55: Neonatal mortality rates in the neonatal intensive care unit at kamuzu central hospital in malawi

Abstract

Neonatal mortality has increased from 37% to 46% worldwide among all causes of under-five mortality from 2010 to 2015. The highest burden of mortality occurs in resource-limited settings, specifically sub-Saharan Africa. No previous studies have evaluated neonatal mortality in Malawi, the country with the highest preterm birth rate at ∼20%, over a year-long period. We aimed to evaluate the neonatal mortality rate and causes of death in a large, tertiary referral hospital, Kamuzu Central Hospital (KCH), in Lilongwe, Malawi. A prospective, observational study was performed in which 123 clinical and demographic variables were collected on all neonates admitted to and treated in the KCH NICU from October 2017 to October 2018. Patients were excluded from data analysis only if they had any known congenital anomaly reported. 2137 newborns were included, of which 86 patient records lacked information regarding the final outcome and were excluded. Of the 2051 patients included in the analysis, 497 patients died (24.2% mortality). Mortality data was stratified by birth weight (Figure 1A), and evaluated with the rate of new admissions per month to the NICU (Figure 1B). Notably, the mortality rate was lowest in January 2018 (17.7%). We examined when mortality occurred (Figure 1C) and found most deaths occurred at 24-48 hours of life. The most common mortality causes were evaluated in those that died in the first 24 hours from birth (Figure 2A) compared to those who died >24 hours after birth (Figure 2B) with the leading cause being prematurity followed by asphyxia and then neonatal sepsis. This is the largest cohort of neonates in Malawi to be prospectively studied and the first study to evaluate neonatal outcomes over a 12-month period assessing for seasonal variation. Mortality was highest in neonates weighing < 1000g. Patients between 1200-1600g at birth had higher baseline mortality than those weighing more, highlighting a specific population to target for interventions to improve neonatal outcomes. Overall, our findings provide a framework to direct future improvements.View Large Image Figure ViewerDownload Hi-res image Download (PPT)