Neonatal mortality at Leratong Hospital
Background. There has been a high demand for delivery services at Leratong Hospital; however, no study on the causes of neonatal mortality has been conducted. It was therefore essential to identify the causes of newborn deaths so as to implement policies that would advance neonatal care.
Objectives. To determine the neonatal mortality rate (NMR), the primary causes of neonatal death and the occurrence of avoidable health factors.
Methods. This prospective descriptive study was conducted at the neonatal unit of Leratong Hospital, Johannesburg, South Africa. Clinical records of all neonates who were admitted between April 2013 and July 2013 were reviewed.
Results. A total of 380 neonates were admitted to Leratong Hospital over the 4-month period and 46 newborns died. The mean age (standard deviation (SD)) of all neonates admitted was 5 (5.8) days. Their mean (SD) weight was 1824.5 (29) g. Almost 37% of neonates died within 24 hours of admission. The 3 most common causes of death were: prematurity (39%), perinatal asphyxia (26%) and infection (20%). More than 60% of deaths occurred in the admission room. Three-quarters of neonates who died (74%) were low-birth-weight neonates. Staff shortage was found to be a contributor in 63% of deaths. Thirty-seven per cent of neonates could not be ventilated due to a shortage of ICU beds. The significant predictors relating to neonatal death were: preterm birth (OR 3.1, 95% CI 1.7 - 6.0), extremely low birth weight (OR 27.5; 95% CI 8.2 - 92.6), very low birth weight (OR 5.0; 95% CI 2.1 - 12.3) and birth by caesarean section (OR 3.2; 95% CI 1.6 - 6.2).
Conclusion. The neonatal mortality rate at Leratong Hospital was lower than the rates found in other studies. Preterm birth, low birth weight and birth by caesarean section were the strongest predictors of death. These deaths could have been avoided through provision of high-care services and an adequate number of nurses who were trained in both newborn care and early detection of perinatal asphyxia.