Resumo

MACKAY, C A et al. Trends in neonatal mortality in a regional hospital in the Eastern Cape, South Africa: Quality improvement in action. S. Afr. j. child health [online]. 2022, vol.16, n.1, pp.1-4. ISSN 1999-7671.  http://dx.doi.org/10.7196/sajch.2022.v16i1.1800.

BACKGROUND: Dora Nginza Hospital had a high neonatal mortality rate (NMR) in 2016. Quality improvement (QI) strategies were subsequently introduced to improve outcomesOBJECTIVE: To report changes in the NMR at Dora Nginza Hospital from 2016 to 2019, following the introduction of QI interventionsMETHODS: A retrospective comparison was conducted of unit-based data from before and after the introduction of QI interventions. Outcomes included total, early and late NMR, NMR by birthweight categories and causes of neonatal deaths. A chi-squared test and relative risk were used to compare groups, with p<0.05 considered significantly differentRESULTS: Total NMR declined from 34.4/1 000 live births to 19.4/1 000 (p<0.01). Early NMR decreased across all birthweight categories (p<0.01). Late NMR decreased in neonates >500 g (p=0.02) but not in those >1 000 g (p=0.99). Relative risk of early or late neonatal death was 0.57 (0.46 - 0.69). Total deaths due to prematurity decreased from 108 in 2016 to 39 in 2019 (p<0.01). There was no significant change in deaths due to congenital abnormalities (p=0.051), infection (p=0.1) or intrapartum events (p=0.08CONCLUSION: We report a significant reduction in NMR following QI interventions, largely due to a decrease in prematurity-related early neonatal mortality. Similar interventions may be beneficial in other poorly resourced settings. Adequate kangaroo-mother care facilities, availability of nasal continuous positive-pressure ventilation to all preterm neonates, promotion of breastfeeding and protocol-driven management of premature newborns are key

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