Neonatal Hospital Mortality in South Vietnam

Project summary

Overall aim: To examine newborn hospital mortality in South Vietnam in order to design intervention studies to be conducted in the next project phase. The studies are conducted in a tertiary specialized hospital and 3 referring secondary general province hospitals in 12 months periods in 2009-2011. Specific aims: 1. To conduct a prospective cohort studies including data registration on admission of all newborns. The infants are followed until discharge or death. Cases are defined as death at age < 29 days, either in hospital or at home after termination of treatment. Primary outcome is Case Fatality Rate and risk/ protective factors at admission associated with newborn hospital mortality. Further, the newborn population admitted to the hospital is described. 2. To conduct prospective qualitative studies of events during hospitalization on all cases from the cohort study. Hospital risk factors of neonatal hospital mortality and possible interventions are identified in a structured audit procedure. Intervention studies designed according to the findings in the present baseline studies will be conducted in the next project phase, planned in 2012. The project is part of a long lasting development cooperation and is part a broader child survival project, supported by The Danida Bistandsfond. The project group includes specialists and 2 PhD students from Denmark and Vietnam. Communication includes international peer reviewed publications and reporting to hospitals and health authorities.

Outputs

Project Completion Report:

In spite of the magnitude, knowledge about newbom mortality is very limited in resource poor settings like Vietnam. We explored newborn morbidity and mortality in hospital (general and specialized pediatric care) and community settings in South Vietnam in 7 studies (n= 7468).

Prematurity, asphyxia and malformations are known to be major causes of newborn mortality. However, these groups of vulnerable newborns seemed significantly underrepresented in the specialized hospital studied. In contrast mild conditions were common (24%). Further, the mortality rate was similar to the general hospital (5%). Our findings suggest utilization of the specialized newborn care may not be optimal.

In both hospitals, vital signs at admission were the most important pre-hospital predictor of death. Notably socio-demographic characteristics like gender, ethnicity and parental education were sigiiiftcant.

Infection was a major problem in both study hospitals and infection management was one of the major potentially preventable in-hospital risk factors identified in a structured audit procedure.

It was possible to implement Nitric Oxide for respiratory failure in specialized newborn intensive care.

In the community, the newbom health seeking behaviour seemed adequate.

We recommend to increase access to specialized care for vulnerable newborns, improve early hospital management and infection control to improve newborn survival in Vietnam.