Abstract
Background
Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed.
Objective
To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality.
Methods
Prospective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models.
Results
Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42–11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10–3.65, p = 0.023).
Conclusion
Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.
Publisher
Public Library of Science (PLoS)
Reference75 articles.
1. 3.6 million neonatal deaths—what is progressing and what is not.;JE Lawn;Semin Perinatol,2010
2. United Nations. Millennium Development Goal 4: Reduce child mortality. 2013 [cited 1 Sep 2020]. Available from: https://www.un.org/millenniumgoals/pdf/Goal_4_fs.pdf.
3. United Nations—Department of Economic and Social Affairs. Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages. 2016 [cited 16 Sep 2020]. Available from: https://sdgs.un.org/goals/goal3.
4. UNICEF. Neonatal mortality. The neonatal period is the most vulnerable time for a child. 2019 [cited 1 Sep 2020]. Available from: https://data.unicef.org/topic/child-survival/neonatal-mortality/.
5. 4 million neonatal deaths: When? Where? Why.;JE Lawn;The Lancet,2005