Survival and Causes of Death in Infants Admitted in NICU in Iran: A Retrospective Cohort Study 2016-2022
Abstract
Background: We aimed to assess neonatal survival and identify predictors of mortality among infants admitted to a tertiary hospital in Iran between 2016 and 2022.
Methods: A retrospective cohort study was conducted on 7,255 neonates admitted to a tertiary hospital in Iran.
Results: Overall neonatal and preterm mortality rates were 6.6% and 9.1%, respectively, with a declining trend across various medical conditions. Multiple Cox regression analysis revealed several predictors of death as gestational age, birth weight, APGAR scores, congenital defects, sepsis, respiratory disorders, intervention treatments, and antibiotic administration history. Implications for Practice: Although survival rates have improved, neonatal mortality in Iran remains a concern. The leading causes of death—congenital anomalies, sepsis, and respiratory disorders—highlight the need for strengthened antimicrobial stewardship and infection control. Managing invasive procedures is essential to prevent hospital-acquired infections.
Conclusion: Further studies are needed to clarify the causal relationship between multiple antibiotic regimens and neonatal survival.
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14. Kamal P, Dixon-Woods M, Kurinczuk JJ, et al (2005). Factors influencing repeat caesarean section: qualitative exploratory study of obstetricians' and midwives' accounts. BJOG, 112 (8):1054-60.
15. Yazdizadeh B, Nedjat S, Mohammad K, et al (2011). Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study. BMC Health Services Research, 11:159.
16. Bettes BA, Coleman VH, Zinberg S, et al (2007). Cesarean delivery on maternal request: obstetrician-gynecologists' knowledge, perception, and practice patterns. Obstet Gynecol, 109 (1):57-66.
17. Cox KJ (2011). Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study. BMC Pregnancy Childbirth, 11:72.
18. Sedigheh Hantoosh Z, Mamak S, et al (2024). Obstetricians’ Views for Reasons Decision-Making for Cesarean Section in Iran. Acta Medica Iranica, doi.org/10.18502/acta.v62i3.17140.
19. Mengesha HG, Sahle BW (2017). Cause of neonatal deaths in Northern Ethiopia: a prospective cohort study. BMC Public Health, 17 (1):62.
20. Weinberg SE, Villedieu A, Bagdasarian N, et al (2020). Control and management of multidrug resistant Acinetobacter baumannii: A review of the evidence and proposal of novel approaches. Infect Prev Pract, 2 (3):100077.
21. Getabelew A, Aman M, Fantaye E, et al (2018). Prevalence of Neonatal Sepsis and Associated Factors among Neonates in Neonatal Intensive Care Unit at Selected Governmental Hospitals in Shashemene Town, Oromia Regional State, Ethiopia, 2017. Int J Pediatr, 2018:7801272.
22. Chen LK, Kuo SC, Chang KC, et al (2017). Clinical Antibiotic-resistant Acinetobacter baumannii Strains with Higher Susceptibility to Environmental Phages than Antibiotic-sensitive Strains. Sci Rep, 7 (1):6319.
23. Wang Y, Ren J, Yao Z, et al (2023). Clinical Impact and Risk Factors of Intensive Care Unit-Acquired Nosocomial Infection: A Propensity Score-Matching Study from 2018 to 2020 in a Teaching Hospital in China. Infect Drug Resist, 16:569-579.
24. Mendelson M, Whitelaw A, Nicol M, et al (2012). Wake up South Africa! The antibiotic 'horse' has bolted. S Afr Med J, 102 (7):607-8.
25. Nayeri F, Dalili H, Shariat M, et al (2023). Epidemiology of nosocomial Staphylococcus epidermidis and Acinetobacter baumannii infections in a neonatal intensive care unit. Iran J Microbiol, 15 (3):350-358.
26. Hug L, Alexander M, You D, Alkema L (2019). National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health, 7 (6):e710-e720.
2. Gebremariam H, Tesfai B, Tewelde S, et al (2022). Demographic, Clinical Profile and Outcomes of Neonates Admitted to Neonatal Intensive Care Unit of Dekemhare Hospital, Eritrea. BMC Pediatrics, 22 (1):716.
3. Tolossa T, Wakuma B, Mengist B, et al (2022). Survival status and predictors of neonatal mortality among neonates admitted to Neonatal Intensive care Unit (NICU) of Wollega University referral hospital (WURH) and Nekemte Specialized hospital, Western Ethiopia: A prospective cohort study. PLoS One, 17 (7):e0268744.
4. Dol J, Hughes B, Bonet M, et al (2023). Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review. JBI Evid Synth, 21 (1):98-199.
5. Rosa-Mangeret F, Benski AC, Golaz A, et al (2022). 2.5 Million Annual Deaths-Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality. Trop Med Infect Dis, 7(5):64.
6. Sankar MJ, Natarajan CK, Das RR, et al (2016). When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries. J Perinatol, 1(Suppl 1):S1-S11.
7. Nayeri F, Emami Z, Mohammadzadeh Y, et al (2019). Mortality and Morbidity Patterns of Very Low Birth Weight Newborns in Eastern Mediterranean Region: A Meta-Analysis Study. Journal of Pediatrics Review, 7 (2):67-76.
8. Lawn JE, Cousens S, Zupan J (2005). 4 million neonatal deaths: when? Where? Why? Lancet, 365 (9462):891-900.
9. Dalili H, Shariat M, Nayeri F, et al (2019). Exclusive Breastfeeding Duration and its Effect on the Health of the Children in Iran, a Meta Analysis. J Pediatr Nurs, 48:e8-e14.
10. Moura H, Costa V, Rodrigues M, et al (2011). End of life in the neonatal intensive care unit. Clinics (Sao Paulo), 66 (9):1569-72.
11. Karimi P, Mahmudi L, Azami M, et al (2019). Mortality in Neonatal Intensive Care Units in Iran: A Systematic Review and Meta-Analysis. Iranian Journal of Neonatology, 10 (3):70-80.
12. Lawn JE, Kinney MV, Black RE, et al (2012). Newborn survival: a multi-country analysis of a decade of change. Health Policy Plan, 3:iii6-28.
13. Colomar M, Cafferata ML, Aleman A, et al (2014). Mode of childbirth in low-risk pregnancies: Nicaraguan physicians' viewpoints. Matern Child Health J, 18 (10):2382-92.
14. Kamal P, Dixon-Woods M, Kurinczuk JJ, et al (2005). Factors influencing repeat caesarean section: qualitative exploratory study of obstetricians' and midwives' accounts. BJOG, 112 (8):1054-60.
15. Yazdizadeh B, Nedjat S, Mohammad K, et al (2011). Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study. BMC Health Services Research, 11:159.
16. Bettes BA, Coleman VH, Zinberg S, et al (2007). Cesarean delivery on maternal request: obstetrician-gynecologists' knowledge, perception, and practice patterns. Obstet Gynecol, 109 (1):57-66.
17. Cox KJ (2011). Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study. BMC Pregnancy Childbirth, 11:72.
18. Sedigheh Hantoosh Z, Mamak S, et al (2024). Obstetricians’ Views for Reasons Decision-Making for Cesarean Section in Iran. Acta Medica Iranica, doi.org/10.18502/acta.v62i3.17140.
19. Mengesha HG, Sahle BW (2017). Cause of neonatal deaths in Northern Ethiopia: a prospective cohort study. BMC Public Health, 17 (1):62.
20. Weinberg SE, Villedieu A, Bagdasarian N, et al (2020). Control and management of multidrug resistant Acinetobacter baumannii: A review of the evidence and proposal of novel approaches. Infect Prev Pract, 2 (3):100077.
21. Getabelew A, Aman M, Fantaye E, et al (2018). Prevalence of Neonatal Sepsis and Associated Factors among Neonates in Neonatal Intensive Care Unit at Selected Governmental Hospitals in Shashemene Town, Oromia Regional State, Ethiopia, 2017. Int J Pediatr, 2018:7801272.
22. Chen LK, Kuo SC, Chang KC, et al (2017). Clinical Antibiotic-resistant Acinetobacter baumannii Strains with Higher Susceptibility to Environmental Phages than Antibiotic-sensitive Strains. Sci Rep, 7 (1):6319.
23. Wang Y, Ren J, Yao Z, et al (2023). Clinical Impact and Risk Factors of Intensive Care Unit-Acquired Nosocomial Infection: A Propensity Score-Matching Study from 2018 to 2020 in a Teaching Hospital in China. Infect Drug Resist, 16:569-579.
24. Mendelson M, Whitelaw A, Nicol M, et al (2012). Wake up South Africa! The antibiotic 'horse' has bolted. S Afr Med J, 102 (7):607-8.
25. Nayeri F, Dalili H, Shariat M, et al (2023). Epidemiology of nosocomial Staphylococcus epidermidis and Acinetobacter baumannii infections in a neonatal intensive care unit. Iran J Microbiol, 15 (3):350-358.
26. Hug L, Alexander M, You D, Alkema L (2019). National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health, 7 (6):e710-e720.
| Files | ||
| Issue | Vol 54 No 11 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Survival Mortality Intensive care Neonatal Drug therapy Combination Kaplan-meier estimate Respiration disorder Sepsis | ||
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How to Cite
1.
Dalili H, Shariat M, Sahebi L. Survival and Causes of Death in Infants Admitted in NICU in Iran: A Retrospective Cohort Study 2016-2022. Iran J Public Health. 2025;54(11):2524-2535.
