Causes of neonatal deaths in Malaysian neonatal intensive care units in 2015-2020: A descriptive study.

INTRODUCTION

To investigate the major causes of neonatal deaths in Malaysian neonatal intensive care units (NICUs).

MATERIALS AND

METHODS

This retrospective observational study analysed prospectively collected data of neonates (gestation ≥22 weeks, birthweight ≥500g) admitted to 44 NICUs in the years 2015-2020 in the Malaysian National Neonatal Registry. Causes of death were reported using the modified Wigglesworth classification.

RESULTS

Out of 759,435 neonates, 1.2% (n=9470) died. Most (72.3%) were early neonatal deaths (0-7days of life), 17.5% were late neonatal deaths (8-28 days of life), and 10.2% were post-neonatal deaths (>28 days of life). Inborn extremely preterm (EPT, <28 weeks gestation) neonates had the highest death rates (427.5/1000 livebirths) and term neonates (1.7/1000 livebirths) had the lowest. Congenital malformations accounted for 33.0% of deaths; the majority were of gestation ≥28 weeks. Trisomy 18 (n=542), trisomy 13 (n=397), cardiovascular (CVS) malformations (n=371) and neurological malformations including neuro-tube defects (NTD) (n=252) were the four most common types of malformations. The three most common causes of non-malformation deaths were EPT (n=1424), sepsis (n=867, affecting all gestations), and hypoxic-ischaemic encephalopathy (HIE) in term neonates with/without multiorgan failure (n=570). Less than one-third of EPT neonates who died received respiratory support at birth. Most (85.3%) sepsis death was late-onset sepsis (≥72 hours of age). Only 27.8% term neonates dying from HIE received adequate therapeutic hypothermia.

CONCLUSIONS

Extreme prematurity, nosocomial sepsis, HIE in term neonates, chromosomal abnormalities due to trisomy 18 and trisomy 13, ductal-dependent CVS malformations, and NTD were the six most common causes of neonatal deaths in Malaysian NICUs.