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Background: The neonatal period is the most vulnerable period during childhood, with the risk of death being the highest even in developed countries/regions. Hong Kong¡¯s neonatal mortality (1¡ë) is among the world¡¯s lowest and has remained similar for 15 years. This study aimed to explore neonatal deaths in Hong Kong in detail and determine whether neonatal mortality is reducible at such a low level.
Methods: Live births in public hospitals in Hong Kong during 01 Jan 2006¨C31 Dec 2017 were included. Relevant data were extracted from the electronic medical records. Gestational age-specific mortality was calculated, and the trends were analyzed using the Cochran¨CArmitage trend test. Causes of death were summarized, and risk factors were identified in multivariate logistic regression analysis.
Results: In 490,034 live births, 755 cases (1.54¡ë) died during the neonatal period, and 293 (0.6¡ë) died during the post-neonatal period. The neonatal mortality remained similar overall (P = 0.17) and among infants born at 24¨C29 weeks¡¯ gestation (P = 0.4), while it decreased in those born at 23 (P = 0.04), 30¨C36 (P < 0.001) and ¡Ý 37 (P < 0.001) weeks¡¯ gestation. Neonates born at < 27 weeks¡¯ gestation accounted for a significantly increased proportion among cases who died (27.6% to 51.9%), with hemorrhagic conditions (24%) being the leading cause of death. Congenital anomalies were the leading cause of death in neonates born ¡Ý 27 weeks¡¯ gestation (52%), but its cause-specific mortality decreased (P = 0.002, 0.6¡ë to 0.41¡ë), with most of the decrease attributed to trisomy 13/18 and multiple anomalies. Conclusion: Reduction of neonatal mortality in developed regions may heavily rely on improved quality of perinatal and neonatal care among extremely preterm infants.
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