Early neonatal death review from two provinces in Papua New Guinea: A retrospective analysis

Abstract

Aim To determine the causes of early neonatal death and the avoidable factors associated with these deaths among women participating in a cluster‐randomised crossover trial in Papua New Guinea. Methods Early neonatal deaths were identified by retrospective chart review of the Women and Newborn Trial of Antenatal Interventions and Management study participants between July 2017 and January 2020. Causes of death and avoidable factors were identified using the Perinatal Problem Identification Program system. Results There were 35 early neonatal deaths among 2499 livebirths (14 per 1000 births). Fifty‐seven percent (20/35) of deaths occurred on the first day of life. Idiopathic preterm birth was the leading obstetric cause of perinatal death (29%; 10/35). Extreme multi‐organ immaturity (23%; 8/35) and hypoxic ischaemic encephalopathy (17%; 6/35) were the most common final causes of neonatal death. Forty‐six avoidable factors were identified among 26 deaths, including delays in care‐seeking, insufficient resources at health facilities, poor intrapartum care and immediate care of the newborn, including neonatal resuscitation. Conclusion In this study, potentially preventable causes and avoidable factors were identified in the majority of early neonatal deaths. Addressing these factors will require health system strengthening, particularly the upskilling of primary level health staff, as well as targeted health education of women and the community.

Quality newborn care in East New Britain, Papua New Guinea: measuring early newborn care practices and identifying opportunities for improvement

“…Only half of the facilities in our study conducted regular perinatal morbidity and mortality audits. Investigations or audits of perinatal morbidity and mortality cases are important and provide an opportunity for clinicians to understand more about individual cases, gain insights into avoidable practice and systems issues, drive changes in clinical practice and stimulate quality improvement initiatives [ 21 , 62 – 64 ]. In addition, this information can be used to instigate research and inform public health initiatives to avoid future preventable newborn deaths and stillbirths [ 62 , 64 , 65 ].…”

“…Stillbirth rates are estimated to be between 20 to 30 per 1000 live births [ 20 ]. A review of 35 early neonatal deaths among 2499 live births across two provinces in PNG (East New Britain and Madang) identified several preventable causes and avoidable factors associated with these deaths, including insufficient resources at health facilities, poor quality of care during labour and birth, and poor management of high-risk newborns, including neonatal resuscitation [ 21 ]. Similarly, a review of stillbirths across the same two provinces identified at least one avoidable factor for 95% of the 59 stillbirths reviewed, included health personnel-associated factors related to poor intrapartum care and lack of early diagnosis and intervention of complications [ 22 ].…”

Trophoblasts Modulate the Ca2+ Oscillation and Contraction of Myometrial Smooth Muscle Cells by Small Extracellular Vesicle‐ (sEV‐) Mediated Exporting of miR‐25‐3p during Premature Labor

“…The Cav3.2 and SERCA2a level was elevated in the PTL myometrium along with the decreased miR-25-3p, proposing that miR-25-3p and its targets may contribute to the PTL. The colonization of Gram-negative germs is a pivotal risk factor for PTL [ 43 , 44 ]. LPS can induce preterm labor by evoking the release of proinflammatory cytokines and is sometimes used to mimic infection-related PTL in murine [ 45 , 46 ].…”

Improving maternal and newborn health and reducing stillbirths in the Western Pacific Region – current situation and the way forward

“…Research from Papua New Guinea and the Solomon Islands 37 , 38 , 39 , 40 highlights factors leading to poor maternal and perinatal outcomes, including stillbirth and early neonatal death. In Papua New Guinea, stillbirth is defined as a baby born without a heartbeat after 22 weeks gestation and weighing more than 500 g. 41 A recent study conducted in two provinces in Papua New Guinea identified a stillbirth rate of 23.4 per 1000 total births 37 and an early neonatal mortality rate (NMR-death within the first seven days) of 14 per 1000 livebirths.…”

“…In Papua New Guinea, stillbirth is defined as a baby born without a heartbeat after 22 weeks gestation and weighing more than 500 g. 41 A recent study conducted in two provinces in Papua New Guinea identified a stillbirth rate of 23.4 per 1000 total births 37 and an early neonatal mortality rate (NMR-death within the first seven days) of 14 per 1000 livebirths. 38 A number of avoidable factors were identified among these adverse outcomes, with the majority related to poor intrapartum care and inadequate clinical management – at least one avoidable factor was identified for 94% of stillbirths. 27 Similarly, in the Solomon Islands, the stillbirth rate (defined as babies born after 28 weeks gestational age) is estimated to be 21.4–29.7 per 1000 livebirths.…”