Audit of neonatal deaths of nonmalformed infants of 34 or more weeks' gestation: unavoidable catastrophic events or suboptimal care?
BACKGROUND
The neonatal death rate (death < or = 28 days/1000 live births) has decreased and the level is now so low that it has been questioned whether further improvement is possible. The aim of this study was to categorize nonmalformed infants of 34 weeks' or more gestational age dying in the neonatal period to analyze if these deaths might have been prevented.


METHODS
We used the audit method to study neonatal deaths during 1986-98 in a county population of approximately 240 000 inhabitants.


RESULTS
Twenty-six neonatal deaths from a population of 41 901 live births were analyzed. The neonatal deaths were found to be associated with antepartum hypoxia (six cases); intrapartum catastrophes (seven cases); intrapartum monitoring deficiencies (five cases); resuscitation and stabilization after birth (two cases); infection (one case); sudden infant death syndrome (four cases); and peritonitis (died at home, one case). Suboptimal care was recorded in 16 cases. Neonatal death was unlikely to be associated with suboptimal care in six cases, but in 10 cases suboptimal care might or was likely to have brought about the fatal outcome.


CONCLUSIONS
Avoiding suboptimal care might or is likely to prevent neonatal death in 10/26 (38.5%) of nonmalformed infants of 34 weeks' or more gestational age. Such improvements may, however, only slightly influence the neonatal death rate, with a reduction from 4.4 to 4.2/1000 live births.
D000367:Age Factors; D000013:Congenital Abnormalities / Q000401:mortality*; D005260:Female; D005865:Gestational Age; D006801:Humans; D002534:Hypoxia, Brain / Q000401:mortality; D007226:Infant Mortality; D007231:Infant, Newborn; D008485:Medical Audit / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000401:mortality*; D008991:Monitoring, Physiologic / Q000592:standards; D009664:Norway / Q000453:epidemiology; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011256:Pregnancy Outcome / Q000453:epidemiology; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality