Abstract
INTRODUCTION: The neonatal mortality rate (NMR) is an essential index in the assessment of community health. With the rapid advancement of neonatal care, the causes of death in this group and the overall mortality rate have changed. For these reasons, the aim of this study was to determine the current NMR and its causes in Sabzevar City's Neonatal Intensive Care Unit (NICU). METHODS: This cross-sectional study was conducted in the NICU at Sabzevar Hospital from 2006 through 2013. Based on previous studies, the sample size was determined to be 365 neonates who were admitted to the NICU and died before they were discharged. The study tool was a researcher-developed checklist related to deceased neonates in the NICU. The checklist was confirmed based on the validity of its content and its inter-rater reliability. We used chi-squared, the Mann-Whitney U test, and the Spearman correlation to analyze the data. RESULTS: The NMR in Sabzevar's NICU was 6.44 per 1000 during the seven-year period; this rate included the following cases per 1000 live births: very early mortality (2.16), early mortality (3.33), and late mortality (0.96). Among 58,270 live births, 3,667 of the neonates were admitted to the NICU during the seven-year period, which was equivalent to 62.93 admissions per 1000 live births. Of the 3,667 neonates admitted to the NICU, 375 (10.23%) died before they were discharged. The most recurrent diagnoses were respiratory distress syndrome (46%), followed by sepsis (12%). The one-sample chi-squared test as a goodness-of-fit test (95% CI) showed that the mortality rates were significantly different based on gender (p = 0.004), birth weight (p < 0.001), gestational age (p < 0.001), different causes of death (p < 0.001), and different years of death (2006-2013) (p < 0.001). There also was a significant difference between the duration of survival (very early mortality, early mortality, and late mortality) (p < 0.001). CONCLUSION: Neonatal mortality in the present study was comparable with that reported in similar studies in Iran and in other countries. The strong association between the mortality rate in the NICU with premature birth and low birth weight indicates the necessity of prenatal care aimed at preventing pre-term labor. Comprehensive programs from antenatal care and care at and after birth are recommended, including the investigation of the risks for neonatal death and offering preventive strategies.