Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Faridpur Medical College Hospital, Faridpur, Bangladesh.
Am J Trop Med Hyg. 2023 Mar 6;108(4):844-850. doi: 10.4269/ajtmh.22-0302. Print 2023 Apr 5.
The 2020 neonatal mortality rate in Bangladesh was 17 deaths per 1,000 live births, higher than the 2030 Sustainable Development Goal target (12 deaths per 1,000 live births). Over the past decade, Bangladesh has established special care newborn units (SCANUs) in medical facilities countrywide to improve neonatal survival. We conducted a retrospective cohort study in the SCANU of a tertiary-level healthcare facility in Bangladesh to study neonatal survival and associated risk factors using descriptive statistics and logistic regression models. Of 674 neonates admitted to the unit between January and November 2018, 263 (39%) died in hospital, 309 (46%) were discharged against medical advice, 90 (13%) were discharged healthy, and 12 (2%) had other discharge statuses. The median duration of time spent in hospital was 3 days, and 60% were admitted at birth. Neonates delivered via Cesarean section (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.2-5.6) had an increased odds of recovering and being discharged, whereas those diagnosed with prematurity and/or low birth weight at admission (aOR: 0.2; 95% CI: 0.1-0.4) had a decreased odds of doing so. The high mortality rate and large number of neonates discharged against medical advice suggest a need to investigate the etiology of death and the factors leading to children leaving hospital prior to recovery. Medical records lacked information on gestational age that could provide key insights about mortality risk and age of viability in this setting. Addressing these knowledge gaps in SCANUs may enable better support for the improvement of child survival.
2020 年，孟加拉国的新生儿死亡率为每 1000 例活产死亡 17 例，高于 2030 年可持续发展目标（每 1000 例活产死亡 12 例）。在过去的十年中，孟加拉国在全国的医疗设施中建立了新生儿特别护理单位（SCANU），以提高新生儿的存活率。我们在孟加拉国一家三级保健设施的 SCANU 中进行了一项回顾性队列研究，使用描述性统计和逻辑回归模型研究新生儿的存活率及其相关的危险因素。2018 年 1 月至 11 月期间，有 674 名新生儿入住该单位，其中 263 名（39%）在医院死亡，309 名（46%）未经医嘱出院，90 名（13%）健康出院，12 名（2%）有其他出院状态。在医院住院的中位时间为 3 天，60%是在出生时入院的。通过剖腹产分娩的新生儿（校正优势比[aOR]：2.5；95%置信区间[CI]：1.2-5.6）恢复和出院的几率增加，而在入院时被诊断为早产和/或低出生体重的新生儿（aOR：0.2；95% CI：0.1-0.4）恢复和出院的几率降低。高死亡率和大量未经医嘱出院的新生儿表明需要调查死亡原因以及导致儿童在康复前出院的因素。医疗记录缺乏有关胎龄的信息，这些信息可以提供有关该环境下死亡率风险和生存年龄的关键见解。解决 SCANU 中的这些知识空白可能有助于更好地支持提高儿童的存活率。
