Neonatal Diseases Managed in the Peripheral Hospital: a study at the sidi Mohamed ben Abdellah; Morocco

Research Article | DOI: https://doi.org/Bennaoui Fatiha, Neonatology Department, Universit

Neonatal Diseases Managed in the Peripheral Hospital: a study at the sidi Mohamed ben Abdellah; Morocco

  • Bennaoui Fatiha 1,2*
  • MROUNA ISMAIL 1,2
  • Abi El AAla Khalid 1,2
  • Lalaoui Abdessamad 1,2
  • El Idrissi Slitine Nadia 1,2
  • Fadl Mrabih Rabou Maoulainine 1,2

1 Neonatal Intensive Care Unit, Mother-Child Hospital, CHU Mohammed VI, Marrakech, Morocco.
 2 Childhood, Health and Development Research LABORATORY, Cadi-Ayyad University, Marrakech, Morocco.

*Corresponding Author: Bennaoui Fatiha, Neonatology Department, University Hospital, Marrakech, Morocco.

Citation: Bennaoui Fatiha, Mrouna Ismail, Abi El AAla Khalid, Lalaoui Abdessamad, Slitine Nadia EI, et al, (2025), Neonatal Diseases Managed in the Peripheral Hospital: à study at the sidi Mohamed ben Abdellah; Morocco, Clinical Research and Clinical Trials, 12(1); DOI:10.31579/2693-4779/250

Copyright: © 2025, Bennaoui Fatiha. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Received: 11 December 2024 | Accepted: 27 December 2024 | Published: 17 January 2025

Keywords: morocco; neonatal; prematurity; peripheral hospital

Abstract

Neonatal pathologies encompass a wide range of diseases and disorders affecting newborns (age ≤28 days). These conditions can have diverse origins, whether infectious, genetic, metabolic, hemodynamic, respiratory, digestive, neurological or other. 
This is a retrospective analytical and descriptive study, carried out in the department of pediatrics the Peripheral Hospital Sidi Mohamed Ben Abdellah of Essaouira, Morocco; over a period of 6 months from June 11, 2023 to December 11, 2023|
The total number of neonates hospitalized was 140 cases with a sex ratio of 1.15. The mean age was 4.68 ± 6.87 days, with extremes ranging from 1 to 28 days. The prematurity rate was (21.7%) and (31%) of newborns had a low birth weight.
More than half (61%) of pregnancies were poorly attended, with medical deliveries accounting for (94%), and in (66%) were by vaginal delivery versus (33%) by caesarean section. Infectious anamnesis was positive in (35%).
Prematurity was the main reason for hospitalization (21%). Hyperleukocytosis or leukopenia was observed in (29.53%) of cases. CRP was above 20 mg/l in (24.61%).  Newborns receiving antibiotic treatment accounted for (83%).
The average hospital stay was 4.72 days. Prematurity was the primary diagnosis (40.7%). The mortality rate was (6%), while the outcome was favorable in (91%) of the newborns in the study.
Neonatal pathologies are frequent and remain associated with high mortality, hence the interest in creating an interconnected care system capable of managing them by guaranteeing regular monitoring of pregnancies, special attention during deliveries, and adequate equipment. 

Introduction

Neonatal pathologies encompass a range of diseases and disorders affecting newborns (age≤ 28 days). These conditions can have diverse origins, whether infectious, genetic, metabolic, hemodynamic, respiratory, digestive, neurological or other. They account for a significant proportion of infant mortality and morbidity worldwide.
The first 28 days of a child′s life are a high-risk period for various types of injury, which can lead to death or have a lasting effect on development and the rest of the child′s life. Of the 130 million births worldwide each year, four million newborns die before one month of age, 99% of them in poor countries, from causes that are mostly known [1, 2] and largely preventable or accessible to treatment [3]. Thus, far more than a public health problem, neonatal mortality is a genuine global development issue. Because newborns account for up to 40% of deaths of children under 5 years of age [2], accelerating the reduction of neonatal mortality is imperative if we are to achieve target 4 of the United Nations Millennium Development Goals [4].
The management of neonatal diseases requires a delicate approach, involving precise diagnoses, specialized medical interventions and close coordination between members of the medical team. Conditions such as neonatal infections, metabolic disorders and congenital anomalies require an individualized approach to ensure optimal care.
This study, carried out over a 6-month period in the pediatrics department of the Sidi Mohamed Ben Abdellah outpatient hospital and involving 240 cases of neonatal pathologies, had the following objectives :
-Evaluate the prevalence of neonatal diseases and their evolution.
-Evaluate the management of neonatal pathologies in peripheral hospitals.

Patients and methods

Our work is a retrospective analytical and descriptive study, carried out in the pediatrics department, Sidi Mohamed Ben Abdellah outpatient hospital in Essaouira, Morocco ;  over a 6-month period from June 11, 2023 to December 11, 2023.
We included in this study all newborns aged from the 1st hour of life to 28 days, hospitalized for a neonatal pathology and having benefited from care within the pediatrics department.
An evaluation form was drawn up for each patient, enabling us to assess the various epidemiological, clinical, paraclinical (biological and radiological), etiological, therapeutic and evolutionary data.

Results

140 neonates were admitted to the neonatology department. The month of December was predominant with a raté of 21%, i.e. 30 newborns; the age of admission of patients varied between one and 21 days of life, with a mean age of 4.68 ± 6.87 days and a median corresponding to one day of life. Females predominated (54%), representing 75 newborns with a sex ratio of 0.86. More than two-thirds of newborns were at term (73%), while 29 were premature. 35% of cases had a positive infectious history (Table I). 

Anamnestic factors Number of casesPercentage
Inexpliquée Unexplained perinatal asphyxia53,56 %
Maternal fever 48h before and 6h after53.57 %
Urogenital infections in the 3rd trimester128.57 %
Tainted or foul-smelling fluid1913.57 %
Unexplained prematurity64.28 %
Premature rupture of membranes >12hrs64.28 %
Prolonged labor >12h42.85 %

Table I: Distribution of anamnestic factors in positive infectious history.
The majority of deliveries were medicalized, with a percentage of 94%. Newborns born at home accounted for 6%. The majority of deliveries (66%) were performed vaginally, with 4

Discussion

The neonatal period is a critical time in human life when a newborn must adapt to a new environment and make several physiological adjustments essential to life [5]. Neonatal mortality contributes significantly to under-five mortality [5]. According to 2018 estimates, more than 2.4 million children died before their second month of life [6]. Neonatal mortality rates differ between regions and nations. A third of neonatal deaths worldwide occur in sub-Saharan Africa, with around 34 deaths per 1,000 live births. The risk of neonatal death is around 55 times higher in the country with the highest mortality rate than in the country with the lowest mortality rate [7]. The neonatal mortality rate in Ethiopia is around 30 per 1,000 live births [7].

The main neonatal diseases are sepsis, respiratory distress syndrome, birth asphyxia and necrotizing enterocolitis, accounting for 26%, 23%, 19% and 7% respectively [8]. In Ethiopia, the most common diseases leading to neonatal death are sepsis, birth asphyxia, necrotizing colitis (NC) and respiratory distress syndrome (RDS) [9]. Factors contributing to neonatal death include shortage of neonatologists and pediatricians, inadequate diagnostic tools, delayed diagnosis and lack of quality care and treatment for neonatal conditions [10]. In resource-constrained countries such as Ethiopia, neonatal diseases take a heavy toll on families, society and the healthcare system. Preventive and curative strategies exist to mitigate the impact. But improvements in outcomes are limited. Preventive approaches focus on maternal health before birth, such as maternal vaccination and efforts to ensure a healthy pregnancy [11, 12]. As for curative approaches, diagnostic tools are limited and diagnostic results take longer. Delayed results often lead to a rapid deterioration in the condition of the newborn [13]. This has serious repercussions, including chronic lung disease, neurodevelopmental abnormality and long-term disability requiring ongoing hospitalization [14]. There are also significant increases in expenses and burdens for survivors and carers. Therefore, early identification of neonatal disease with appropriate antibiotic therapy can be effective in reducing neonatal mortality, cutting costs and reducing antibiotic resistance in the community [15]. Detecting disease at an early stage with minimal cost is an area of interest for many researchers [16].

Conclusion

The management of neonatal pathologies in the periphery is a complex but essential challenge to ensure the health and well-being of newborns. Effective measures must be put in place to rapidly identify problems and provide adequate treatment, especially in cases of perinatal asphyxia where time is of the essence.
Adequate training of medical staff in the delivery room and appropriate equipment for emergency interventions are essential. This can help reduce the risk of complications and improve outcomes for newborns facing critical situations right from birth.
However, it is also important to recognize the limitations of the resources available in peripheral settings, and to work to improve access to specialist care where necessary. In addition, ongoing research into neuroprotective treatments could open up new avenues for improving long-term outcomes for newborns facing neonatal complications.

Acknowledgement

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References

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