Analysis of neonatal deaths in critical neonatal treatment centers at different levels in Henan province

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Objective To investigate the death status and cause of death of newborns in critical care centers at different levels in Henan province. Methods Retrospective analysis was performed on the death cases at 85 critical neonatal treatment centers in 18 cities of Henan province from January to December 2018, and the similarities and differences in neonatal mortality, age of death and causes of death among cities and county-level critical neonatal care centers were compared. Results (1) A total of 99 832 neonates were admitted to 85 hospitals, and 318 neonates died, with a mortality rate of 3.19‰.A total of 42 066 neonates were admitted to 21 municipal hospitals, and 194 neonates died, with a mortality rate of 4.6‰.Among them, 109 cases (56.2%) were premature infants (14 cases were of 28 weeks, 70 cases were of 28-34 weeks, 25 cases were of >34-37 weeks), and 85 cases (43.8%) were full-term infants.A total of 57 766 neonates were admitted to 64 county-level hospitals, with 124 deaths and a mortality rate of 2.1‰.Among them, 67 cases (54.0%) were full-term infants, 57 cases (46.0%) were premature infants (9 cases were of 28 weeks, 34 cases were of 28-34 weeks and 14 cases were of >34-37 weeks). The mortality rates at muni-cipal hospital were higher than those at the county-level hospitals, and the difference was statistically significant (χ2=46.589, P<0.05). (2) Neonatal death mainly occurred within 1 week after birth, especially within 1 day after birth.There were 81 deaths (41.8%) in 21 municipal hospitals within 1 day, including 50 premature infants (61.7%) and 31 full-term infants (38.3%). There were 75 deaths (60.5%) in 64 county-level hospitals within 1 day, including 34 premature infants (45.3%) and 41 full-term infants (54.7%). The mortality rate in county-level hospitals was higher than that in the municipal hospital within 1 day, and the difference was statistically significant(χ2=10.621, P< 0.05). (3)The top 5 causes of neonatal death in the municipal and the county-level hospitals were pulmonary diseases (130 cases, 40.8%), birth asphyxia (74 cases, 23.3%), infection (50 cases, 15.7%), congenital malformation (24 cases, 7.5%), and very-early premature/very-low birth weight infants (12 cases, 4.1%). (4)For early (within 1 week after birth) death of full-term infants, the main causes of death in municipal hospitals were lung diseases (mainly neonatal respiratory distress syndrome/acute respiratory distress syndrome), birth asphyxia, infection, congenital malformation.The leading causes of death at county-level hospitals were birth asphyxia, pulmonary diseases and infection.For premature infants who died within 1 week, the main causes of death at the municipal and the county-level hospitals were pulmonary diseases and birth asphyxia.For late-stage (2-4 weeks after birth) death of neonates, whether full-term infants or premature infants, the main cause of death in municipal and county-level hospitals was infection. Conclusions There are differences in neonatal mortality, mortality within 1 day after birth and the first cause of death at critical neonatal treatment centers at municipal and county-level hospitals.For the early-stage(within 1 week) neonates, the main causes of death in municipal and county-level hospitals are lung diseases (mainly neonatal respiratory distress syndrome/acute respiratory distress syndrome), birth asphyxia and infection.For the late-stage neonates, infection is the main cause of death in the municipal and the county-level hospitals.It is necessary to improve the neonatal care ability of critical neonatal treatment centers at different levels separately in order to reduce neonatal mortality. Key words: Infant, newborn; Mortality; Cause of death