Neonatal Mortality in an Iranian Referral Level Ш Neonatal Intensive Care Unit: A Cross-Sectional Study

Background: Despite the significant improvement in neonatal intensive care, neonatal death is still one of the most important challenges worldwide. Understanding the causes of neonatal mortality is important for health policymakers. This study aimed to assess neonatal mortality in an Iranian referral level Ш Neonatal Intensive Care Unit (NICU). Methods: This cross-sectional study was conducted on the neonates who were referred to a level Ш NICU between 2014 and 2019. Data collection was performed by the research assistants, using a pre-designed checklist from the neonatal medical records. All the neonatal records of the patients who died during the infancy period were collected. Data were analyzed using SPSS (version 23). Results: In total, 388 (12%) out of 3,078 inpatient neonates died In this study. The mean gestational age of neonates who died was 34.9 weeks and 53% of them were males. In addition, 92 (23%) of them died when they aged between 0-7 days and hyponatremia was the most common (30.9%) abnormal laboratory finding among them. The main causes of mortality included sepsis (26%), congenital multiple anomalies (21%), prematurity (20%), surgical procedures (15%), congenital heart disease (8%), inborn metabolic disorder (6%), hypoxic-ischemic encephalopathy (2.8%), and some unknown reasons (1.2 %), respectively. Sepsis, as the most common disorder in neonatal mortality among the patients, was detected in 74 (58.27%) preterm infants, and Acinetobacter was the main microbial detected pathogen. The rate of sepsis was significantly different in different gestational ages (P<0.001). Conclusion: Based on the obtained results, sepsis, prematurity, and congenital multiple anomalies are the most common causes of mortality among neonates. Causes of mortality during the first month of life were different indicating the need for evidence-based interventions and proper policymaking in the field of neonatal health.