Neonatal Morbidity and Mortality in a Neonatal Unit in a Vietnamese Hospital

Document Type : Original Article

Authors

1 Pediatric Center, Hue Central Hospital, Hue city, Vietnam Department of Health, Thua Thien Hue Provincial People’s Committee, Hue city, Vietnam

2 Pediatric Center, Hue Central Hospital, Hue city, Vietnam

3 Pediatric Department, Hue University of Medicine and Pharmacy, Hue city, Vietnam

Abstract

Background: Despite the numerous advances in newborn care, neonatal mortality and morbidity remain high, especially in developing countries, which requires us to find a way to improve facility-based care. The present study investigates the pattern of diseases and mortalities among these neonates admitted to the Neonatal Intensive Care Unit of Hue Central Hospital, Hue city, Vietnam, and explores the factors associated with the mortality.
Methods: A cross-sectional study was carried out at the Neonatal Intensive Care Unit of Hue Central Hospital between January 2019 and December 2019. Factors including age, sex, gestational age (GA), weight, diagnosis, and causes of neonatal death were studied. Each case was analyzed regarding factors affecting neonatal mortality.
Results: A total of 724 neonates were enrolled in this study. Of them, 403 (55.7%) were male, and 321 (44.3%) were female. Early-onset neonatal sepsis was the most frequent problem (49.9%), sequentially followed by late-onset neonatal sepsis (35.5%), congenital anomalies (14%), hyaline membrane disease (12.6%), unconjugated hyperbilirubinemia (12.2%), and asphyxia (10.2%). Moreover, the mortality rate was reported as 13.2%. The factors associated with mortality included GA, birth weight, multiple anomalies, critical congenital heart defects, asphyxia, hyaline membrane disease, cerebellar hemorrhage, and early-onset neonatal sepsis.
Conclusion: Neonatal sepsis was the primary cause of morbidity in the neonatal care unit in Vietnam. Preterm birth, asphyxia, and multiple anomalies were the main risk factors associated with mortality. Early management of preterm births and neonatal diseases should be given priority for improving neonatal outcomes.
 
 

Keywords


  1. Cherif MS, Dahal P, Mansoor R, Camara F, Bah A, Kone A, et al. Morbidity and mortality outcomes in neonates who were transferred from home and hospitals to the only neonatal intensive care unit in Guinea: a descriptive report using routinely collected health data. Int Health.2019;11(6):455-462.
  2. Hug L, Alexander M, You D, Alkema L, Estimation UNI-aGfCM. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030:
    a systematic analysis. Lancet Glob Health. 2019;7(6):e710-e20.
  3. Million Death Study C. Changes in cause-specific neonatal and 1-59-month child mortality in India from 2000 to 2015: a nationally representative survey. Lancet. 2017;390(10106):1972-80.
  4. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018;
    6(3):223-30.
  5. Collaborators GBDU-M. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet. 2021;398(10303):870-905.
  6. Pham TD, Hoang VT, Dao TL, Tran XD, Phi DL, To MM, et al. Morbidity and Mortality Patterns in Children Admitted to Hospital in Thai Binh, Vietnam: A Five-year Descriptive Study with a Focus on Infectious Diseases. J Epidemiol Glob Health. 2021;11(1):69-75.
  7. He C, Liu L, Chu Y, Perin J, Dai L, Li X, et al. National and subnational all-cause and cause-specific child mortality in China, 1996-2015: a systematic analysis with implications for the Sustainable Development Goals. Lancet Glob Health. 2017 ;5(2):e186-e97.
  8. Shane AL, Sanchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770-80.
  9. Wang XY, Liu YJ. Analysis on disease pattern and causes of death of 11,769 hospitalized newborn infants. Zhongguo Dang Dai Er Ke Za Zhi. 2003;41(7):551-2.
  10. Engle WA, American Academy of Pediatrics Committee on F, Newborn. Age terminology during the perinatal period. Pediatrics. 2004;114(5):1362-4.
  11. Marin Gabriel MA, Martin Moreiras J, Lliteras Fleixas G, Delgado Gallego S, Pallas Alonso CR, de la Cruz Bertolo J, et al. Assessment of the new Ballard score to estimate gestational age. An Pediatr. 2006;
    64(2):140-5.
  12. Sasidharan K, Dutta S, Narang A. Validity of New Ballard Score until 7th day of postnatal life in moderately preterm neonates. Arch Dis Child Fetal Neonatal Ed. 2009 ;94(1):F39-44.
  13. Singhal R, Jain S, Chawla D, Guglani V. Accuracy of New Ballard Score in Small-for-gestational Age Neonates. J Trop Pediatr. 2017;63(6):489-94.
  14. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.
  15. Dong Y, Basmaci R, Titomanlio L, Sun B, Mercier JC. Neonatal sepsis: within and beyond China. Chinese medical journal. 2020;133(18):2219-28.
  16. Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev. 2014 ;35(10):417-28; quiz 29.
  17. Singh A, Jialal I. Unconjugated Hyperbilirubinemia. StatPearls. Treasure Island (FL)2021.
  18. Morales P, Bustamante D, Espina-Marchant P, Neira-Pena T, Gutierrez-Hernandez MA, Allende-Castro C, et al. Pathophysiology of perinatal asphyxia: can we predict and improve individual outcomes? EPMA J. 2011;2(2):211-30.
  19. Raju U, Sondhi V, Patnaik SK. Meconium Aspiration Syndrome: An Insight. Med J Armed Forces India. 2010;66(2):152-7.
  20. Jha K, Nassar GN, Makker K. Transient Tachypnea of the Newborn. StatPearls. Treasure Island (FL); 2021.
  21. Akbarian-Rad Z, Riahi SM, Abdollahi A, Sabbagh P, Ebrahimpour S, Javanian M, et al. Neonatal sepsis in Iran: A systematic review and meta-analysis on national prevalence and causative pathogens. PloS One. 2020;15(1):e0227570.
  22. Singh M, Alsaleem M, Gray CP. Neonatal Sepsis. StatPearls. Treasure Island (FL)2021.
  23. Odabasi IO, Bulbul A. Neonatal Sepsis. Şişli Etfal Hastan Tıp Bul. 2020;54(2):142-58.
  24. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21-47.
  25. Toan ND, Darton TC, Boinett CJ, Campbell JI, Karkey A, Kestelyn E, et al. Clinical features, antimicrobial susceptibility patterns and genomics of bacteria causing neonatal sepsis in a children's hospital in Vietnam: protocol for a prospective observational study. BMJ Open. 2018;8(1):e019611.
  26. Tran HT, Doyle LW, Lee KJ, Dang NM, Graham SM. A high burden of late-onset sepsis among newborns admitted to the largest neonatal unit in central Vietnam. J Perinatol. 2015 Oct;35(10):846-51.
  27. Kruse AY, Ho BT, Phuong CN, Stensballe LG, Greisen G, Pedersen FK. Prematurity, asphyxia and congenital malformations underrepresented among neonates in a tertiary pediatric hospital in Vietnam. BMC Pediatr. 2012;12:199.
  28. Miles M, Dung KT, Ha LT, Liem NT, Ha K, Hunt RW, et al. The cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam over a one year period. PloS One. 2017;12(3):e0173407.
  29. Tran HT, Doyle LW, Lee KJ, Dang NM, Graham SM. Morbidity and mortality in hospitalised neonates in central Vietnam. Acta Paediatr. 2015;104(5):e200-5.
  30. Viral enteritis causes deaths and stunting in neonatal piglets in Scotland. Vet Rec. 2019;
    185(23):719-23.
  31. Alliance for M, Newborn Health Improvement mortality study g. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6(12):e1297-e308.
  32. Al-Sheyab NA, Khader YS, Shattnawi KK, Alyahya MS, Batieha A. Rate, risk factors, and causes of neonatal deaths in jordan: analysis of data from jordan stillbirth and neonatal surveillance system (JSANDS). Front Public Health. 2020;8:595379.
  33. Kalter HD, Perin J, Amouzou A, Kwamdera G, Adewemimo WA, Nguefack F, et al. Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries. BMC Med. 2020;18(1):183.
  34. Liu Y, Kang L, He C, Miao L, Qiu X, Xia W, et al. Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014-2018. BMJ Open. 2021 Feb 4;11(2):e042654.
  35. Shattnawi KK, Khader YS, Alyahya MS, Al-Sheyab N, Batieha A. Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Deaths Surveillance (JSANDS) system. BMC Pregnancy Childbirth. 2020;20(1):571.
  36. Abdel Razeq NM, Khader YS, Batieha AM. The incidence, risk factors, and mortality of preterm neonates: A prospective study from Jordan (2012-2013). Turk J Obstet Gynecol. 2017;14(1):28-36.
  37. Tietzmann MR, Teichmann PDV, Vilanova CS, Goldani MZ, Silva CHD. Risk factors for neonatal mortality in preterm newborns in the extreme south of Brazil. Sci Rep. 2020;10(1):7252.
  38. Leisher SH, Teoh Z, Reinebrant H, Allanson E, Blencowe H, Erwich JJ, et al. Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system. BMC Pregnancy Childbirth. 2016;16:269.
  39. Muktan D, Singh RR, Bhatta NK, Shah D. Neonatal mortality risk assessment using SNAPPE- II score in a neonatal intensive care unit. BMC Pediatr. 2019;19(1):279.
  40. World Health Organization. The World Health Report 2005—Make Every Mother and Child Count. Geneva, Switzerland; World Health Organization; 2005.
  41. Bamji MS, PV VSM, Williams L, Vardhana Rao MV. Maternal nutritional status & practices & perinatal, neonatal mortality in rural Andhra Pradesh, India. Indian J Med Res. 2008;127(1):44-51.
  42. Cherif MS, Dahal P, Mansoor R, Camara F, Bah A, Kone A, et al. Morbidity and mortality outcomes in neonates who were transferred from home and hospitals to the only neonatal intensive care unit in Guinea: a descriptive report using routinely collected health data. Int Health. 2019;11(6):455-62.