most common cause of infants’ hospitalization which can be due to differences in socioeconomic status and health care services in various countries. This study helps us identify and control the risk factors involved in neonatal morbidity and mortality.

 

Acknowledgement

This study was part of an approved project by North Khorasan University of Medical Sciences. The authors would like to thank Mr. Akbari for editing the article and also Mrs. Tabatabaee Chehr for her great assistance.

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