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
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.
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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