A retrospective review of trends in neonatal mortality in a regional hospital in the Eastern Cape: Quality improvement in action

Background: Dora Nginza Hospital had a high neonatal mortality rate (NMR) of 32.5/1000 live births in 2016. Quality improvement strategies were introduced between 2016 and 2020 in order to improve neonatal outcomes. Aim and objectives: The aim of the study was to report changes in neonatal mortality at Dora Nginza Hospital in the Eastern Cape, using available data from 2016 as baseline. Methods: A retrospective review of monthly neonatal statistics and morbidity and mortality audits was conducted. Primary outcome was neonatal death rates (NDR) by month and year from 1 January 2016 to 31 December 2019. Secondary outcomes included early (ENDR) and late neonatal death rates (LNDR) by year, annual neonatal death rates by birth weight categories ≥500g and ≥1000g, and major causes of neonatal deaths. Chi square test and relative risk were used to compare differences in outcomes and p<0.05 was considered significant. Ethics approval was granted prior to commencement. Results: NDR declined at a rate of 4.5 deaths per 1000 live births annually from 32.5 / 1000 live births to 19.0 / 1000 (p < 0.005). Reduction in ENDR was statistically significant (p < 0.005) but not LNDR (p (LNDR≥500g) = 0.167 and p (LNDR≥1000g) = 0.87). Relative risk of early and/or late neonatal death was 0.59 (0.48 – 0.72) in the ≥500g birth weight category (p <0.005) and 0.69 (0.53 – 0.91) in the ≥1000g birth weight category (p = 0.008). Deaths due to prematurity decreased by 63.9% from 108 to 39 (p<0.005). There was a 12.5% increase in deaths due to congenital abnormalities from 24 to 27 but this did not reach statistical significance (p = 0.051). There was no significant difference in the number of deaths due to infection, intrapartum events or other/uncategorised causes. Conclusion: There has been significant improvement in neonatal survival at Dora Nginza Hospital from 2016 to 2019, mainly due to decreased early neonatal deaths related to prematurity. Strategies to improve infection prevention and control, reduce adverse intrapartum events and streamline organisation and integration of district and regional neonatal services will be fundamental to ongoing quality improvement.背景：多拉·恩金扎医院（Dora Nginza Hospital）2016年的新生儿死亡率（Neonatal Mortality Rate, NMR）高达32.5/1000活产儿。该院于2016至2020年间推行质量改进策略，以改善新生儿预后结局。 研究目的：本研究以2016年的现有数据为基线，报告东开普省多拉·恩金扎医院的新生儿死亡率变化情况。 研究方法：本研究对2016年1月1日至2019年12月31日的月度新生儿统计数据、发病率及死亡率审计资料开展回顾性分析（Retrospective Review）。主要结局指标为按年月统计的新生儿死亡率（Neonatal Death Rate, NDR）；次要结局指标包括按年度划分的早期新生儿死亡率（Early Neonatal Death Rate, ENDR）与晚期新生儿死亡率（Late Neonatal Death Rate, LNDR）、按出生体重分层（≥500g及≥1000g）的年度新生儿死亡率，以及新生儿死亡的主要病因。本研究采用卡方检验（Chi Square Test）与相对危险度（Relative Risk）比较结局差异，以p<0.05作为差异具有统计学意义的判定标准。研究启动前已获得伦理审查批准。 研究结果：新生儿死亡率从每1000活产儿32.5例降至19.0例，年均下降4.5例/1000活产儿（p<0.005）。早期新生儿死亡率的下降具有统计学显著性（p<0.005），但晚期新生儿死亡率的变化无统计学意义（p(LNDR≥500g)=0.167，p(LNDR≥1000g)=0.87）。在出生体重≥500g的群体中，早期和/或晚期新生儿死亡的相对危险度为0.59（95%置信区间：0.48~0.72），差异具有统计学意义（p<0.005）；在出生体重≥1000g的群体中，该相对危险度为0.69（95%置信区间：0.53~0.91），差异同样具有统计学意义（p=0.008）。因早产导致的新生儿死亡数从108例降至39例，降幅达63.9%（p<0.005）。因先天性畸形导致的死亡数从24例增至27例，增幅为12.5%，但未达到统计学显著性（p=0.051）。因感染、产时事件或其他/未分类病因导致的死亡数无显著变化。 研究结论：2016至2019年间，多拉·恩金扎医院的新生儿存活率得到了显著改善，这主要得益于与早产相关的早期新生儿死亡率下降。后续仍需推行感染防控、减少产时不良事件、优化区域及区级新生儿医疗服务的组织与整合等策略，以持续推进质量改进工作。