Causes of neonatal deaths in Malaysian neonatal intensive care units in 2015-2020: A descriptive study.

Introduction: To investigate the major causes of neonatal deaths in Malaysian neonatal intensive care units (NICUs).

Materials and methods: This retrospective observational study analysed prospectively collected data of neonates (gestation ≥22 weeks, birthweight ≥500g) admitted to 44 NICUs in the years 2015-2020 in the Malaysian National Neonatal Registry. Causes of death were reported using the modified Wigglesworth classification.

Results: Out of 759,435 neonates, 1.2% (n=9470) died. Most (72.3%) were early neonatal deaths (0-7days of life), 17.5% were late neonatal deaths (8-28 days of life), and 10.2% were post-neonatal deaths (>28 days of life). Inborn extremely preterm (EPT, <28 weeks gestation) neonates had the highest death rates (427.5/1000 livebirths) and term neonates (1.7/1000 livebirths) had the lowest. Congenital malformations accounted for 33.0% of deaths; the majority were of gestation ≥28 weeks. Trisomy 18 (n=542), trisomy 13 (n=397), cardiovascular (CVS) malformations (n=371) and neurological malformations including neuro-tube defects (NTD) (n=252) were the four most common types of malformations. The three most common causes of non-malformation deaths were EPT (n=1424), sepsis (n=867, affecting all gestations), and hypoxic-ischaemic encephalopathy (HIE) in term neonates with/without multiorgan failure (n=570). Less than one-third of EPT neonates who died received respiratory support at birth. Most (85.3%) sepsis death was late-onset sepsis (≥72 hours of age). Only 27.8% term neonates dying from HIE received adequate therapeutic hypothermia.

Conclusions: Extreme prematurity, nosocomial sepsis, HIE in term neonates, chromosomal abnormalities due to trisomy 18 and trisomy 13, ductal-dependent CVS malformations, and NTD were the six most common causes of neonatal deaths in Malaysian NICUs.