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Neonatal intensive care in a developing country: outcome and factors associated with mortality
R Kambarami1, O Chidede, M Chirisa
1Department of Paediatrics and Child Health, Medical School, Box A 178, Avondale, Harare, Zimbabwe.
Objective:
To determine outcome and factors associated with mortality in a tertiary level neonatal intensive care unit.
Design:
Retrospective descriptive study.
Setting:
Harare Central Hospital Neonatal Intensive Care Unit (NICU).
Subjects:
All neonates admitted to the NICU in 1998.
Main Outcome Measure:
Mortality.
Results:
A total of 234 neonates were admitted to the NICU in 1998. Median age at admission was one day (Q1 = 0, Q3 = 3). Median birth weight was 1,730 gms (Q1 = 690, Q3 = 2,209). The commonest reason for admission was respiratory distress. Medical cases were 171 (73.1%), surgical 61 (26.1%) and two were not indicated. The median duration of stay in the NICU was three days (Q1 = 1, Q3 = 6). Median age at death was three days (Q1 = 1, Q3 = 5). Case fatality rate was 46.4% and 85.9% died during the first week. Receiving mechanical ventilation was associated with high mortality. The odds of dying were 12.29 times greater for those who were ventilated compared to those who received continuous positive airways pressure (CPAP) via nasal prongs. Birth weight, age at admission to the NICU, sex and duration of stay in the NICU had no significant influence on mortality.
Conclusion:
Mortality rates in this NICU were unacceptably high and call for urgent action. Attempts to identify true risk factors for the NICU mortality on the face of sub-optimal care may be misleading. There is need to improve neonatal audit in order to identify effective treatments and guide policies for the NICU care.
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