"THE FIRST 24 HOURS OF LIFE MORTALITY AT FOUR TEACHING HOSPITALS IN SOUTH OF TEHRAN: PREVALENCE AND RISK FACTORS"

Abstract

Despite reduction in infant mortality rate, neonatal mortality rate particularly during the first 24 hours of life is still high in developing countries. A cross-sectional study was performed to determine neonatal mortality prevalence during the first 24 hours of life (F24NM) and its probable risk factors. Data collection were performed by a structured form containing maternal and neonatal characters. Newborns' mothers underwent an interview about their age, gravidity, parity, history of chronic illnesses, history of reproduction (including stillbirth, abortion and infertility) and conditions during recent pregnancy (including vaginal bleeding, multiple pregnancy, gestational illnesses and duration of premature rupture of membranes [PROM]). Neonatal characters contained sex, gestational age (GA), birth weight (BW), first minute Apgar score (FMAPG), visible congenital malformation, meconium stained amniotic fluid, nonperipheral cyanosis, hydrops fetalis, type of first respiration and neonatal death during first 24 hours of life which were obtained from medical records. A total of 1220 live-born neonates were studied during autumn 1999 at four teaching general hospitals in south of Tehran. The prevalence of F24NM was 22/1000. There were 48.42% males and 51.58% females. Of twenty seven first 24 hours neonatal deaths 23 cases (85.19%) were delivered prematurely or were low birth weight (LBW). Eighty nine percent of cases had abnormal FMAPG or cried for the first time only after resuscitation. Prolonged premature rupture of membranes and positive history of stillbirth (SB) was found in 29.63% and 18.52% of the mothers, respectively. FMAPG less than 4 (odds ratio [OR] 46.87, 95% confidence interval [CI] 3.97-55.85), history of SB (OR 12.48, CI 3.45-45.12), visible congenital malformation(s) (OR 12.44, CI2.06-75.00), PROM longer than 24 hours (OR 9.77, CI 3.64-26.19), birth weight less than 1500g(OR 8.45, CI 1.22-58.38), vaginal bleeding during recent pregnancy (OR 6.61, CI 1.93-22.60) and nonperipheral cyanosis(OR 6.55, CI 1.76-24.30) were significant risk factors for the F24NM by multiple logistic regression. According to this study, it seems offering adequate prenatal care particularly in high risk pregnancies and on time management of high risk labors or deliveries might reduce the number of neonatal deaths during the first 24 hours of life.