PhD defence - Neonatal Hospital Mortality in South Vietnam – University of Copenhagen

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PhD defence - Neonatal Hospital Mortality in South Vietnam

MD Alexandra Yasmin Kruse will defend her PhD thesis with the title:

Neonatal Hospital Mortality in South Vietnam

Time: Friday 19 April, at 14:00

Place: Medicinsk Museion, Bredgade 62, Copenhagen

 

 

Supervisors:

Freddy Karup Pedersen, Gorm Greisen and Lone Graff Stensballe

Opponents:

Professor Ib Christian Bygbjerg, Lars Åke Persson and Bo Mølholm Hansen

Summary

Of the 4 million neonates (≤ 28 days of age) dying annually, the vast majority die

Private photo Aleandra Yasmin Kruse

in developing countries. Most die of infections, prematurity, asphyxia and congenital malformations. Compared to the decrease in child mortality, achievements to reduce neonatal mortality lag behind, globally and in Vietnam. An estimated 17,000 neonates die annually in Vietnam. Considering that 90% of women deliver in health care facilities, the majority of neonates presumably die in hospital settings. Current knowledge about neonatal morbidity and mortality, however, is limited.

We explored neonatal mortality in the tertiary Paediatric Hospital number 1 in Ho Chi Minh City, Vietnam (PH1). In a 12 month period in 2009 – 2010, 5,763 neonates were admitted. The case fatality rate was 4%. Another 1% was discharged alive after withdrawal-of-life-sustaining-treatment.

In our first study, we described the neonatal hospital population in PH1 and compared to the neo-natal population of Rigshospitalet, Copenhagen, Denmark. Our findings indicate that prematurity, asphyxia and congenital malformations were significantly underrepresented in the hospital, compared to both Rigshospitalet and to the catchment population of the hospital. Further, almost a quarter of the neonates had mild conditions, which could probably have been treated sufficiently at lower levels. The findings suggest that utilization of the specialized care available in PH1 may not be optimal.

In our second study, we examined pre-hospital predictors of death in the hospital among a vulnerable sub-group of 2,196 neonates with a case fatality rate of 9%. The predictors were socio-demography, pregnancy-delivery, neonatal history and clinical status at admission. Notably, ethnicity, parental education and gender were not associated with death, once admitted to the hospital. Impaired respiration, circulation and consciousness at admission were associated with an increased risk of death, which underlines the importance of vital signs at admission.

In our third study, we investigated the 385 neonates, who had blood stream infections defined as positive blood cultures. Most infections were late onset. Frequent isolates were Klebsiella spp., Acinetobacter spp. and Escherichia coli. No Streptococcus group B was identified. The septicaemia related case fatality rate in the study population was 16% and Gram-negative infections carried the highest mortality. Antibiotic resistance was common. Surveillance of neonatal blood stream infections in the hospital is recommended.

In our fourth study, we investigated death cause and potentially avoidable in-hospital risk factors of death (235 neonates) and expected death (67 neonates discharged alive after withdrawal-of-life- sustaining-treatment). Major causes were congenital malformations, infections, prematurity and asphyxia. Among the 85% of the 71 cases with a relatively good prognosis at arrival to the hospital, we identified 6 risk factors, which could be addressed without implement-tation of new technologies or major organizational changes. The risk factors were related to management of general danger signs, septicaemia, internal transfer, equipment, and parental misperception of prognosis.

In conclusion, our studies increase the understanding of neonatal hospital mortality in Vietnam. To decrease neonatal mortality in the study hospital and possibly in similar hospitals, we suggest: increased access to specialized care for vulnerable groups of neonates, further research on early warning scores, implementation of blood stream infection surveillance, and addressing the potentially avoidable risk factors identified in the hospital. Furthermore, implementation of standard mortality audit could be considered.