Multicenter assessment of mortality risk in the neonatal intensive care unit

OBJECTİVE: In neonatal intensive care, mortality is a source of great pressure and sadness on the family and the doctor. By its nature, intensive care services serve as a support point on the fine line between life and death. Minimizing this mortality is one of our colleagues' primary goals. For this reason, this study, it is aimed to determine the causes that have an effect on mortality and to minimize these causes with subsequent evaluations. 
MATERİAL AND METHOD: 
Our study covers the retrospective data of the babies who died in the neonatal unit between 2015 and 2019. In this context, patients who were born at 22 weeks and older and were hospitalized in the neonatal unit or needed resuscitation in the delivery room were included. Our colleagues from three different hospitals participated in this study with the patients they registered. One of these centers is a training and research hospital and the other centers are state hospitals with busy delivery rooms. Babies lost in utero were not included in the study. Maternal and newborn mortality risk factors were recorded in the perinatal period. In addition, family demographic characteristics, causes of death, and mortality rates were recorded. These recorded data were analyzed according to Wiggleswort's mortality classification. Snappe ll scoring was used to evaluate the probability of death. 
RESULT: Of the 3112 babies admitted to our neonatal units during the aforementioned four years, we lost 79. When we examined the records of the newborns we lost, prematurity stood out as the most common cause of death. The causes we see less frequently, such as fatal congenital anomalies and severe genetic anomalies incompatible with life, drew attention as their incidence decreased. When we focus, we found that the loss rate was higher in the early neonatal period than in other periods. İn further detail, we see that the highest mortality rate occurred on the first day. While losses due to prematurity were more common in the first weeks of gestation, it was observed that the causes of death changed as the weeks of gestation progressed, and the incidence of genetic diseases and congenital anomalies increased. 
 
CONCLUSİON: As we know, the causes of neonatal intensive care losses are diverse, although their frequency varies. The most important determinant of this diversity is gestational age. In this retrospective study, we found that causes such as prematurity and congenital anomalies were among the most common causes. Similar to our results, many international publications have shown that these causes have the highest mortality rate. 
Improving follow-up and care in the perinatal period has an impact on reducing the causes of mortality we listed. Although not all causes can be eliminated, there are ethical debates about abortion for diseases incompatible with life.