Open AccessMortality, morbidity and clinical care in a referral neonatal intensive care unit in Haiti
Author(s) -
Josie Valcin,
Skenda Jean-Charles,
Ana Malfa,
Richard Tucker,
Lindsay Dorcélus,
Jacqueline Gautier,
Michael Köster,
Beatrice E. Lechner
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0240465
Subject(s) - medicine , pediatrics , neonatal intensive care unit , neonatology , respiratory distress , gestational age , referral , mortality rate , asphyxia , sepsis , retrospective cohort study , birth weight , infant mortality , medical record , intensive care , intensive care medicine , pregnancy , population , surgery , family medicine , genetics , environmental health , biology
Background Neonatal mortality rates in Haiti are among the highest in the Western hemisphere. Few mothers deliver with a skilled birth attendant present, and there is a significant lack of pediatricians. The neonatal intensive care unit (NICU) at St. Damien Pediatric Hospital, a national referral center, is one of only five neonatology departments in Haiti. In order to target limited resources toward improving outcomes, this study seeks to describe clinical care in the St. Damien NICU. Methods A retrospective medical record review was performed on available medical records on all admissions to the NICU between April 2016 and April 2017. Results 220 neonates were admitted to the NICU within the study epoch. The mortality rate was 14.5%. Death was associated with a maternal diagnosis of hypertension (p = 0.03) and neonatal diagnoses of lower gestational age (p<0.0001), lower birth weight (p<0.0001), prematurity (p = 0.002), RDS p = 0.01), sepsis (p<0.0001) and kernicterus (p = 0.04). The most common diagnoses were sepsis, chorioamnionitis, respiratory distress syndrome, jaundice, prematurity and perinatal asphyxia. Conclusions This study demonstrates that preterm birth, sepsis, RDS and kernicterus are key contributors to neonatal mortality in a Haitian national pediatric referral center NICU and as such are promising interventional targets for reducing the neonatal mortality rate in Haiti.