Pattern of neonatal and postneonatal deaths over a decade at Riyadh Military Hospital KSA

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Slide 1 :

The Pattern of Neonatal and Postneonatal Death at R.A.F.HOVER A DECADE Dr. M.A. Majeed-Saidan Dr. Fawaz T Kashlan, Dr. Atyah A. Al-Zahrani, Faisal Y. Ezzedeen Dr. Amer N. Ammari Neonatal Intensive Care Unit Department of Paediatrics Riyadh Armed Forces Hospital Riyadh, Saudi Arabia

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R.K.H. Medical Illustration:1429-04 Total No. of Deliveries & NICU admission and % of Admission1995 -- 2004 80.0 6.7 8.4% thousands

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R.K.H. Medical Illustration:1429-04 Methodology Death summary and computerized data sheet NICU senior staff discussion for all the death Monthly Perinatal mortality meeting Data entered on a special computer program (using Epi. Info.)

Slide 4 :

R.K.H. Medical Illustration:1429-04 Number of Neonatal Deaths Per Year Total No. of Death 526

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R.K.H. Medical Illustration:1429-04 Number of Still Birth Per Year Total No. of Still Birth 615

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R.K.H. Medical Illustration:1429-04 Number of Inborn and Outborn Per Year

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R.K.H. Medical Illustration:1429-04 Source of Admission 15% 85 % 80

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R.K.H. Medical Illustration:1429-04 Inborn Death by Sex 60.3% 39.7% Male 269 Female 177

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R.K.H. Medical Illustration:1429-04 Age at Death

Slide 10 :

R.K.H. Medical Illustration:1429-04 Classification of Perinatal DeathThe Modified Wigglesworth’s Classification Kelling J.W. et al. ADCH-fetal ed.,1989, vol. 64, pp 1345-51

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R.K.H. Medical Illustration:1429-04 Cause of DeathWigglesworth’s Classification 17% 36% 42% 5%

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R.K.H. Medical Illustration:1429-04 G2 -- Lethal MalformationsNo. -- 161

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R.K.H. Medical Illustration:1429-04 G3 – Prematurity & ComplicationsNo. -- 187 9.6 % 53% 22% 7.5% 3% 4.8

Slide 14 :

R.K.H. Medical Illustration:1429-04 G3 – Prematurity & ComplicationsNo. -- 187 27% 31.5%

Slide 15 :

R.K.H. Medical Illustration:1429-04 G4 -- Hypoxic Ischemic EncephalopathyNo. -- 22 Year

Slide 16 :

R.K.H. Medical Illustration:1429-04 G5 -- Specific DiagnosisNo. -- 76

Slide 17 :

R.K.H. Medical Illustration:1429-04 What is PNMR at RMH ? Is the Wigglesworth’s classification applicable to all deaths ?

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R.K.H. Medical Illustration:1429-04 Factors Affect PNMR Improved Perinatal Care Maternal age Parity Percentage of high risk pregnancies No. of ELBW babies Parental occupations Others

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Slide 21 :

R.K.H. Medical Illustration:1429-04 Perinatal Mortality Rate, Ireland: 1979-1999 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 Year 18 14 10 6 2 EU Countries, Report on Perinatal Statistics for 1999. December 2002

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R.K.H. Medical Illustration:1429-04 Effect of Maternal Age EU Countries, Report on Perinatal Statistics for 1999. December 2002

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R.K.H. Medical Illustration:1429-04 Effect of Maternal Age EU Countries, Report on Perinatal Statistics for 1999. December 2002 Obstetrical Department RAFH, Annual reports 2002

Slide 24 :

R.K.H. Medical Illustration:1429-04 Effect of Parity EU Countries, Report on Perinatal Statistics for 1999. December 2002

Slide 25 :

R.K.H. Medical Illustration:1429-04 Effect of Parity EU Countries, Report on Perinatal Statistics for 1999. December 2002 Obstetrical Department RAFH, Annual reports 2002

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R.K.H. Medical Illustration:1429-04 Definition of High Risk Pregnancy Parity 7 – 9 = 10 Renal patient Cardiac patient Preterm pregnancy Breech (C/S & vaginal) Multiple pregnancy Previous section Placenta praevia Diabetic patient Hypertensive patient Pregnancy with IUGR fetus Annual reports, Obstet. Department, RAFH, 1998 - 2004

Slide 27 :

R.K.H. Medical Illustration:1429-04 % of High Risk Pregnancies at R.A.F.H Years Annual reports, Obstet. Department, RAFH, 1998 - 2004

Slide 28 :

R.K.H. Medical Illustration:1429-04 Wigglesworth's Classification

Slide 29 :

R.K.H. Medical Illustration:1429-04 ???????? ?????? 1423 ??HEALTH INDICATORS ???? ???????? ?????? ????? ????? ????????? ????? ????? ???? 17.3 ??????? ????? ??? 1000 ????? ?? . WWW.MOH.org

Slide 30 :

R.K.H. Medical Illustration:1429-04 Conclusions Of all the babies admitted to NICU 7.6% died One third of death were due to lethal malformations Over 60% of death in G3 were ELBW babies Although the PNMR rate dropped from 22.3 in 1979 to 10.2 in 2004 but it plateau over the last 5 years National data based on clear definitions is needed Efforts should continue to reduce the PNMR

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