Neonatal mortality rate and burden of disease in Thai neonates: A nationwide data analysis

Abstract

Background: Neonatal mortality rate (NMR) is an international indicator reflecting a country’s health problems and services. This study is the most extensive nationwide effort to evaluate in-hospital mortality and disease burden among neonates in Thailand. Methods: A descriptive-analytic study used data from neonates born in hospitals under the Universal Health Coverage Scheme between 2015 and 2020. Data were extracted from discharge summaries using the International Statistical Classification of Diseases and Related Health Problems, 10^th Revision, Thai Modification (ICD-10-TM). Results: Overall, 3,141,215 live births were recorded during the 6-year study period, and 10,623 infants died within 28 days of life. In-hospital NMR was 3.38 per 1,000 live births. The annual NMR decreased significantly from 3.60 per 1,000 in 2015 to 3.05 per 1,000 in 2020 (p-value <0.001). Sixty-seven percent (n=7,149) of deaths occurred within 7 days of life (early neonatal death), and 46.7% (n=4,957) died within 3 days. The leading causes of neonatal death were disorders related to prematurity (36.3%), followed by congenital malformations and chromosomal abnormalities (23.5%), respiratory problems and persistent pulmonary hypertension of the newborn (17.8%), neonatal sepsis (12.3%), and perinatal asphyxia (7.6%). The regional NMR varied significantly, from 2.35 per 1,000 in the northern region to 5.22 per 1,000 in Bangkok. Factors significantly associated with NMR include low birth weight, small for gestational age, persistent pulmonary hypertension of the newborn, pulmonary hemorrhage, air leak, major congenital anomalies, severe asphyxia, hypo-hyperglycemia, disturbance of sodium balance, and sepsis. Common comorbidities among Thai neonates were neonatal jaundice (23.9%), respiratory problems (12.1%), disorders related to prematurity and low birth weight (11.1%), congenital malformations and chromosomal abnormalities (7.2%), sepsis (5.8%), and perinatal asphyxia (2.1%). Conclusion: The declining birth rate and NMR in Thailand highlight significant changes in the country’s demographics and improvements in healthcare services. Prematurity remains the leading cause of neonatal death, emphasizing the critical need for targeted interventions in maternal and neonatal care. Regional disparities in NMR indicate uneven distribution and access to healthcare resources, suggesting that strategic allocation and improvement of perinatal and post-natal care services are necessary to address these variations and enhance overall neonatal health outcomes in Thailand.