The rate and risk factors of mortality in neonate in the largest NICU in Southern Iran

Introduction: There is an extremely high risk of mortality for fetuses and newborns around the time of birth (1). The late prenatal and early neonatal periods are the two age groups with the highest rates of mortality (2). Neonatal mortality rate (NMR), is considered one of the basic indicators of a society’s health status (2) and is often used as a standard indicator in the development of educational, social and healthcare systems in a country (9). Therefore, by focusing on this fact and improving the conditions in prenatal and neonatal stages, we might come to witness an increased survival rate among newborns all around the world (10).It has been estimated that 3 million newborn infants lose their lives within the first 7 days annually (16), and 98% of all these neonatal deaths occur in developing countries (6, 7, 8). Given that over two thirds of newborn deaths happen in the sub-Saharan Africa and South Asia, these regions must become the focal point of efforts toward reducing these deaths (12, 13, 14).In Iran, NMR was reported as 32 deaths per 1000 live births in 1976 (18), which had reached to 18.3 deaths per 1000 live births in the year 2000 (18). Currently, our country has a neonatal mortality rate of 12-15 deaths per 1000 live births, while this rate equals 5 deaths per 1000 live births in developed countries (20).Since the neonatal intensive care unit (NICU) in Hazrat-e Zainab hospital, Shiraz, is the largest NICU in Southern Iran, we tried to take an effective step toward reducing neonatal mortality by exploring the causes of neonatal death in this center and using the results to arrive at suitable solutions. Methodology: The present article involves a cross-sectional study. Since the study population consisted of all infants deceased in the NICU of Hazrat-e Zainab hospital in late 2013-early 2014 (1392 SH). Thereby, the census method was used in this study. In regard to the data collection procedure, the researcher visited the hospital records collection to extract the required data from respective files in order to complete a number of questionnaires. Data were analyzed based on causes of death, gender, age of death, gestational age, birthweight, mother’s age, mother’s tobacco use, presence of disease, mother’s history of drug use, and method of childbirth. It must be noted that in this study, the causes involved in neonatal death were selected based on a table provided by the Iranian Ministry of Health and Medical Education. The causes of death were determined based on medical records and diagnoses provided by neonatologists. Descriptive-analytic methods were used to describe the variables under study. Data analysis was carried out using SPSS Statistics 22.0, with the statistical significance level set at P < 0.05.The population under study included all infants deceased in the NICU of Hazrat-e Zainab hospital, Shiraz, in late 2013-early 2014 (1392 SH). Thus, a sample of 166 deceased infants was investigated in this research, and the group only involved newborns passed away within the first 28 days following birth.Exclusion Criteria: Deceased infants with a gestational age of under 23 weeks or a birth weight of under 400 g and still-born fetuses were excluded from the study. Furthermore, patient files with incomplete data were also eliminated.In this study, the Chi-square test was used to analyze the inter-variable relationships (i.e. relationships between pairs of qualitative variables). The questionnaires were designed in a way that would not require names, and therefore, data were collected anonymously.Results: According to the present study, of the 166 deceased infants under research, 92 (55.4%) were boys and 74 (44.6%) were girls. The causes of death were almost similar in male and female infants, and no statistically significant relationships were found between gender and cause of death (P = 0.819).