Deaths at King Abdulaziz Medical City
Results and Discussion
Results
The current study aimed to determine the time trends and the determinants of deaths at King Abdulaziz Medical City. The pattern of preterm infants’ mortality at King Abdulaziz Medical City has been irregular for ten years (2007-2017). In 2007, the number of preterm deaths was low at 2. In the following year, the number increased to 11. In 2009, premature deaths amounted to eight. The results for the remaining years are as displayed in Graph 1 below.
Cause of Death
Prematurity related causes accounted for 65.79% of the total preterm deaths. The second major cause was sepsis at 30.26%, followed by Asphyxia at 2.63%. Other reasons that were not related to prematurity, sepsis or asphyxia accounted for 1.32% of the total deaths.
Prematurity Related Causes
In terms of prematurity related causes, Major Intraventricular Hemorrhage was the leading cause of preterm deaths (51%). Respiratory Distress Syndrome also accounted for 27% of all prematurity related preterm births. The other cause associated with prematurity was Necrotizing Enterocolitis at 22%.
48.5% of survived preterm infants were male while the percentage of those who died for male infants was significantly high at 55.4%. Other demographic and clinical characteristics of preterm infants who survived or died are as displayed in the table below:
| Table1. Demographic and clinical characteristics of preterm infants who died or survived, in a retrospective study at King Abdulaziz Medical City – Jeddah, 2007–2017
| |||
| P- value | Died Preterm infants | Survived preterm infants | |
| 0.92 | 55.4% | 48.5% | Gender (Male %)
|
| <0.001 | 1 (1-1) | 7 (6-8) | APGAR Score at 5 Minutes *
|
| 0.02 | 27 (3.6) | 31.9 (2.6) | Gestational Age **
|
| <0.0001 | 936 (437) | 1921 (624) | Birth Weight **
|
| <0.001 | 64.5% | 36.7% | Mode of Delivery (Caesarean Delivery %)
|
| <0.001 | 68.4% | 2.6% | Antenatal Visits |
| <0.002 | 9.2% | 1.3% | Multiple Pregnancies
|
| <0.001 | 32.9% | 7.6% | Previous Preterm
|
| <0.001 | 14.5% | 42.1% | Antenatal Steroids
|
| <0.001 | 10.5% | 2.4% | Antenatal Antibiotics *
|
| <0.001 | 48.7% | 12.5% | Maternal Health Disease |
| <0.0001 | 30.3% | 1.7% | Premature Rupture of Membranes (PROM)
|
Discussion
The results of this study showed that Major Intraventricular Hemorrhage was a significant cause of preterm deaths. This finding is in line with the findings of Schindler et al. (1). In their study about the causes of mortality in preterm infants in neonatal intensive care units, they identified Major Intraventricular Hemorrhage and acute respiratory illnesses as the most common causes. The trend of preterm deaths was also found to be wavering. This finding is also in line with the results of Schindler et al. (1). The discovery provides insight into the prolonged vulnerability for illnesses like necrotizing enterocolitis. This finding implies that newborn units should have essential facilities such as ventilators to control the mortality of preterm infants.
In terms of the clinical and demographic characteristics, the current study indicated that male infants had a significantly high chance of preterm deaths (55.4 %) compared to female infants. A study by Jones et al. (2) found out that survival for female and male infants was not meaningfully different except for infants born at 24 weeks gestation whereby the female infants had a higher number of survivals. Jones et al. (2) established that female infants had a considerably lower prevalence of severe intraventricular haemorrhage than the male infants did. This finding may be supported by the fact that female infants tend to be more mature at any given birth weight. The high survival for female infants may also be related to the favourable hormonal milieu in a female fetus that leads to enhanced lung maturation compared to male infants.
The current study showed that administration of Antenatal Steroids increased the chances of survival for the preterm infants admitted at King Abdul-Aziz Medical City. The survival rate was at 42.1% compared to the death rate at 14.5%. This finding is in line with the results of a previous study by Temesgen, Worku & Regassa (3) whereby antenatal steroid administration had a protective impact for preterm infants. Furthermore, the current study indicated that higher birth weight and longer gestation age increased the chances of survival for preterm babies. This aspect suggests that very premature and deficient birth weight babies require more attention as well as immediate and prompt assistance. Other clinical and demographic characteristics such as maternal health disease, previous preterm, multiple pregnancies, antenatal antibiotics, and premature rupture of membranes were associated with high death rates for premature infants at King Abdul-Aziz Medical City. This finding is in line with the results of the study by Schindler et al. (1). This finding underlines the need to identify such characteristics at the early stages of pregnancy, so that appropriate care may be given.
References
- Schindler T, Koller-Smith L, Lui K, Bajuk B, Bolisetty S. Causes of death in very preterm infants cared for in neonatal intensive care units: a population-based retrospective cohort study. BMC Pediatrics. 2017; 17(1).
- Jones H, Karuri S, Cronin C, Ohlsson A, Peliowski A, Synnes A et al. Actuarial survival of a large Canadian cohort of preterm infants. BMC Pediatrics. 2005; 5(1).
- Temesgen M, Worku B, Regassa Y. Survival Of Preterm Infants Admitted To Tikur Anbessa Hospital Nicu, Addis Ababa [Internet]. Ejol.aau.edu.et. 2014 [cited 4 September 2019]. Available from: http://ejol.aau.edu.et/index.php/EJPC/article/view/773