648 - Pathological and non-pathological (modifiable factors) causes of deaths in infants admitted to a neonatal unit in a public tertiary hospital in South Africa: a descriptive study.

Understanding infant characteristics, pathological and modifiable causes of neonatal deaths is critical in identifying appropriate interventions. It is important that information about causes of deaths is locally derived as much as possible, and appropriately categorized for decision-making.

Objective:

To determine characteristics, underlying and immediate pathological and modifiable causes of deaths in infants admitted to a neonatal unit in a public-tertiary hospital from a low-resource setting.

Design/Methods:

This was a retrospective review of neonatal death summaries for an 8-month period from Chris Hani Baragwanath Academic Hospital. They were reviewed for infants’ birthweight, gestational age, human immunodeficiency virus (HIV) exposure/infection status, postnatal age at death, main diagnosis on admission (underlying cause), condition assessed to have caused death (immediate cause) and possible modifiable factors for each death.

Results:

There were 377 deaths, of which 350 (92.8%) had death summaries and were reviewed. Their mean birthweight was 1544±937 grams, with 42.3% and 63.4% weighing < 1000 grams and < 1500 grams respectively. Mean gestational age was 30±5 weeks, with 72.2% born at ≤34 weeks. Among 338 with HIV results, 100 (29.6%) were HIV-exposed and 5 (1.5%) infected. Deaths occurred in Labor and Delivery room (7.4%), Level 1 and 2 nurseries (51.4%) and Level 3 nursery (41.1%). 215 (61.4%) were early-neonatal deaths (postnatal-age: 0-6 days). Underlying causes of deaths were prematurity (63.1%), intrapartum-asphyxia (17.1%), congenital anomalies (16.6%), infections (1.4%) and others (1.7%). The immediate causes of death were infections (47.4%), prematurity-related (28%), asphyxia-related (17.4%), congenital anomalies (4.0%) and others (3.4%). Amongst the deaths with prematurity as the underlying cause of death, 46% died from infections, with 93.6% being hospital acquired (HAI). HAI accounted for 69% of deaths in neonates with congenital anomalies. Non-pathological causes or modifiable factors were identified in 77.4% of deaths, with infection control, unavailability of Level 3 nursery beds and hypothermia in 65.6%, 35.1% and 18.3% of deaths respectively.

Conclusion(s):

About two-thirds of neonatal deaths were < 1500 grams, ≤34 weeks and occurred within the first week of life. Though the common underlying causes of deaths were prematurity, congenital anomalies and intrapartum-asphyxia, the common immediate cause was HAI. Interventions to reduce neonatal deaths should focus on infection prevention and control, increasing neonatal bed numbers and improve quality of care of preterm infants.