Gestational age-specific neonatal mortality in Hong Kong: a population-based retrospective study

• Published in: World journal of pediatrics : WJP Vol. 19; no. 2; pp. 158 - 169
• Main Authors: Wang, Xue-Lian, Leung, Eman, Fung, Genevieve Po Gee, Lam, Hugh Simon
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.02.2023; Department of Paediatrics,Faculty of Medicine,The Chinese University of Hong Kong,Hong Kong SAR,China%The Jockey Club School of Public Health and Primary Care,Faculty of Medicine,The Chinese University of Hong Kong,Hong Kong SAR,China%Department of Paediatrics,Faculty of Medicine,The Chinese University of Hong Kong,Hong Kong SAR,China%Department of Paediatrics,Faculty of Medicine,The Chinese University of Hong Kong,Hong Kong SAR,China; Department of Paediatrics,6/F Lui Che Woo Clinical Sciences Building,Prince of Wales Hospital,Sha Tin,New Territories,Hong Kong SAR,China; Department of Neonatology,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangdong Provincial Clinical Research Center for Child Health,Guangzhou,China
• Subjects: Critical Care Medicine; Female; Gestational Age; Hong Kong - epidemiology; Humans; Imaging; Infant; Infant Mortality; Infant, Newborn; Infant, Premature; Intensive; Maternal and Child Health; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Pregnancy; Radiology; Retrospective Studies; Surgery; Hong Kong; Trend; Population based; Neonatal mortality; Cause of death; Risk factor
• ISSN: 1708-8569; 1867-0687
• DOI: 10.1007/s12519-022-00633-2

Background The neonatal period is the most vulnerable period during childhood, with the risk of death being the highest even in developed countries/regions. Hong Kong’s neonatal mortality (1‰) is among the world’s lowest and has remained similar for 15 years. This study aimed to explore neonatal deaths in Hong Kong in detail and determine whether neonatal mortality is reducible at such a low level. Methods Live births in public hospitals in Hong Kong during 01 Jan 2006–31 Dec 2017 were included. Relevant data were extracted from the electronic medical records. Gestational age-specific mortality was calculated, and the trends were analyzed using the Cochran–Armitage trend test. Causes of death were summarized, and risk factors were identified in multivariate logistic regression analysis. Results In 490,034 live births, 755 cases (1.54‰) died during the neonatal period, and 293 (0.6‰) died during the post-neonatal period. The neonatal mortality remained similar overall ( P  = 0.17) and among infants born at 24–29 weeks’ gestation ( P  = 0.4), while it decreased in those born at 23 ( P  = 0.04), 30–36 ( P  < 0.001) and ≥ 37 ( P  < 0.001) weeks’ gestation. Neonates born at < 27 weeks’ gestation accounted for a significantly increased proportion among cases who died (27.6% to 51.9%), with hemorrhagic conditions (24%) being the leading cause of death. Congenital anomalies were the leading cause of death in neonates born ≥ 27 weeks’ gestation (52%), but its cause-specific mortality decreased ( P  = 0.002, 0.6‰ to 0.41‰), with most of the decrease attributed to trisomy 13/18 and multiple anomalies. Conclusion Reduction of neonatal mortality in developed regions may heavily rely on improved quality of perinatal and neonatal care among extremely preterm infants.