Neonatal Morbidity and Mortality from 2010 to 2016 in the Neonatal Care Unit of the University Teaching Hospital of Parakou/Benin

Introduction: Neonatal mortality accounts for 44% of deaths among children. This study aimed to investigate neonatal morbidity and mortality in the neonatal care unit of the University Teaching Hospital of Parakou (CHU-P) from 2010 to 2016. Patients and Methods: This research was a retrospective, descriptive and analytical study that covered the period from January 1, 2010 to December 31, 2016. It focused on the medical records of newborns hospitalized in the said unit during the period mentioned above. Study variables were sociodemographic, clinical, paraclinical and outcome. Findings: During the time span of the study, 6204 newborns were registered. Sex ratio was 1.32. Mean age for newborns was 6.01 ± 5.39 days. Clinically obvious neonatal infection (54.1%), prematurity and low birth weight (34.8%) and perinatal asphyxia (30%) were the main diseases of newborns recorded in the unit during the study period. Mortality rate was 16.8% including 77.9% occurred in the first week of life and 62.1% in the first 24 hours of life. Conclusion: More than one in six newborns died and three out of five deaths occurred in the first 24 hours of life. Therefore, it seems wise to carry out a case-control study with multivariate analysis in order to identify the main risk factors for that mortality. How to cite this paper: Noudamadjo, A., Kpanidja, G.M., Mohamed, F.A., Zinvokpodo, K.M., Ahodegnon, R., Agossou, J., Adédémy, J.D. and Ayivi, B. (2021) Neonatal Morbidity and Mortality from 2010 to 2016 in the Neonatal Care Unit of the University Teaching Hospital of Parakou/Benin. Open Journal of Pediatrics, 11, 215-224. https://doi.org/10.4236/ojped.2021.112021 Received: January 23, 2021 Accepted: May 28, 2021 Published: May 31, 2021 Copyright © 2021 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access A. Noudamadjo et al. DOI: 10.4236/ojped.2021.112021 216 Open Journal of Pediatrics


Introduction
Neonatal mortality accounts for 44% of deaths among under-five year children [1]. If the higher number of deaths of newborns is recorded in South Asia, the higher mortality rates are noted in Sub-Saharan Africa [2]. In Benin, according to the 4th Benin Population and Health Survey (EDSB-IV), neonatal mortality was estimated at 20‰ between 2008 and 2012 for child mortality of 36‰ in the Borgou region [3]. In the CHU-P neonatal care unit where a similar study had already been carried out between 2002 and 2009, intra-hospital neonatal mortality was estimated at 21.1% [4]. This research work was initiated in order to measure the progression of trends in neonatal mortality within the hospital during the next seven years. Its objective was to investigate neonatal morbidity and mortality in CHU-P neonatal care unit from 2010 to 2016.

Patients and Methods
This research was a retrospective, descriptive and analytical study carried out in the neonatal care unit of the CHU-P pediatric ward in the North of Benin. It covered the period running from January 1, 2010, to December 31, 2016, i.e. seven (07) years and involved all the newborns hospitalized in the neonatal care unit during the study period. To be included, the newborns should be admitted alive during the study period with a medical bearing the diagnosis and type of discharge. The study excluded all the newborns admitted alive, dead on admission within fifteen minutes, who had no usable medical record (including neither diagnosis nor type of discharge). The cases were recruited through an exhaustive census including systematically all the medical records of patients meeting inclusion criteria. The main variables were morbidity expressed with frequencies of diagnosed diseases and then mortality expressed using death rates.
The other variables were sociodemographic (mothers' age and occupation), clinical (gestational age, birth weight, neonatal morbidity), and outcome (neonatal mortality). The different diagnoses were considered as recorded in the medical records. The data were entered and processed using the software EPI INFO version 7.2. The measures of central tendency and dispersion (Mode, Median, Standard deviation) were used to describe the quantitative variables. Ratios or proportions were used to describe qualitative variables. Khi test was used to compare ratios and proportions and difference was considered as significant if p-value < 0.05.

Ethical and Professional Considerations
The performance of this study has been authorized in writing by the CHU-P Di-

Chronological Evolution of Admissions and Deaths per Year
We note an overall trend of increase in admissions over the years until 2013; it was followed by a decline. Figure 1 illustrates the chronological trends in admissions and deaths during the study period.

Neonatal Morbidity
As regards diseases and syndromes concerning all the newborns, 3357 had a clinically obvious neonatal-infection (54.1%), 2158 were premature (34.8%), and 1863 had perinatal asphyxia (30.0%). Table 2 shows the distribution of newborns admitted from 2010 to 2016 to the CHU-P neonatal care unit according to diseases and syndromes.     Figure 2 shows the distribution of newborns deaths in the unit according to their age.

Factors Associated with Death
As presented in the Table 4, the factors associated with neonatal death, were the mothers' age (<20 years), the mothers' occupation (housewife, /craftwoman), the newborn sex (male), the newborns' age (>1 day), the gestational age (<37 weeks), and the birth weight (<2500 g).

Discussion
This cross-sectional study based on a retrospective and analytical collection of data was carried out in the CHU-P neonatal care unit over a seven-year period.
It thus has the merit of taking stock of admissions and mortality cases in the neonatal care unit since 2010. This may help make organizational and therapeutic decisions to improve the provision of care for newborns in the future. Despite its retrospective nature, source of possible missing data, it has the particular advantage of addressing a health issue in that area of the country.

Neonatal Morbidity
During the study period, intra-hospital-based neonatal morbidity accounted for

Neonatal Mortality
During the study period, the gross rate of neonatal mortality in the CHU-P was 16.8%. This high rate may be due to the method of recruitment of newborns.
This rate is lower than the one found by Noudamadjo

Factors Associated with Death
This study shows that the following factors were associated with death: the age of the mother (less than 20 years), the mother occupation (poorly paid), the male gender of the newborn, the newborns' age less than a day, the place of birth outside the reference hospital (out born), low birth weight and prematurity. These factors related to death are those described in the literature [4] [7] [9] [13] [15].
It is by acting on these factors that we can reduce the still high death rate in our unit.

Conclusion
This study points out that newborn admissions accounted for more than a quarter of admissions to the pediatric ward. The most common diseases were neonatal infection, prematurity and low birth weight and perinatal asphyxia. More than one out of six newborns died and three out of five deaths occurred in the first 24 hours of life. This high mortality suggests conducting a prospective study on the real factors associated with deaths.