Abstract
BackgroundNeonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed.ObjectiveTo determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality.MethodsProspective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models.ResultsHalf of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42–11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10–3.65, p = 0.023).ConclusionNeonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.
Highlights
The neonatal period, defined as the first 28 days of life, is the most vulnerable time for an infant’s survival
Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy
Hypothermia at admission was associated with a higher hazard of death (HR 2.00, 95%-confidence interval (CI) 1.10–3.65, p = 0.023)
Summary
The neonatal period, defined as the first 28 days of life, is the most vulnerable time for an infant’s survival. Eight Millennium Development Goals (MDG) were defined by the United Nations (UN) in 2000, with the fourth goal focusing on the reduction of the under-five-mortality rate by two-thirds between 1990 and 2015 [2]. Target 3.2.2 of the SDG calls for a reduction in neonatal mortality in all countries to twelve or fewer deaths per 1,000 live births by 2030 [3]. Due to national and international achievements, the global neonatal mortality rate (NMR) fell by 51 percent from 37 deaths per 1,000 live births in 1990 to 18 in 2017; neonatal deaths still account for 47 percent of worldwide under-five deaths [4]. Prospective data on patient characteristics and factors of neonatal death are needed.
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