Potential causes of early death among admitted newborns in a rural Tanzanian hospital


Autoři: Robert Moshiro aff001;  Jeffrey M. Perlman aff003;  Paschal Mdoe aff004;  Hussein Kidanto aff005;  Jan Terje Kvaløy aff006;  Hege L. Ersdal aff001
Působiště autorů: Faculty of Health Sciences, University of Stavanger, Stavanger, Norway aff001;  Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania aff002;  Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States of America aff003;  Department of Obstetrics and Gynecology, Haydom Lutheran Hospital, Manyara, Tanzania aff004;  School of Medicine, Aga Khan University, Dar es Salaam, Tanzania aff005;  Research Department, Stavanger University Hospital, Stavanger, Norway aff006;  Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway aff007;  Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222935

Souhrn

Background

Approximately 40,000 newborns die each year in Tanzania. Regional differences in outcome are common. Reviewing current local data, as well as defining potential causal pathways leading to death are urgently needed, before targeted interventions can be implemented

Objective

To describe the clinical characteristics and potential causal pathways contributing to newborn death and determine the presumed causes of newborn mortality within seven days, in a rural hospital setting.

Methods

Prospective observational study of admitted newborns born October 2014–July 2017. Information about labour/delivery and newborn management/care were recorded on data collection forms. Causes of deaths were predominantly based on clinical diagnosis.

Results

671 were admitted to a neonatal area. Reasons included prematurity n = 213 (32%), respiratory issues n = 209 (31%), meconium stained amniotic fluid with respiratory issues n = 115 (17%) and observation for < 24 hours n = 97 (14%). Death occurred in 124 infants. Presumed causes were birth asphyxia (BA) n = 59 (48%), prematurity n = 19 (15%), presumed sepsis n = 19 (15%), meconium aspiration syndrome (MAS) n = 13 (10%) and congenital abnormalities n = 14 (11%). More newborns who died versus survivors had oxygen saturation <60% on admission (37/113 vs 32/258; p≤0.001) respectively. Moderate hypothermia on admission was common i.e. deaths 35.1 (34.636.0) vs survivors 35.5 (35.036.0)°C (p≤0.001). Term newborns who died versus survivors were fourfold more likely to have received positive pressure ventilation after birth i.e. 4.57 (1.22–17.03) (p<0.02).

Conclusion

Intrapartum-related complications (BA, MAS), prematurity, and presumed sepsis were the leading causes of death. Intrapartum hypoxia, prematurity and attendant complications and presumed sepsis, are major pathways leading to death. Severe hypoxia and hypothermia upon admission are additional contributing factors. Strategies to identify fetuses at risk during labour e.g. improved fetal heart rate monitoring, coupled with timely interventions, and implementation of WHO interventions for preterm newborns, may reduce mortality in this low resource setting.

Klíčová slova:

Amniotic fluid – Heart rate – Hypoxia – Labor and delivery – Neonatal sepsis – Neonates – Sepsis – Hypothermia


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2019 Číslo 10

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