Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS),
Sana Mahtab1, Shabir A Madhi1, Vicky L Baillie1
1South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Millions of newborns die annually. The Child Health and Mortality Prevention Surveillance (CHAMPS) network investigated causes of neonatal death, revealing complex causal chains involving infections, prematurity, and intrapartum events, highlighting critical prevention needs.
Area of Science:
- Global Health
- Pediatrics
- Epidemiology
Background:
- Neonatal mortality remains a significant global health challenge, with millions of deaths occurring within the first month of life annually.
- Accurate data on the causes of neonatal death are crucial for developing effective prevention strategies.
- The Child Health and Mortality Prevention Surveillance (CHAMPS) network was established to address this data gap in seven countries.
Purpose of the Study:
- To investigate the underlying and contributing causes of neonatal deaths using a comprehensive methodology.
- To analyze the full causal chain of events leading to neonatal mortality.
- To identify key maternal factors associated with neonatal deaths.
Main Methods:
- A multi-country surveillance study (CHAMPS) involving Medical and Social Autopsy (MITS) for neonatal deaths (December 2016-December 2021).
- Comprehensive testing included cultures, multi-pathogen PCR, and histopathology.
- Standardized verbal autopsy and clinical record review were used for data collection, with expert review for cause of death determination.
Main Results:
- 1458 neonatal deaths were analyzed, stratified by timing: early (within 24 hours), late (1-6 days), and late (7-27 days).
- Leading underlying causes included intrapartum events (31%), prematurity (28%), infections (17%), respiratory disorders (11%), and congenital malformations (8%).
- Infections (40%), prematurity (32%), and respiratory distress syndrome (28%) were most common when considering the entire causal chain; 62% of deaths had additional conditions.
Conclusions:
- Neonatal deaths often result from complex, multi-factorial causal chains, not single causes.
- Maternal factors such as hypertension, delivery complications, and placental issues significantly contribute to neonatal mortality.
- Improvements in prenatal care, obstetric management, and infection prevention are urgently needed in high-mortality settings to reduce preventable neonatal deaths.
Abstract:
Each year, 2.4 million children die within their first month of life. Child Health and Mortality Prevention Surveillance (CHAMPS) established in 7 countries aims to generate accurate data on why such deaths occur and inform prevention strategies. Neonatal deaths that occurred between December 2016 and December 2021 were investigated with MITS within 24-72 hours of death. Testing included blood, cerebrospinal fluid and lung cultures, multi-pathogen PCR on blood, CSF, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver and brain. Data collection included clinical record review and family interview using standardized verbal autopsy. The full set of data was reviewed by local experts using a standardized process (Determination of Cause of Death) to identify all relevant conditions leading to death (causal chain), per WHO recommendations. For analysis we stratified neonatal death into 24-hours of birth, early (1-<7 days) and late (7-<28 days) neonatal deaths. We analyzed 1458 deaths, 41% occurring within 24-hours, 41% early and 18% late neonatal deaths. Leading underlying causes of death were complications of intrapartum events (31%), complications of prematurity (28%), infections (17%), respiratory disorders (11%), and congenital malformations (8%). In addition to the underlying cause, 62% of deaths had additional conditions and 14% had ≥3 other conditions in the causal chain. The most common causes considering the whole causal chain were infection (40%), prematurity (32%) and respiratory distress syndrome (28%). Common maternal conditions linked to neonatal death were maternal hypertension (10%), labour and delivery complications (8%), multiple gestation (7%), placental complications (6%) obstructed labour and chorioamnionitis (5%, each). CHAMPS' findings showing the full causal chain of events that lead to death, in addition to maternal factors, highlights the complexities involved in each death along with the multiple opportunities for prevention. Highlighting improvements to prenatal and obstetric care and infection prevention are urgently needed in high-mortality settings.
More Related Videos
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
05:50International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
