Evaluation of Mortality in Surgical Neonates at Ewha Womans University Hospital

The mortality of surgical neonates at Ewha Womans University Hospital was analysed and classified during 1976 through 1993 in order to assess e change of mortality rate and provide an opportunity for developing strategies to take off our neonatal surgery.

The study period was devided three groups-'76 to'81 as period I,'82 to '87 as period II, and'88 to'93 as period III. Author evaluated retrospectively and compared the mortality rates and causes of death in three periods one another. The clinical classification system(CCS) and morality pattern were used to assess the severity of illness in each death.

Surgical neonates were 35 cases during period I, 61 cases in period II, and 115 cases in period III. And during the period III, there was threefold increase in comparision with period I. The number of death and mortality rate were 12 and 34.3% In period I,8 and 13.1%in period II, and 5 and 4.6% in period III. And the mortality rate in period III was significantly decreased. The most marked improvement of survival in neonatal surgery was in esophageal atresia and gastroschisis/omphalocele . And congenital diaphragmatic hernia was the most challenging problem in neonatal surgery with 40% of the overall mortality rate.

The CCS of death cases in period I were 5 Class II, 4 Class III, and 3 Class IV, and 1 nonpreventable, 2 permissible, and 9 preventable deaths. There were 2 Class II, 1 Class III, and 5 Class IV in period II. And in period III, there were 3 Class III, and 2 Class IV. Although'preventable death' hold the first place as mortality pattern, it dropped from 9 of 12 cases in period I to 3 of 5 cases in period III. The most common causes of death were respiratory failure and sepsis.

Although our hospital had very limited the trained intensive care unit physician and nurses and well-equipped NICUs, the treatment results were very significantly improving progressively. However we should keep up advance the survival of the neonates with multiple anomalies and severely malformed premature giving the adequate attention and active management.