Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical College, PO Box 3010, Moshi, Tanzania.
BMC Pediatr. 2012 Aug 7;12:116. doi: 10.1186/1471-2431-12-116.
The current decline in under-five mortality shows an increase in share of neonatal deaths. In order to address neonatal mortality and possibly identify areas of prevention and intervention, we studied causes of admission and cause-specific neonatal mortality in a neonatal care unit at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.
A total of 5033 inborn neonates admitted to a neonatal care unit (NCU) from 2000 to 2010 registered at the KCMC Medical Birth Registry and neonatal registry were studied. Clinical diagnosis, gestational age, birth weight, Apgar score and date at admission and discharge were registered. Cause-specific of neonatal deaths were classified by modified Wigglesworth classification. Statistical analysis was performed in SPSS 18.0.
Leading causes of admission were birth asphyxia (26.8%), prematurity (18.4%), risk of infection (16.9%), neonatal infection (15.4%), and birth weight above 4000 g (10.7%). Overall mortality was 10.7% (536 deaths). Leading single causes of death were birth asphyxia (n = 245, 45.7%), prematurity (n = 188, 35.1%), congenital malformations (n = 49, 9.1%), and infections (n = 46, 8.6%). Babies with birth weight below 2500 g constituted 29% of all admissions and 52.1% of all deaths. Except for congenital malformations, case fatality declined with increasing birth weight. Birth asphyxia was the most frequent cause of death in normal birth weight babies (n = 179/246, 73.1%) and prematurity in low birth weight babies (n = 178/188, 94.7%). The majority of deaths (n = 304, 56.7%) occurred within 24 hours, and 490 (91.4%) within the first week.
Birth asphyxia in normal birth weight babies and prematurity in low birth weight babies each accounted for one third of all deaths in this population. The high number of deaths attributable to birth asphyxia in normal birth weight babies suggests further studies to identify causal mechanisms. Strategies directed towards making obstetric and newborn care timely available with proper antenatal, maternal and newborn care support with regular training on resuscitation skills would improve child survival.
目前五岁以下儿童死亡率的下降表明新生儿死亡比例的增加。为了解决新生儿死亡问题，并可能确定预防和干预的领域，我们研究了坦桑尼亚基督城医疗中心（KCMC）新生儿护理病房（NCU）入院原因和特定病因新生儿死亡的原因。
研究了 2000 年至 2010 年在 KCMC 医疗出生登记处和新生儿登记处登记的 5033 名在胎内出生并入住新生儿护理病房（NCU）的新生儿。记录了临床诊断、胎龄、出生体重、阿普加评分以及入院和出院日期。根据改良威格尔斯沃思分类法对新生儿死亡的特定病因进行分类。在 SPSS 18.0 中进行统计分析。
入院的主要原因是出生窒息（26.8%）、早产（18.4%）、感染风险（16.9%）、新生儿感染（15.4%）和出生体重超过 4000g（10.7%）。总体死亡率为 10.7%（536 例死亡）。单一主要死因是出生窒息（n=245，45.7%）、早产（n=188，35.1%）、先天性畸形（n=49，9.1%）和感染（n=46，8.6%）。出生体重低于 2500g 的婴儿占所有入院婴儿的 29%，占所有死亡婴儿的 52.1%。除先天性畸形外，随着出生体重的增加，病死率下降。出生窒息是正常出生体重婴儿死亡的最常见原因（n=246，73.1%），早产是低出生体重婴儿死亡的最常见原因（n=188，94.7%）。大多数死亡（n=304，56.7%）发生在 24 小时内，490 例（91.4%）发生在第一周内。
本研究人群中，正常出生体重婴儿的出生窒息和低出生体重婴儿的早产各占所有死亡人数的三分之一。正常出生体重婴儿中因出生窒息导致的死亡人数较多，表明需要进一步研究以确定因果机制。通过及时提供产科和新生儿护理、提供适当的产前、产妇和新生儿护理支持以及定期进行复苏技能培训，制定改善儿童生存的战略，将提高儿童的生存机会。
