The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
J Paediatr Child Health. 2021 Jun;57(6):841-846. doi: 10.1111/jpc.15333. Epub 2021 Jan 15.
To determine the causes of early neonatal death and the avoidable factors associated with these deaths among women participating in a cluster-randomised crossover trial in Papua New Guinea.
Early neonatal deaths were identified by retrospective chart review of the Women and Newborn Trial of Antenatal Interventions and Management study participants between July 2017 and January 2020. Causes of death and avoidable factors were identified using the Perinatal Problem Identification Program system.
There were 35 early neonatal deaths among 2499 livebirths (14 per 1000 births). Fifty-seven percent (20/35) of deaths occurred on the first day of life. Idiopathic preterm birth was the leading obstetric cause of perinatal death (29%; 10/35). Extreme multi-organ immaturity (23%; 8/35) and hypoxic ischaemic encephalopathy (17%; 6/35) were the most common final causes of neonatal death. Forty-six avoidable factors were identified among 26 deaths, including delays in care-seeking, insufficient resources at health facilities, poor intrapartum care and immediate care of the newborn, including neonatal resuscitation.
In this study, potentially preventable causes and avoidable factors were identified in the majority of early neonatal deaths. Addressing these factors will require health system strengthening, particularly the upskilling of primary level health staff, as well as targeted health education of women and the community.
确定巴布亚新几内亚参与一项群组随机交叉试验的女性中早期新生儿死亡的原因以及与这些死亡相关的可避免因素。
通过对 2017 年 7 月至 2020 年 1 月期间 Women and Newborn Trial of Antenatal Interventions and Management 研究参与者的回顾性图表审查，确定早期新生儿死亡。使用围产期问题识别程序系统确定死亡原因和可避免因素。
在 2499 例活产中，有 35 例早期新生儿死亡（每 1000 例出生 14 例）。57%（20/35）的死亡发生在生命的第一天。特发性早产是围产期死亡的主要产科原因（29%；10/35）。极端多器官不成熟（23%；8/35）和缺氧缺血性脑病（17%；6/35）是新生儿死亡的最常见最终原因。在 26 例死亡中，确定了 46 个可避免因素，包括寻求护理的延迟、卫生设施资源不足、分娩期间护理不佳以及新生儿复苏等新生儿立即护理。
在这项研究中，大多数早期新生儿死亡都存在潜在可预防的原因和可避免因素。解决这些因素需要加强卫生系统，特别是提高初级卫生人员的技能，以及对妇女和社区进行有针对性的健康教育。
