Socio-demographic, obstetric and fetal determinants of neonatal mortality

The PEARL Study Project prospectively estimated Qatar's national neonatal mortality rate (NMR) during 2011 (January 1st till December 31st) using the database of Qatar's National Perinatal Registry (Q-Peri-Reg). The project also estimated trends in Qatar's NMR since 1975, compared current NMR with other high income countries and analysed 32 determinants of neonatal mortality. During the study period Qatar's mid-year population was 1.7 million, the total number of live births were 20583 and total neonatal deaths 102. The national NMR was 4.95/1000 (n 102), ENMR 2.7/1000 (n 56), and LNMR 2.2/1000 (n 46) for reporting purposes. For international comparison purposes (after excluding babies ≤ 1000 g) the NMR was 2.9/1000 (n 59), ENMR 1.6/1000 (n 33) and LNM 1.3/1000 (n 26). A total of 33.3% neonatal deaths (n 34) were due to futility. Among the 34 futile cases, 25 died following a Do Not Resuscitate (DNR) order after parental consent (14 had antenatal parental counselling and DNR while 11 had post-natal parental counselling and DNR). Qatar's cNMR (NMR corrected for futility) during 2011 was 3.3/1000 (after excluding 34 futile cases and based on 68 non-futile cases). Qatar has made significant improvement in its NMR since 1975. The trend has always been downwards with significant drop between 1975 and 1982. Qatar's current NMR is comparable to most regional Gulf Cooperation Council (GCC) countries, and also comparable to many highincome countries both from the West and East. The project analysed a total of 32 variables (sociodemographic 13, Obstetric 11 and Fetal 8) of neonatal mortality using univariate and multivariate analyses. The univariate analysis revealed a total of eleven variables as significant determinants of neonatal mortality (p<0.05). These included birth weight, gestational age, maternal education, mode of delivery, presentation at birth, fetal growth, Apgar score at 1 and 5 minutes, delivery room resuscitation, previous preterm baby and antenatal care. Multivariate analysis was conducted in two models; fist with birth weight data included and second without birth weight data included. Together both models revealed ten significant determinants of neonatal mortality (p<0.05). These included maternal education, father occupation, father age, birth weight, delivery room resuscitation, Apgar score at 5 minutes, type of housing, domestic help, gestational age and parental consanguinity. Significant achievements in reducing neonatal mortality are possible even in low income settings using low cost techniques at the primary care level. However, the development approach has to be holistic and comprehensive including improvement in socioeconomic conditions, care of the pregnancy (antenatal, natal and postnatal) and care of the baby from delivery room through postnatal follow up. The national strategies should ensure a strong political and economic commitment to the care of mother and baby.