title: The cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam over a one year period.
abstract: OBJECTIVE
  To describe the cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam.
  
  
  METHODS
  A prospective hospital based observational study.
  
  
  METHODS
  The Neonatal Department, National Hospital of Pediatrics, Hanoi, Vietnam.
  
  
  METHODS
  All admissions to the Neonatal Department over a 12 month period.
  
  
  METHODS
  Cause-specific morbidity and mortality; deaths.
  
  
  RESULTS
  There were 5064 admissions with the commonest discharge diagnoses being infection (32%) and prematurity (29%). The case fatality ratio (CFR) was 13.9% (n = 703). Infection (38%), cardio/respiratory disorders (27%), congenital abnormalities (20%) and neurological conditions (10%) were the main causes of death. Of all the deaths, 38% had an admission weight ≥2500g. Higher CFR were associated with lower admission weights. Very few deaths (3%) occurred in the first 24 hours of life. Most referrals and deaths came from Hanoi and neighbouring provincial hospitals, with few from the most distant provinces. Two distant referral provinces had the highest CFR.
  
  
  CONCLUSIONS
  The CFR was high and few deaths occurred in neonates <24 hours old. The high rates of infection call for an improvement in infection control practices and peripartum antibiotic use at provincial and tertiary level. Understanding provincial hospital capacity and referral pathways is crucial to improving the outcomes at tertiary centres. A quality of care audit tool would enable more targeted interventions and monitoring of health outcomes.
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Merinda
authors.initials: M
authors.lastname: Miles
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Khu Thi Khanh
authors.initials: KT
authors.lastname: Dung
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Le Thi
authors.initials: LT
authors.lastname: Ha
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Nguyen Thanh
authors.initials: NT
authors.lastname: Liem
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Khu
authors.initials: K
authors.lastname: Ha
authors.affiliation: Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia.|Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia.|Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
authors.forename: Rod W
authors.initials: RW
authors.lastname: Hunt
authors.affiliation: Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia.|Menzies School of Health Research, Darwin, Australia.|London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Kim
authors.initials: K
authors.lastname: Mulholland
authors.affiliation: Centre for International Health, Burnet Institute, Melbourne, Australia.|Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Australia.|Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
authors.forename: Fiona M
authors.identifier: http://orcid.org/0000-0002-3077-9639
authors.initials: FM
authors.lastname: Russell
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D002423:Cause of Death; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D008297:Male; D009017:Morbidity; D011446:Prospective Studies; D062606:Tertiary Care Centers; D014744:Vietnam