Early neonatal mortality and causes of death in Ramathibodi Hospital: 1981-1990.

This study examined the trends in early neonatal mortality by birthweight during 1981-90 at Ramathibodi Hospital in Thailand. Deaths were analyzed by causes of death within the first 7 days of life. Causes included congenital malformation, immaturity, asphyxia, respiratory distress syndrome (RDS), infection, and other causes. The results showed that 71,153 births occurred during the 10 year period, an increase of 22% over the period. Low birthweight increased from 6.3% in the first five years to 7.1% in the last five years. Very low birthweight (less than 1500 g) increased from 0.47% in the first five years to 0.57% in the last five years. Early neonatal mortality decreased from 0.53% in 1981 to 0.23% in 1990, which was over a reduction of over 50%. The reduction was 60% when congenital malformations were excluded. Early neonatal mortality declined for all birthweight groups by 40-75%, with the exception of birthweights under 1000 g. 90% of early neonatal deaths were due to congenital malformation, immaturity, RDS, asphyxia, and infection. Mortality due to congenital malformation remained at a rate of about 1.3:1000 live births. Causes of death varied with birthweight group. Neonates less than 1000 g died of RDS and immaturity in both 5-year periods. Neonates between 1000-1499 g and 1500-1999 g died of congenital malformation in the most recent period; for the first period, neonatal mortality was caused by RDS and infection respectively. Congenital malformation was the primary cause over the 10-year period for births weighing 2000 and higher grams. Hospital management for delivering and postpartum women changed over the ten year period. Although there was no specific intensive care unit, equipment for intensive neonatal care management was available. The improvement in neonatal mortality occurred during a period of increased numbers of births and low birthweight babies. Neonates under 1000 g were not managed as aggressively by medical staff because of the poor chances of survival and the high cost of care. In 1990, there was a change for more aggressive management of neonates with a birthweight between 750-999 g. The incidence of infection, asphyxia, and RDS decreased or remained stable due to better management of RDS and early detection and treatment with antibiotics of infection.