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The cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam over a one year period.

The cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam over a one year period.
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Miles M, Dung KT, Ha LT, Liem NT, Ha K, Hunt RW, Mulholland K, Morgan C, Russell FM,


Miles M, Dung KT, Ha LT, Liem NT, Ha K, Hunt RW, Mulholland K, Morgan C, Russell FM, (click to view)

Miles M, Dung KT, Ha LT, Liem NT, Ha K, Hunt RW, Mulholland K, Morgan C, Russell FM,

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PloS one 2017 03 1012(3) e0173407 doi 10.1371/journal.pone.0173407
Abstract
OBJECTIVE
To describe the cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam.

DESIGN
A prospective hospital based observational study.

SETTING
The Neonatal Department, National Hospital of Pediatrics, Hanoi, Vietnam.

PATIENTS
All admissions to the Neonatal Department over a 12 month period.

MAIN OUTCOME MEASURES
Cause-specific morbidity and mortality; deaths.

RESULTS
There were 5064 admissions with the commonest discharge diagnoses being infection (32%) and prematurity (29%). The case fatality ratio (CFR) was 13.9% (n = 703). Infection (38%), cardio/respiratory disorders (27%), congenital abnormalities (20%) and neurological conditions (10%) were the main causes of death. Of all the deaths, 38% had an admission weight ≥2500g. Higher CFR were associated with lower admission weights. Very few deaths (3%) occurred in the first 24 hours of life. Most referrals and deaths came from Hanoi and neighbouring provincial hospitals, with few from the most distant provinces. Two distant referral provinces had the highest CFR.

CONCLUSIONS
The CFR was high and few deaths occurred in neonates <24 hours old. The high rates of infection call for an improvement in infection control practices and peripartum antibiotic use at provincial and tertiary level. Understanding provincial hospital capacity and referral pathways is crucial to improving the outcomes at tertiary centres. A quality of care audit tool would enable more targeted interventions and monitoring of health outcomes.

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