Evaluation of factors affecting mortality in newborn intensive care

Introduction and Objective: The rates of neonatal mortality are gradually decreasing thanks to the increase in the number of tertiary neonatal intensive care units with both new treatment modalities and advanced materials. Despite this, rates of neonatal mortality are not at the desired levels. There are many factors that affect neonatal mortality rates. This study aims to determine these risk factors. Material and Method: In this retrospective research, the cases with accessible records, hospitalized in Dicle University Faculty of Medicine Hospital, Pediatrics Department, Neonatalogy Clinic between January 1st, 2018 and December 31st 2019, were investigated to reveal the risk factors that cause mortality in these cases. Results: Of the 157 (11 doa) cases included in the study, 51.6% was male, 48.4% was female, 80.3% was referred from Dicle University Faculty of Medicine and 19.7% from different hospitals. Of the cases, 24.2% was normal birth, 75.2% was cesarean, and 0.6% was vacuum/forceps delivery. Of the cases, 63.7% was born <27 weeks and below, 16.2% was born between 28-32 weeks, 13.4% was born between 33-38 weeks, and 7% was born between 39-42 weeks. Of the cases, 64.3% was found to be <1000 gr and below, 14% was between 1001-1500 gr, 3.8% was between 1501-2000 gr, 6.4% was between 2001-2500 gr, and 11.5% was >2500 gr and above. Of the cases, 83.4% was singleton, and 16.6% was multiple birth. Considering the distribution of cases by seasons, 21% was born in spring, 27.4% in summer, 24.2% in autumn, and 25.4% in winter. Looking at the duration of hospital stay of the cases, the average was 17.557±34.762 (min. 0 - max. 215 days). The average maternal age was found to be 28.922±6.821 (min. 16 - max. 46 years). Resuscitation was performed in 22.3% of cases, cranial ultrasound in 43.2%, mechanical ventilation in 84.1%, computarized tomography in 1.9%, and magnetic resonance imaging in 0.6%. In deceased cases, statistically significant differences were found in terms of gender, place of birth, mode of delivery, hypoxic ischemic encephalopathy, gestational age, respiratory distress syndrome, sepsis, hydrops fetalis, oligohydramnios, meconium aspiration syndrome, surfactant, and birth weights. Looking at the distributions of the diagnosis of cases, 6.3% had hypoxic-ischemic encephalopathy, 36.9% had congenital heart disease, 7% had urinary tract anomalies, 0.6% had meningomyelocele, 5.1% had convulsion, 83.4% had respiratory distress syndrome, 88.5% had sepsis, 5.1% had intraventricular hemorrhage, 41.4% had jaundice, 3.8% had hydrops fetalis, 2.5% was diabetic mother infant, 15.9% had preeclampsia, 5.1% had polyhydramnios, 30.6% had oligohydramnios, and 3.2% had meconium aspiration syndrome. Considering the distribution of cases according to the type of treatment applied, 49% underwent fresh frozen plasma, 49.5% erythrocyte suspension, 20.4% platelet suspension, 40.8% phototherapy, 77.7% surfactant, 5,1% exchange, 1.9% intravenous immunoglobulin, 97.5% ampicillin, 47.8% amikacin, 5.1% cefotaxime, 78.3% gentamicin, 48.4% meropenem, 43.9% teicoplanin treatment. Conclusion: It is observed that the mortality rate increases as the gestational age decreases in newborns, and mortality rates and causes are similar to country data, and the majority of cases is observed to be due to prematurity, congenital anomalies, infection and related problems. Therefore, it is of importance and necessary to generalize pregnancy follow-up programs, to provide adequate antenatal care, and to provide delivery and postpartum care in centers with appropriate conditions to determine the causes of preventable mortality and to reduce neonatal mortality rates. Keywords: Neonatal, Intensive Care, Mortality, prematurity