Identifying flaws in the newborn care by neonatal death audit in Dhaka Shishu (children) Hospital

Md. Mahbubul Hoque1, MAK Azad Chowdhury2, Mohammad Abdullah Al Mamun3, Mohammad Faizul Haque Khan3, Mahfuza Shirin1, M Monir Hossain1, Mohammed Maruf-ul-Quader4
Background: Medical audit is a widely promoted strategy in hospitals. In highincome
countries, mortality audits are associated with improved quality of care; this
must be the case with our low and middle-income countries. Unfortunately this is
not routinely done in these settings and there is dearth of information about this.
Objectives: To review the neonatal deaths and look for the possible loopholes and
flaws in the management of these cases.
Methodology: All neonatal deaths in Dhaka Shishu Hospital from June 2007 to
November 2007 were reviewed thoroughly. The details of each neonate were recorded
on standardized proforma. Age at admission, time and place at admission, time
taken to start treatment, time taken to receive investigation reports, time of death,
duration of hospital stay and disease pattern were recorded.
Results: Out of 653 neonates admitted during the 6 month period, 101(15.5%) died.
Fifty-six (55.4%) were male and 45(44.6%) were female. Neonates admitted within 72
hours of birth had highest mortality (71.3%). Those admitted after office hours had
higher mortality (66.3%) and also the admitted cases died mainly during this time
(76.2%). Majority of the deaths 75(64.4%) occurred within 24 hours of hospital
admission. Preterms had higher mortality ( 54.5%). Neonates treated outside the
neonatal ward had unfortunately much higher (86.1%) mortality. Most (60.4%) of
the investigation results were received after office hours. In about 1/3rd of the cases
(29.7%) there were some delay in attending the sick neonates. ICU bed could not be
provided to majority (75.3%) of them who required ICU care. Prematurity with
complications, asphyxia and septicaemia were the three principal cause of death.
Conclusion: Early neonates (<72 hours old) and late arrival in critical condition die
within hours of admission. In-appropriate bed allocation in wards/cabins (other than
neonatal ward) where proper observation and monitoring cannot be done, delay in
availability of investigation results, in-adequate supervision and management during
off-hours when majority of the serious cases are usually admitted contribute to higher
neonatal deaths at hospital.

Key words: Neonate, death audit.

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