Mortality in Neonatal Intensive Care Units in Iran: A Systematic Review and Meta-Analysis

Background and Objective: The neonatal mortality rate is an important health index. The present study was conducted to determine the mortality rate and its causes in neonatal intensive care units (NICUS) in Iran. Search Method: This review was conducted according to the PRISMA statement. All the steps were performed by two authors independently. A comprehensive search was carried out in national and international databases, including PubMed, Web of Science, Scopus, ScienceDirect, Magiran, Iranmedex, SID, Medlib and Google Scholar search engine. The keywords used were Infant, Newborn [MeSH], Intensive Care Units, Neonatal [MeSH], Mortality [MeSH], Causality [MeSH], Etiology [Subheading], Neonatal [Text Word], and Iran [MeSH]. Online search was done without time limit until June 2018. After reviewing the inclusion and exclusion criteria, the studies were assessed according to the modified Newcastle Ottawa Scale (NOS). Cochran s Q and I2 index were used for heterogeneity of studies. Meta-analysis was done based on a random effects model in Comprehensive Meta-Analysis Software Version 2. Findings: 31 eligible studies were analyzed. Mortality rate among 24995 neonates admitted to NICUs in Iran was estimated to be 11.40% (95% CI: 9.10-14.20). The lowest mortality rate was related to the Center of Iran (7.70% [95%CI: 6.01-9.82]) and the highest mortality rate was in West of Iran (19.26% [CI 95 %: 15.82-23.24]) and this difference was significant (p<0.001). The most common causes of mortality in NICUs in Iran were prematurity (44.14% [95% CI: 31.95-57.08]), respiratory distress syndrome (RDS) (31.93% [95% CI: 22.83-42.66]), congenital malformation (16.09% [95% CI: 12.85-19.95]) septicemia (12.66% [95%CI: 8.87-17.75]) and asphyxia (7.58% [95%CI: 4.63-12.19]). Conclusion: The most common causes of mortality in Iranian neonates were prematurity, RDS, and congenital anomalies. We also noted the mortality rate to be acceptable (11.4%). To reduce this, we recommend pre-natal screening tests and genetic counseling. In addition, maternal care during pregnancy should be improved to reduce premature delivery.

Keywords:

Mortality , Neonatal , Intensive Care Unit , Iran , Meta-analysis