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Factors Associated with Neonatal Survival in a Special Care Newborn Unit in a Tertiary Care Hospital in Bangladesh
ABSTRACT.
The 2020 neonatal mortality rate in Bangladesh was 17 deaths per 1,000 live births, higher than the 2030 Sustainable Development Goal target (12 deaths per 1,000 live births). Over the past decade, Bangladesh has established special care newborn units (SCANUs) in medical facilities countrywide to improve neonatal survival. We conducted a retrospective cohort study in the SCANU of a tertiary-level healthcare facility in Bangladesh to study neonatal survival and associated risk factors using descriptive statistics and logistic regression models. Of 674 neonates admitted to the unit between January and November 2018, 263 (39%) died in hospital, 309 (46%) were discharged against medical advice, 90 (13%) were discharged healthy, and 12 (2%) had other discharge statuses. The median duration of time spent in hospital was 3 days, and 60% were admitted at birth. Neonates delivered via Cesarean section (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.2–5.6) had an increased odds of recovering and being discharged, whereas those diagnosed with prematurity and/or low birth weight at admission (aOR: 0.2; 95% CI: 0.1–0.4) had a decreased odds of doing so. The high mortality rate and large number of neonates discharged against medical advice suggest a need to investigate the etiology of death and the factors leading to children leaving hospital prior to recovery. Medical records lacked information on gestational age that could provide key insights about mortality risk and age of viability in this setting. Addressing these knowledge gaps in SCANUs may enable better support for the improvement of child survival.
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Author Notes
Financial support: This research was supported by the Child Health and Mortality Prevention Surveillance (CHAMPS) project through the Johns Hopkins Bloomberg School of Public Health and the International Centre for Diarrhoeal Disease Research, Bangladesh.
The study protocol was reviewed and approved by the Research and Ethical Review Committees of the International Centre for Diarrhoeal Disease Research, Bangladesh. Because the study was conducted using hospital data collected retrospectively as part of routine care, participant consent was waived by the review committees.
Authors’ addresses: Ananya A. Kumar and Kyu Han Lee, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: akumar58@alumni.jh.edu and kyuhanlee86@gmail.com. Abu Faisal Md Pervez and Chayon Deb, Faridpur Medical College Hospital, Faridpur, Bangladesh, E-mails: afmpervez@gmail.com and chayondeb53@gmail.com. Sanwarul Bari, Shams El Arifeen, and Farzana Islam, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: bari@icddrb.org, shams@icddrb.org and drfarzaana@gmail.com. Emily S. Gurley, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mail: egurley1@jhu.edu.