Neonatal Mortality in a High-Risk Tertiary Referral Center in Southern Turkiye: A 5-Year Retrospective Descriptive Study

Abstract

Objective: To evaluate neonatal mortality rates and causes of death and describe the clinical and demographic characteristics of non-surviving infants admitted to a tertiary referral neonatal intensive care unit (NICU) in southern Türkiye. Materials and Methods: This retrospective descriptive study included all neonates admitted to the NICU who died between January 2019 and August 2024. Demographic characteristics, perinatal and maternal risk factors, neonatal morbidities, severity scores (Score for Neonatal Acute Physiology, Score for Neonatal Acute Physiology with Perinatal Extension II, and Vasoactive-Inotropic Score [VIS]), and causes of death were analyzed. Results: During the study period, 4339 infants were admitted to the NICU, and 631 deaths were recorded, corresponding to an overall mortality rate of 14.5%. The majority of deaths occurred in preterm infants (83%), particularly those born at <26-week gestation (39%). Most deaths (61.8%) occurred within the first 7 days of life. Major congenital anomalies were present in 27.7% of infants, and severe congenital heart disease in 8.3%. The most common causes of death were severe congenital malformations (27.7%), extreme prematurity (11.8%), and early-onset sepsis (12%). Among infants receiving inotropic support, 32.8% had a VIS > 20, indicating significant hemodynamic instability. Exclusion of infants with conditions incompatible with life reduced the mortality rate to 13.8%. Conclusion: Neonatal mortality was primarily driven by extreme prematurity, major congenital anomalies, and sepsis. Elevated disease severity scores, particularly VIS, reflected substantial hemodynamic burden among non-survivors. Mortality rates in referral NICUs may be influenced by patient complexity, referral burden, and treatment limitation practices.