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Vallely LM, Smith R, Laman M, Riddell MA, Mengi A, Au L, Polomon C, Vogel JP, Pomat WS, Vallely AJ, Homer CS. Early neonatal death review from two provinces in Papua New Guinea: A retrospective analysis. J Paediatr Child Health 2021; 57:841-846. [PMID: 33450113 DOI: 10.1111/jpc.15333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
AIM To determine the causes of early neonatal death and the avoidable factors associated with these deaths among women participating in a cluster-randomised crossover trial in Papua New Guinea. METHODS Early neonatal deaths were identified by retrospective chart review of the Women and Newborn Trial of Antenatal Interventions and Management study participants between July 2017 and January 2020. Causes of death and avoidable factors were identified using the Perinatal Problem Identification Program system. RESULTS There were 35 early neonatal deaths among 2499 livebirths (14 per 1000 births). Fifty-seven percent (20/35) of deaths occurred on the first day of life. Idiopathic preterm birth was the leading obstetric cause of perinatal death (29%; 10/35). Extreme multi-organ immaturity (23%; 8/35) and hypoxic ischaemic encephalopathy (17%; 6/35) were the most common final causes of neonatal death. Forty-six avoidable factors were identified among 26 deaths, including delays in care-seeking, insufficient resources at health facilities, poor intrapartum care and immediate care of the newborn, including neonatal resuscitation. CONCLUSION In this study, potentially preventable causes and avoidable factors were identified in the majority of early neonatal deaths. Addressing these factors will require health system strengthening, particularly the upskilling of primary level health staff, as well as targeted health education of women and the community.
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Affiliation(s)
- Lisa M Vallely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Rachel Smith
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Moses Laman
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Michaela A Riddell
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Alice Mengi
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Lucy Au
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Cherolyn Polomon
- School of Nursing and Midwfery, Pacific Adventist University, Port Moresby, Papua New Guinea
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - William S Pomat
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew J Vallely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Caroline Se Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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Vallely LM, Smith R, Bolnga JW, Babona D, Riddell MA, Mengi A, Au L, Polomon C, Vogel JP, Pomat WS, Vallely AJ, Homer CSE. Perinatal death audit and classification of stillbirths in two provinces in Papua New Guinea: A retrospective analysis. Int J Gynaecol Obstet 2020; 153:160-168. [PMID: 33098672 DOI: 10.1002/ijgo.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To undertake a retrospective perinatal death audit and assessment of avoidable factors associated with stillbirths among a cohort of women in two provinces in Papua New Guinea. METHODS We used data from an ongoing cluster-randomized crossover trial in 10 sites among 4600 women in Papua New Guinea (from 2017 to date). The overarching aim is to improve birth outcomes. All stillbirths from July 2017 to January 2020 were identified. The Perinatal Problem Identification Program was used to analyze each stillbirth and review associated avoidable factors. RESULTS There were 59 stillbirths among 2558 births (23 per 1000 births); 68% (40/59) were classified "fresh" and 32% as "macerated". Perinatal cause of death was identified for 63% (37/59): 30% (11/37) were due to intrapartum asphyxia and traumatic breech birth and 19% (7/37) were the result of pre-eclampsia. At least one avoidable factor was identified for 95% (56/59) of stillbirths. Patient-associated factors included lack of response to reduced fetal movements and delay in seeking care during labor. Health personnel-associated factors included poor intrapartum care, late diagnosis of breech presentation, and prolonged second stage with no intervention. CONCLUSION Factors associated with stillbirths in this setting could be avoided through a package of interventions at both the community and health-facility levels.
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Affiliation(s)
- Lisa M Vallely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Rachel Smith
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | | | - Delly Babona
- St Mary's Hospital Vunapope, East New Britain Province, Papua New Guinea
| | - Michaela A Riddell
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Alice Mengi
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Lucy Au
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | | | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew J Vallely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
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