Gannon Hannah, Chimhini Gwendoline, Cortina-Borja Mario, Chiyaka Tarisai, Mangiza Marcia, Fitzgerald Felicity, Heys Michelle, Neal Samuel R, Chimhuya Simbarashe
Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
Unit of Child and Adolescent Health, Faculty of Medicine and Health Sciences. Primary Healthcare Sciences, University of Zimbabwe, Harare, Zimbabwe.
PLOS Glob Public Health. 2022 Dec 20;2(12):e0000911. doi: 10.1371/journal.pgph.0000911. eCollection 2022.
Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with neonatal encephalopathy from a tertiary neonatal unit in Zimbabwe. A retrospective review of risk factors of short-term neonatal encephalopathy mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 -October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of neonatal encephalopathy, incorporating maternal, intrapartum, and neonatal risk predictors of the primary outcome: mortality. 494/2894 neonates had neonatal encephalopathy on admission and were included. Of these, 94 died giving a neonatal encephalopathy-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence interval (CI) 1.39-6.25), convulsions (OR 7.13 (1.41-36.1)), lethargy (OR 3.13 (1.24-7.91)), Thompson score "11-14" (OR 2.98 (1.08-8.22)) or "15-22" (OR 17.61 (1.74-178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Nearly 1 in 5 neonates diagnosed with neonatal encephalopathy died before discharge, similar to other low-resource settings but more than in typical high-resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with neonatal encephalopathy was an appropriate predictive clinical scoring system to identify at risk neonates in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on neonatal encephalopathy mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions.
新生儿脑病（NE）占全球每年240万例新生儿死亡的约23%。然而，全球约99%的新生儿死亡发生在资源匮乏地区，而这些地区的准确数据稀缺。我们回顾了来自津巴布韦一家三级新生儿病房收治的患有新生儿脑病的新生儿的死亡风险因素。在萨利·穆加贝中心医院（SMCH）（2018年11月至2019年10月）对短期新生儿脑病死亡的风险因素进行了回顾性研究。数据通过基于平板电脑的数据采集和质量改进新生儿护理应用程序（Neotree）收集。对所有诊断为新生儿脑病的入院新生儿的数据进行分析，纳入主要结局（死亡率）的母亲、分娩期和新生儿风险预测因素。494/2894例新生儿入院时患有新生儿脑病并被纳入研究。其中，94例死亡，新生儿脑病病例死亡率（CFR）为每1000例入院新生儿中有190例。剖宫产（比值比（OR）2.95（95%置信区间（CI）1.39 - 6.25））、惊厥（OR 7.13（1.41 - 36.1））、嗜睡（OR 3.13（1.24 - 7.91））、汤普森评分“11 - 14”（OR 2.98（1.08 - 8.22））或“15 - 22”（OR 17.61（1.74 - 178.0））与新生儿死亡显著相关。没有母亲风险因素与死亡率相关。近五分之一被诊断为新生儿脑病的新生儿在出院前死亡，这与其他资源匮乏地区相似，但高于典型的资源丰富中心。汤普森评分是一种经过验证的、敏感且特异的诊断新生儿脑病的工具，可以作为识别该地区高危新生儿的合适的临床预测评分系统。单变量分析显示，时间段，特别是因罢工导致人员短缺的时期，对新生儿脑病死亡率有显著影响。急诊剖宫产与死亡率增加相关，这表明围产期护理可能是未来干预的关键时机。
