Investigation of in-patient neonatal death at 18 hospitals in Henan Province

Objective To investigate the situation and the causes of neonatal death in Henan Province. Methods This study retrospectively analyzed the clinical data of 277 neonates who died at 18 hospitals in Henan Province in 2017. Distribution and causes of neonatal deaths, differences between perinatal conditions of premature and term/post-term infants, causes of early (<7 d) and late (7-28 d) neonatal deaths and the differences in neonatal death cases between Maternal and Child Health Care Hospitals and General/Children's Hospitals were analyzed. We used t, rank-sum and Chi-square test (or corrected Chi-square test, or Fisher's exact test) for statistical analysis. Results (1) A total of 50 993 newborns were admitted to the 18 hospitals in 2017, 297 of which died with a mortality of 5.82‰. After excluding 20 cases with uncertain birth or maternal pregnancy history or clinical data, 277 cases with complete data were analyzed. Among them, 168 (60.6%) were preterm neonates and 109 (39.4%) were term/post-term ones. Early and late neonatal deaths accounted for 74.0% (205 cases) and 26.0% (72 cases), respectively. (2) The top five causes of neonatal deaths were infection (78 cases, 28.2%), asphyxia (54 cases, 19.5%), neonatal respiratory distress syndrome (NRDS, 33 cases, 11.9%), severe congenital malformations (26 cases, 9.4%) including cyanotic congenital heart diseases, digestive malformations, airway malformations and neural tube defects and pulmonary hemorrhage (23 cases, 8.3%). Among them, the top three causes of early neonatal deaths were asphyxia (48 cases, 23.4%), infection (43 cases, 21.0%) and NRDS (33 cases, 16.1%), while the main causes of late neonatal deaths were infection (35 cases, 48.6%), major congenital malformations (9 cases, 12.5%) and chromosome abnormities/inherited metabolic diseases (7 cases, 9.7%). (3) Maternal complications during pregnancy accounted for 79.1% (219 cases) and the predominant types were pregnancy-induced hypertension (43 cases, 19.6%), followed by infection (36 cases, 16.4%), placental-related conditions (32 cases, 14.6%), gestational diabetes mellitus (23 cases, 10.5%), hypothyroidism (20 cases, 9.1%), fetal distress (18, 8.2%), twin-twin transfusion syndrome (10 cases, 4.6%) and cholestasis syndrome (9 cases, 4.1%). (4) Compared with the term/post-term cases, the preterm cases had higher proportions of multiple births [27.4% (46/168) vs 6.4% (9/109), χ2=14.016, P<0.05], assisted reproduction [7.1% (12/168) vs 0.9% (1/109), χ2=4.421, P<0.05] and maternal hypertensive disorders of pregnancy [21.4% (36/168) vs 6.4% (7/109), χ2=11.353, P<0.05], infection [16.7% (28/168) vs 7.3% (8/109), χ2=4.295, P<0.05] and twin-to-twin transfusion syndrome [6.0% (10/168) vs 0.0% (0/109), χ2=6.707, P<0.05]. (5) Among all the early neonatal deaths, preterm cases had a higher incidence of NRDS than term/post-term neonates [20.3% (27/133) vs 8.3% (6/72), χ2=11.937, P<0.05], but lower incidence of meconium aspiration syndrome (MAS), severe congenital malformations and chromosome abnormalities/inherited metabolic diseases [0.8% (1/133) vs 5.6% (4/72), χ2=4.508; 3.8% (5/133) vs 16.7% (12/72), χ2=10.233; 1.5% (2/133) vs 6.9% (5/72), χ2=4.172; all P<0.05]. Among the late neonatal deaths, the incidence of severe intracranial hemorrhage in preterm infants was higher than that in term/post-term neonates [7.1% (3/42) vs 0.0% (0/30), χ2=2.205, P<0.05]. (6) Compared with the cases in General/Children's Hospitals, those in Maternal and Child Health Care Hospitals showed a higher proportion of preterm neonatal deaths [67.3% (105/156) vs 52.1% (63/121), χ2=6.010, P<0.05], younger gestational age [(32.8±5.3) weeks vs (34.6±4.9) weeks, t=3.072, P<0.05], lower birth weight [(2 132.6±1 014.5) g vs (2 409.4±987.3) g, t=2.513, P<0.05], and higher average age of death [M (P25-P75), 3 (1-8) d vs 2 (1-4) d, Z=3.710, P<0.05]. Conclusions Neonatal death occurs mainly within one week after birth in those with maternal complications. Late preterm deaths and term/post-term cases account for nearly half of total neonatal deaths. The causes of death for preterm and term/post-term newborns vary with postnatal age. Infection, asphyxia and severe congenital malformations are important causes of neonatal deaths. Key words: Infant mortality; Cause of death; Inpatients; Retrospective studies