الفهرس 
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Abstract
Immediate proper care of newborn is vitally important for survival,
growth and development of a newborn.
Egyptian Neonatal Network (EGNN) aims to train pediatricians on
electronic registration of neonatal health records, to develop the skills of
academic staff and clinicians and to achieve improved outcomes through
the improved quality of delivery of health care.
Also, EGNN aims to establish and maintain a neonatal database
that will allow comparison between participating hospitals and to study
the mortality and morbidity of high risk infants admitted to the
participating neonatal care units in EGYPT to be a basis for policy
planning, resource allocation, quality improvement and management at a
departmental, regional and national level and to join other international
neonatal networks, which will provide the ability to benchmark
healthcare in Egypt against international standards.
This was a prospective study of the cases admitted to Neonatal
intensive care unit of Damanhur Teaching Hospital using the Egyptian
Neonatal Network to evaluate neonatal care in it.
This study described the epidemiological aspects of all neonates
admitted along 12 months from the 1 st of April 2014 till the 31st of March
2015 in NICU of Damanhur Teaching Hospital. The data included
patient’ admission data (e.g. demographic data, neonatal measurements
and maternal history), NICU stay data (e.g. average duration of stay,
requirements for assisted ventilation and development of complications)
and discharge data (e.g. clinical outcome).
The total number of admitted cases was 467 neonates with mean
hospital stay of (9.3days) with total mortality rate 16.6%.
Among cases of admission, 267 were males while 200 were
females, 30.8% were born by normal vaginal deliver y and 69.2% were
born by CS. 67% were delivered inborn and 33% out born. 49.7% had
normal birth weight and 50.3% had low birth weight.
Also found that 58.7% of admitted cases needed simple
resuscitation and only 2.8% of cases needed aggressive resuscitation with
cardiac compression and drugs.
The most common causes of admission were respiratory
causes(62.5%) followed by prematurity (52%) and then neonatal
jaundice (23.9%).
The most common complications among admitted cases were
BPD(8.6%) followed by seizures (6.2%) and then pneumothorax (5.6%),
while the least complication was NEC (1.7%).
The most common birth defect was the cardiac anomalies (4.3%).
The most common cardiac anomalies were PDA (24.3%) and then ASD
(16.2%).
The most commonly recovered microorganism from blood cultures
was Klebsiella Pneumoniae (28.6%) followed by Staph coagulase –ve
species (22.6%). The highest sensitivity was to Amikacin (26.2%)
followed by Meropenem (22.6%) and then Vancomycin (21.4%) while
the least sensitivity was to penicillins.
Phototherapy alone was the primary management in all cases of
neonatal jaundice supported by exchange transfusion in 25.9% of
jaundiced cases.
As regard the clinical outcome, in the current study, the total
mortality was (78 cases, 16.6%) with the highest mortality in prematurity
and low birth weight (89.7%) followed by respiratory illness (52 .6%) and
then neonatal sepsis (33.3%).
Neonatal sex and mode of delivery had no significant effect on
clinical outcome. While low birth weight, prematurity and some
procedures as, the use of conventional ventilation for more or less than 5
days highly significant increased the mortality. Also, Length of Hospital
stay and out born neonates had better outcome.
As regard the relation between cause of admission and clinical outcome,
there was highly significant effect of prematurity, sepsis, pneumothorax
and seizures on clinical outcome. The highest mortality was found in
prematurity, respiratory illness and sepsis.
Sepsis was one of the commonest morbidities in our study which is
non significantly related to prenatal care, mode of delivery or sex of
infant, but highly related to prematurity, low birth weight ,conventional
ventilation and duration of hospital admission.
Also, the current study showed high significant relationship
between pneumothorax and (prematurity, low birth weight, mechanical
ventilation and ventilation duration).
Comparison of mortality between Damanhur Hospital and EGNN
shows that total mortality in Damanhur Hospital was slightly more than
total mortality in EGNN. It was 16.6% and 15.5% respectively.
According to birth weight, the highest mortality in Damanhur Hospital,
was 88.6% in neonates with birth weight1000 gram or less and the lowest
mortality was 3.3% in birth weight> 2500 gm. In EGNN the highest
mortality was 88.6% in neonates with birth weight1000 gram or less and
the lowest mortality was 9% in birth weight> 2500 gm.
According to gestational age, the highest mortality in Damanhur
Hospital, was 100% in neonates with gestational age<27 weeks and the
lowest mortality was 3.6% in gestational age(37 – 41) weeks. In EGNN
the highest mortality was 88 %gestational age<27weeks and the lowest
mortality was 7.9% in gestational age (37 – 41) weeks.
Comparison of Morbidities between Damanhur Hospital and
EGNN revealed that, chronic lung disease was 8.6% in Damanhur
Hospital and 9.8% in EGNN. Also, chronic lung disease infants <33
weeks were 8.3% in Damanhur Hospital and 9.2 % in EGNN. Respiratory
distress syndrome (RDS) was 37.3 % in Damanhur Hospital and 31.3 %
in EGNN. Pneumothorax was 5.6% in Damanhur Hospital and 5.2% in
EGNN.
Early bacterial infection was 4.7% in Damanhur Hospital and
6.4% in EGNN. Late bacterial infection was 11.8 % in Damanhur
Hospital and 13 .3% in EGNN. Necrotizing enterocolitis ( NEC) was 1.7
% in Damanhur Hospital and 1.5% in EGNN. Also, it revealed that intra
ventricular heamorrhage (IVH) in Damanhur Hospital was 3.8% and in
EGNN was 2.5%, while Severe IVH in Damanhur Hospital was 5.5% and
in EGNN was 11.1%.