Determination of Neonatal Case-Specific Fatality Rates in a tertiary health institution in North Central Nigeria

Abstract

Background The current neonatal mortality rate in Nigeria (37/1000) is among the highest in the world and the major causes have consistently been reported as sepsis, perinatal asphyxia and prematurity. However, case-specific fatality which defines the risk of dying from these and other neonatal morbidities is rarely emphasized. Determination of case-specific fatality rates (CSFR) may inform a change in our current approach to neonatal care interventions which may eventually bring about the much-needed reduction in our neonatal mortality rate. Our aim was to determine the case-specific fatality rates for the common causes of mortality among hospitalized neonates at the National Hospital Abuja (NHA).Methods: Relevant demographic and clinical data on all neonates admitted into the NICU at the NHA over a period of 13 months (January 2017 to February 2018) were extracted from the Neonatal Registry database and analyzed using appropriate statistical methods with the SPSS version 20 software. The case-specific fatality rates were computed for the predominant morbidities in addition to determination of the neonatal mortality rates and associated risk factors.Results and conclusion: A total of 730 neonates were admitted, out of which 391 (53.6%) were females, 396 (54.5%) were inborn and 396 (54.2%) were term. The three most prevalent morbidities were prematurity 272(37.2%), neonatal Jaundice 208(28.4%) and perinatal asphyxia 91(12.5%) while the most common causes of mortality were prematurity 47/113(41.6%), congenital malformations 27/113(23.9%) and perinatal asphyxia 26/113(23%). Congenital malformations had the highest case-specific fatality 27/83(32.5%) followed by Perinatal Asphyxia 26/91(28.6%) and prematurity 47/272(20.7%). The mortality pattern differed between inborn and out born babies. Implications of these case-specific fatality rates for targeted interventions are discussed.

Pattern of Neonatal Mortality at a Special Care Baby Unit in Rivers State, Nigeria

“…This corroborates the findings in the United States vital statistics data which indicates a 1.5-fold increased risk of neonatal mortality after Caesarean delivery (both elective and emergency) compared to vaginal delivery [32]. This was contrary to the study carried out by Mukhtar & Mshelia [14] and Eke et al [15] in a 1year retrospective study in Abuja and Umuahia in Nigeria respectively, in which neonates delivered via CS had a much lower mortality rate. This difference could be because the duration of study was much shorter with a much smaller sample size.…”

“…The mortality rate of neonates admitted in the Special Care Baby Unit of the Rivers State University Teaching Hospital was 12.2%. This was comparable to the 12.4%, 12.9% and 13.2% documented in a previous study in Port Harcourt [10], Uyo [11] and Jigawa [12] in Nigeria but lower than the 14.1%, 15.5%, 16.0%, 18.8% and 19.4% documented in other parts of Nigeria [13][14][15][16][17]. Much higher mortality rates of 25.45%, 30.0% and 34.7% were documented in India [18] and some other parts of Nigeria [19,20] respectively.…”

“…Neonatal sepsis and perinatal asphyxia were also observed as the commonest causes of mortality in a previous study carried out in a bigger tertiary centre in the same locality, Port Harcourt [10]. In contrast, asphyxia was reported as the commonest cause of mortality in some parts of Nigeria [24,37,21,15,7] and India [38] while prematurity was documented as the commonest cause of mortality in other parts of Nigeria [14,12,11,16,17] and Ghana [22]; low birth weight in Benue State [13] Nigeria; respiratory distress in India [18] whereas respiratory distress syndrome was commonest in Pakistan [39]. These varying patterns of mortality could be attributable to the different geographic locations as well as the varying pattern of morbidities in these locations.…”

“…Varying diagnostic criteria could also be accountable. In the present study as well as the previous study in Port Harcourt [10], NNS was defined as those with either culture proven or probable sepsis unlike some other studies [14] where NNS was strictly defined as only those with suspicious clinical symptoms and signs with positive blood culture. It is pertinent to note that these causes of neonatal mortality are preventable and thus, high coverage of quality antenatal care for all pregnant women, skilled care at birth and quality care of small and sick newborns will reduce neonatal mortality significantly.…”

Impact of the use of surfactant and Nasal CPAP in the reduction of mortality among very low birth weight preterm babies in Ile-Ife, south western Nigeria

“…5 Studies in Nigeria have reported mortality rate of preterm babies to be between 24.6% to 41.6% of neonatal admissions. [6][7][8] Sadly, due to the lack of up-to-date neonatal intensive care facilities across low-income countries, deaths of fragile babies still occur. 9 Therefore, efforts must be geared towards preterm survival as a strategy to reduce neonatal mortality.…”