Morbidity and Mortality Characteristics of Infants Hospitalized in the Pediatrics Department of the Largest Turkish Military Hospital in 2001

Military Medicine, Jan 2005 by Kiliç, Selim, Tezcan, Sabahat, Tasçilar, M Emre, Çakir, Banu, Et al

A descriptive study was conducted in the pediatric inpatient unit of Gulhane Military Medical Academy, to investigate the morbidity and mortality characteristics of 532 infants hospitalized between January 1 and December 31, 2001, for treatment purposes. Of the study participants, 55.8% were boys and 44.2% were girls. The most common cause of hospitalization was neonatal hyperbilirubinemia (19.7%). The most common admission month was January (12.4%). Of 532 infants, 510 (95.9%) were discharged, whereas 22 patients died in the hospital. Twenty-one patients died in the neonatal period, and respiratory distress syndrome and neonatal sepsis were identified as the most common causes of death. Our finding of associations between male gender and low birth weight and hospital death is consistent with previous knowledge. Despite the high frequencies of pneumonia and gastroenteritis as admission diagnoses, the finding of only one pneumonia-related death and no gastroenteritis-related deaths in the study population is pleasing.

Introduction

Infancy is a high-risk period of life for morbidity and death. In developing countries, in particular, infant deaths represent the major part of all deaths.1 In Turkey also, the proportion of infant deaths among all deaths is quite high.2 Despite a decreasing rate in past decades, the countrywide proportion of infant deaths in provinces and central districts was 8.6% in 1999, and deaths occurred mainly in the first month of life.2

It has been reported recently that the annual number of deaths at

In developing countries such as Turkey, limited resources require that health priorities be selected wisely and child health-related research is clearly warranted, to identity high-risk groups and to suggest appropriate preventive and therapeutic approaches for decreasing morbidity and mortality rates among children. This descriptive study aims to identify the sociodemographic, morbidity, and mortality characteristics and associated risk factors (such as admission diagnosis and length of hospitalization) for infants hospitalized in the Department of Pediatrics of the Gulhane Military Medical Academy (GMMA) between January 1 and December 31, 2001.

Methods

The study was conducted in the Department of Pediatrics of the GMMA, located in Ankara, which is the largest military hospital in Turkey, with a 50-bed pediatric hospital (with 15 beds for neonates and 12 beds for infants). All infants, 0 to 365 days of age, who were hospitalized for at least 24 hours in the pediatric inpatient clinic between January 1 and December 31, 2001, were included in the study. Data were collected retrospectively from patients' medical charts, between December 2001 and January 2002, using a standardized data collection form.

This descriptive study included a total of 532 infants who were hospitalized for longer than 24 hours. This group made up 42.5% of all 0- to 15-year-old children admitted to the clinic for various reasons during the study period. The variables included in the study were birth weight and gender of the infant, length of hospitalization, month of hospitalization, admission diagnosis, and hospital outcome.

All health care personnel (N = 3) responsible for data collection were trained before the study, they used a standardized data collection form and procedures, and they were all tested for reliability before the data collection process. The data collection process took 30 days. Statistical analyses were conducted using the SPSS version 10.0 statistical software package (SPSS, Chicago, Illinois) and included calculation of frequencies, percentages, and cross-tabulations. Statistical differences between groups were investigated using χ^sup 2^ tests.

Results

Between January 1 and December 31, 2001, 1,613 children (0-14 years) were hospitalized in the pediatric inpatient unit of the GMMA. Of these, 1,253 were hospitalized for more than 24 hours, with 532 (42.5%) being 0 to 365 days old. The study included all 532 infants eligible for the study. Of these, 55.8% were boys and 29.8% had low birth weights. Information on gender and birth weight characteristics of the infants is presented in Table I.

The length of hospitalization ranged from 1 to 97 days, with an average of 6.7 ± 9.9 days (median, 3 days). Approximately 40% of participants stayed in the hospital for ≤2 days, whereas 18% stayed for > 10 days. Twenty-two patients, 21 of whom were in the neonatal period, died in the hospital. The proportion of discharges in the study period was 95.9%. The most common admission month was January (12.4%) and admission rates were lowest in December (5.3%), which suggests a statistically significant difference in the distribution of admissions during the year (χ^sup 2^ test = 28.42, df = 11, p

The distribution of admission diagnoses is presented in Table III. Neonatal hyperbilirubinemia was the most common admission diagnosis (19.7%), followed by prematurity, pneumonia, acute gastroenteritis, and neonatal sepsis.

Of the 22 deaths, one infant, who had an admission diagnosis of pneumonia, was 10 months of age; the rest of the infants (95.5%) were in the neonatal period when they died. Respiratory distress syndrome, neonatal sepsis, and prematurity were the causes of 59.3% of all deaths. For 27.4% of deaths, respiratory distress syndrome was reported as the underlying cause of death. Among the reportedly respiratory/circulatory insufficiency-related deaths, two patients had cardiac pathological conditions (aortic insufficiency and left hypoplastic heart), one had intracranial bleeding attributable to birth trauma, and one developed hypovolemic shock after a traffic accident. The distribution of causes of death is presented in Table IV.