Contributory factors to early neonatal deaths in the Upper East Regional Hospital in Ghana

Objective: This study examined factors identified during early neonatal death audits contributing to preventable newborn deaths at the Upper East Regional Hospital. Method: Data for this study was collected retrospectively from perinatal death audit forms using three data collectors. Data collection lasted two weeks, from 18th June to 2nd July 2021. The data collectors submitted 113 filled hard copy data collection forms. This was then entered into a designed Excel sheet and exported to STATA software version 15.0 for analysis. The analysis was descriptive statistics with cross-tabulation. The results were presented in charts and tables focusing on percentages. Results: Most of the 113 neonatal deaths were from birth asphyxia (63%). Forty-six (40.7%) of the deaths occurred within 24 hrs after birth. There were 38 factors reported 254 times in the audits as contributory to all the newborn deaths; 17 health personnel-related factors stated 141 (55.5%) times, four transportation and communication-related factors stated 43 (16.9%) times, seven health facility factors stated 31 (12.2%) times. Inappropriate care during transportation to the regional hospital was reported most - 21 times, followed by delay in referral - 18 times. Conclusion: The study identified many factors, such as medical personnel-related factors, transportation and communication factors, family-related factors, and health facility administration factors, contributing to early neonatal deaths. Effective implementation of neonatal death audit-based recommendations arising from these contributory factors is critical to preventing avoidable newborn deaths.

Factors associated with clinical outcomes among neonates admitted with acute bilirubin and hypoxic-ischaemic encephalopathies at a tertiary hospital in south-west Nigeria

Background:Babies who are delivered outside hospital are most at risk of serious illnesses such as perinatal asphyxia and severe hyperbilirubinaemia. These conditions are major contributors to neonatal mortalities in resource-poor settings. Objective: To explore the relationship between pre-admission and intra-facility care and immediate outcomes among neonates with acute bilirubin and hypoxic-ischaemic encephalopathies. Methods: Using a retrospective design, the outcome of outborn babies with acute bilirubin encephalopathy (ABE) and hypoxic-ischaemic encephalopathy (HIE) were studied in a Nigerian hospital between 2012 and 2016. Results: A total of 40 and 80 babies with ABE and HIE were studied. Among babies with ABE, 67.5% arrived at the hospital on self-referral and of the babies with official referral, only 61.5% had had a serum bilirubin check prior to referral. Among the babies with ABE, 25.0% had both social and facility-related challenges, 45.0% had only facility-related challenges and 20.0% had only social challenges. All the babies with ABE who died had either social or facility-related challenges. For the babies with HIE, 56.2% came on self-referral while 70% received no care prior to presentation at the hospital. Some 40% of babies with HIE had both social and facility-related challenges while 12.5% had only facility-related challenges. None of the babies who died presented early. Comparable proportions of babies who died or survived had social challenges and facility-related challenges. Conclusion: Most of the outborn babies with HIE and ABE who arrived at the hospital on self-referral and facility-based care were hindered by social issues and facility-related challenges

Evaluation des ressources humaines et matérielles des maternités de Kisangani en matière de réanimation néonatale

Introduction: La réduction de la mortalité néonatale passe par celle des trois principales causes: la prématurité, les infections néonatales et l'asphyxie péripartale. Celle-ci exige des ressources humaines qualifiées et compétentes ainsi qu'unéquipement approprié et disponible. La présente étude vise l'évaluation de ces ressources.Méthodologie:Il s'agit d'une étude qualitative et descriptive qui a consisté en l'interview des infirmiers des maternités des 5 hôpitaux généraux de référence, de l'Hôpital du Cinquantenaire de Kisangani et des Cliniques Universitaires de Kisangani. Outre les variables sociodémographiques, nous avons évalué les connaissances du matériel, des indications et de la technique de réanimation du nouveau-né. Ensuite, un check-list a été complété à partir de l'observation de l'équipement existant dans chaque hôpital. Résultats: Deux hôpitaux possédaient un aspirateur et un ballon d'ambu. Deux possédaient une source d'oxygène. Près de 75% des infirmiers avaient un niveau deconnaissances bas (score ≤25%) sur la réanimation néonatale et aucun des interviewés n'a réalisé un score supérieur à 75%. Il n'y avait pas d'association avec le niveau de qualification (p= 0,28) ni avec la formation en soins obstétricaux et néonataux d'urgence ou SONU (p= 0,18). Plusieurs pratiques néfastes et inefficaces étaient rapportées. Conclusion: Les hôpitaux de niveau secondaire et tertiaire de Kisangani sont sous-équipés en ressources humaines et matérielles nécessaires à la prise en charge descas d'asphyxie néonatale. L'enseignement et la formation des prestataires doivent être améliorés pour un meilleur rendement sur terrain

Effect of Prophylactic Phenobarbital on Seizures; Encephalopathy and Mortality in Neonates with Perinatal Asphyxia

Background. Seizures after an asphyxial insult may result in brain damage in neonates. Prophylactic phenobarbital may reduce seizures.Objective. To determine the effect of prophylactic phenobarbital on seizures; death and neurological outcome at hospital discharge.Methods. Neonates with base deficit 16 mmol/l and Apgar score at 5 minutes 7 or requiring resuscitation for 5 minutes at the time of birth were randomised to prophylactic phenobarbital 40 mg/kg (n=50) or placebo (controls) (n=44) within the first 6 hours of life. They were monitored for clinical seizures; hypoxic ischaemic encephalopathy (HIE) and mortality.Results. Seizures developed in 30.0 of the phenobarbital group as opposed to 47.7 of the control group (relative risk 0.63; 95 confidence interval -0.37 - 1.06; p=0.083). The proportions of patients who had died and/or had HIE II or III at time of discharge from hospital were similar in the two groups (42.0 v. 45.5). There were no differences in mortality between the two groups (14.0 v. 15.9). Conclusion. In infants with asphyxia; prophylactic phenobarbital does not reduce the incidence of seizures; HIE and mortality

The Effect of Maternal HIV Status on Perinatal Outcome at Mowbray Maternity Hospital and Referring Midwife Obstetric Units; Cape Town

Objectives. To study the effect of maternal HIV status on perinatal outcome at Mowbray Maternity Hospital (a secondary-level hospital in Cape Town) and its satellite community midwife obstetric units. Design. A retrospective descriptive and comparative study.Setting. Public sector maternity facilities serving historically disadvantaged populations. Subjects. All deliveries at Mowbray Maternity Hospital and its referral midwife obstetric units from January to December 2008. Outcome measures. Stillbirth; early neonatal death; perinatal mortality and neonatal encephalopathy rates in HIV-positive and HIVnegative subjects. Results. There was a total of 18 870 deliveries at the units studied; 3 259 (17.2) of them to HIV-positive mothers. The stillbirth rate in the HIV-positive population was 17.1/1 000 births; compared with 8.3/1 000 in the HIV-negative population (odds ratio (OR); 2.07; 95 confidence interval (CI) 1.5 - 2.8). The early neonatal death rate in the HIV-positive population was 4.6/1 000 live births; compared with 3.1/1 000 in the HIV-negative population (OR 1.46; 95 CI 0.8 - 2.6). The perinatal mortality rate in the HIV-positive population was 21.7/1 000 births; compared with 11.7 in the HIV-negative population (OR 1.91; 95 CI 1.4 - 2.5). A comparison of the pattern of primary obstetric causes of perinatal mortality showed that infection; intra-uterine growth restriction (IUGR) and antepartum haemorrhage (APH) were significantly more common as causes for perinatal death in the HIV-positive population. The risk of neonatal encephalopathy in the HIV-exposed population was 4.9/1 000 live births compared with 2.07 in the HIV-negative group (OR 2.36; 95 CI 1.28 - 4.35). The 1 643 women (8.7 of total deliveries) who were not tested for HIV were at particularly high risk of adverse perinatal outcome. This group included women who had either declined testing or not attended for antenatal care. Conclusion. The perinatal mortality rate in the group of HIV-exposed mothers was significantly higher than that in the HIV-negative group due to a higher stillbirth rate. Infection; IUGR and APH were significantly more common obstetric causes for mortality in the HIV-infected population. The risk of neonatal encephalopathy was also significantly higher in the HIV-positive population

Causes of Neonatal Admissions and Deaths at a Rural Hospital in Kwazulu-Natal; South Africa

One of the Millennium Development Goals (MDG-4) is to reduce child mortality by up to two-thirds by 2015. In most developing countries; a higher proportion of neonatal deaths are observed. We quantify the causes of neonatal morbidity and mortality at a rural hospital. A retrospective review of consecutive neonatal admissions to Empangeni Hospital; between January and December 2005; was conducted. Of 1;573 admissions; male babies made up 57.8 of admissions and 63 of the deaths. The most common causes of admission were birth asphyxia (38.2); prematurity (23.5); and infection (21). The average length of stay was 9.2 days (SD 12 days). The overall mortality rate was 13.8 but higher (23.4) among the referred babies. Admission and death rates of low birthweight babies ( 2;500g) were 53 and 84; respectively. Two-thirds (67.7) of those babies who died were born preterm. Over half (56.6) of the deaths took place within the first three days of life. Logistic regression showed that extremely low birthweight (OR

Morbidity and Mortality Pattern of Neonates Admitted into Nursery Unit in Wad Medani Hospital; Sudan

Background: Neonatal outcome is an important indicator of obstetrics and health care. Few or no published data are available concerning neonatal morbidity and mortality in Sudan. Objectives: To study morbidity and mortality pattern amongst inborn neonates admitted into nursery unit in Wad Medani Hospital; Sudan during the period Jan-June; 2009. Results: A total of 1211 (29.5) out of 4098 in-born neonates were admitted during study period. The major indications for neonatal admission were; infections 300 (24.8); low birth weight (LBW) 307(25.4) and asphyxia 130(10.7). There were 133(11) neonatal deaths; preterm delivery; LBW and birth asphyxia were the major causes of death among these neonates. Conclusion: neonatal infection; preterm birth and LBW were the common causes of neonatal morbidity and mortality. There is an urgent need for more research throughout the country concerning these common causes of morbidity and mortality

Iatrogenic burns injury complication neonatal resuscitation

A case of iatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury; with surface area coverage of about 4; involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice

Causes of sudden death as seen at autopsy in Mulago

The autopsy study was carried out in the mortuaries found at Mulago to studt lesions in sudden death in respect to age; sex; tribe and high light any other disorders identified in the cases. There were 51 cases on which autopsy was carried on; 26 from the hospital mortuary and 25 from forensic mortuary. These cases fufilled the definition of sudden death using the WHO definition 1971. 26 cases were male (51) and 2 female (49) The median age was 35 years and the average age was 40.73 years. The highest number of cases came from Ganda tribe with 28; (54.9) and the lowest cases were from Samia; Nyoro; Lugbara; and Rwanda. Infection was the commonest cause of sudden death accounting for 12 cases followed by asphyxia 9 and then pulmonary embolism 5 cases. In general respiratory causes of death contributed the highest number of death with 21 out of 51 (41.2). In 12 months 25 cases of sudden deaths were seen in Mulago Hospital this represented (6.25) of the 400 autopsies done in 1997. The study showed that sudden death is quite common in Mulago with an almost equal male to female ratio and was found to be highest in the young active age group but no age was exempted. The study also demonstrated that some of the causes of sudden death are preventable and if identified early this can go along way to limit the incidences of sudden death. There were also a number of limitations. Because of Religious and cultural reasons; autopsy was not done on all people who died suddenly. Since in most cases bodies had to be carried from long distances to the mortuary were postmortem could be performed; distance to Mulago also had a role to play. Lack of some technical facilities limited the scope of findings in sudden death i.e. toxicological and biochemical examinations were not done yet this could have added on more information