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Original Research (Original Article) 


Abdulrahman Saleh Alrasheed et al, 2019;3(10):065–070.

International Journal of Medicine in Developing Countries

The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (2012–2017)

Abdulrahman Saleh Alrasheed1, Khalid Alhussein2, Mohammed Alsayed2, Waleed Mohammed Alzahrani1, Abdullah Dhaifallah Alotaibi1, Faris Mohammad Alosaimi1, Mohammed Hamad Aldebasi1, Abdulrahman Abdullah Alshuwayrikh1, Saleh Mansoor Alkhonezan1, Mohammed Ali Hassan AlShehri1, Osama Ahmed Alshaya1, Abdulrahman Abdullah Aljethaily1, Abdullah Ibrahim Alasmari1, Mohammed Abdulfttah AlMakhdob1, Abdullah Alfaris2, Mosleh Jabari3

Correspondence to: Abdulrahman Saleh Alrasheed

*College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.

Email: uwv111 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 06 July 2019 | Accepted: 06 August 2019


ABSTRACT

Background:

Understanding the causes of neonatal and post neonatal death helps to develop strategies to reduce death rates and improve the quality of care. The present study aims to investigate the causes of neonatal and post neonatal deaths in the neonatal intensive care unit (NICU) at Security Forces Hospital, Riyadh region, Saudi Arabia.


Methodology:

This is a retrospective descriptive study, addressing the causes of neonatal and post neonatal death in the NICU at Security Forces Hospital, Riyadh, Saudi Arabia, over 5 years, from January 1, 2012, to March 31, 2017. All the death cases in the NICU were included and classified using the modified version of Wigglesworth classification.


Results:

We have studied 204 NICU deaths from 2012 to 2017 (7.2% of total admissions). Out of all deaths, 52% were male, 84.8% were neonatal, and 15.2% were post neonatal deaths. Two-thirds of deaths occurred in neonates with abnormal Apgar scores in the first minute (65.2%). Most infants weighing below 1,000 g died due to prematurity (89.2%). Overall, preterm birth and its complications were the most prevalent cause of death at 51.5%, followed by congenital malformations at 33.3% and various specific diagnoses at 13.2%.


Conclusion:

Prematurity and its related complications are the primary cause of death in the NICU.


Keywords:

Neonatal intensive care unit, neonatal mortality, post neonatal mortality, cause of death.


Introduction

The infant mortality rate is a significant indicator of the quality of the health care provided to the population and gives insight into the factors that influence health [1]. According to Millennium Development Goal 4, minimizing the infant mortality rate is a major challenge. Substantial efforts and resources are necessary to overcome these challenges, especially during the neonatal period, which is the main contributor to mortality figures for children under age five [2,3].

The worldwide infant mortality rate in 1990 was 62.7 per 1,000. It declined to 53 per 1,000 in 2000 and continued to fall, reaching 33.6 per 1,000 in 2013 [4]. In Saudi Arabia, there was an evident, continuous decrease in infantile death rates in the period of 1994 to 2004 [3]. Other authors had confirmed this decline of the infant mortality rate: from 35.3 per 1,000 in 1990 down to 19.3 per 1,000 in 2000 and decreasing to 2013, when it was 13.4 per 1,000 [4].

Among 2.76 million deaths occurred in the neonatal population in 186 countries worldwide in 2013. The percentage of deaths on the same day of birth and in week 1 was 36.3% and 73.2%, respectively [4]. In Canada and the United States of America, the risk of neonatal death on day 0 was 2.3 and 2.4 per 1,000 births, respectively. While in Africa, particularly in the sub-Saharan region, where nine out of ten countries with the highest risk of neonatal death are located, the figures found were 14–17 deaths per 1,000 births on day 0 [4]. For comparison, the neonatal mortality rate in Saudi Arabia was reduced from 20.7 in 1990 to 8.8 in 2013 [4]. In 187 countries worldwide, the number of post neonatal deaths was 2.3 million in 2010 [5].

There are certain common causes of infant mortality. Eighty-five percent of 3.1 million reported neonatal deaths worldwide had been caused by infections, preterm birth, and intrapartum complications like birth asphyxia [6]. In the United States, chromosomal anomalies and congenital malformations, diseases associated with low birth weight and short gestation, as well as Sudden Infant Death Syndrome were found to be the most impactful causes of infant mortality [7]. Other studies have also confirmed that one of the critical factors implicated in neonatal death is low birth weight [8]. In Saudi Arabia, prematurity and its complications, together with congenital anomalies, accounted for 85.5% of all the causes of neonatal mortality [9]. In the neonatal intensive care unit (NICU), complications associated with premature birth—especially extreme prematurity— were found to be the most common factors responsible for mortality at low gestational ages [10]. Conversely, structural or genetic anomalies and hypoxic-ischemic encephalopathy (HIE) were found to be more common causes of death at higher gestational ages [10]. Sudden Infant Death Syndrome was reported as the most common cause of death among post neonates in the United States, followed by chromosomal anomalies, congenital malformations, and accidents [7].

Understanding the causes of neonatal and post neonatal death helps to develop strategies to reduce death rates and improve the quality of care. The present study aims to investigate the causes of neonatal and post neonatal deaths in the NICU at Security Forces Hospital, Riyadh region, Saudi Arabia.


Methodology

This is a retrospective descriptive study, addressing the causes of neonatal and post neonatal death in the NICU at Security Forces Hospital, one of the major tertiary centers in Riyadh, Saudi Arabia. The hospital’s capacity is more than 700 beds, covering almost all subspecialties in both medical and surgical fields. It exclusively serves employees of the Ministry of the Interior and their families, and this hospital performs about 6,000 deliveries each year. The present study was conducted retrospectively to assess deaths for 5 years, from January 1, 2012, to March 31, 2017. All the death cases in the NICU were included and classified using the modified version of the Wigglesworth classification. However, cases of stillbirths and abortions were excluded. The Institutional Review Board of Security Forces Hospital granted ethical approval to this study. This study adheres to the principles of the Helsinki Declaration.

Data were obtained from maternal and neonatal medical records. The data included gestational age, neonatal length and weight, gender, mode of delivery, admission diagnosis, congenital anomalies, associated comorbidity, ultrasound abnormalities, Apgar score after the first minute, Apgar score at five minutes, and registered causes of death.

A digital scale measured neonatal weight in the labor room. All neonates in the present study were clustered based on their birth weight into four groups: <1,000 g; 1,000–1,999 g; 2,000–2,999 g; and ≥3,000 g. After any neonatal death in the NICU, a consulting doctor would write a death summary and document it in the computerized patient report. In Saudi Arabia, autopsies are only performed for exceptional cases with legal issues. In this study, the author has primarily categorized the causes of death into congenital malformations, preterm birth, and birth asphyxia. The definitions used were the following:

  • Neonatal mortality: Deaths of live babies between births up to 27 days of age [11].
  • Early neonatal mortality: Deaths of live babies occurring during the first six completed days of life [11].
  • Late neonatal mortality: Deaths of live babies between seven to 27 days of age [11].
  • Post neonatal mortality: Deaths of live babies after 27 days up to one year of age [11].
  • Preterm delivery: Gestation at birth less than 37 completed weeks [2].
  • Term delivery: Gestation at birth between 37 to 42 completed weeks [2].
  • Post-term delivery: Gestation at birth equal to or more than 42 completed weeks [2].

The data of the present study were carefully extracted from the hospital’s records onto an Excel sheet. Subsequently, a second review of the entered data was performed by a NICU consultant. In the case of conflicting data, a third-party consultant was contacted to ensure the accuracy of the entered diagnosis. The analysis was conducted by R statistical analysis software (Version 3.3.4).


Results

During the study period, there were a total of 26,992 live births, and 2,818 (10.44%) of them were admitted to the NICU. We studied 204 NICU deaths from 2012 to 2017 (7.2%) of all admissions. Out of all deaths, 84.8% were neonatal, and 15.2% were post neonatal deaths. Out of all deaths, 52% were male; two-thirds were preterm neonates, one-third were infants with meager birth weight (<1,000 g), whereas two-thirds (65.2%) were associated with an abnormal Apgar score in the first minute. However, most infants who died had average Apgar scores at five minutes (Table 1).

Approximately, two-thirds of deaths (63.7%) occurred in the preterm delivery group (Figure 1). Overall, preterm birth and its complications were the most common cause of death at 51.5%, followed by congenital malformations at 33.3% and various specific diagnoses at 13.2%. Preterm birth and its complications were the most common causes of deaths (both postnatal and neonatal), followed by congenital malformations (Table 2). Congenital abnormalities (33.3%) consisted of multiple anomalies in 23.5% of cases, while 23.5% had pulmonary hypoplasia, and 20.6% had chromosomal abnormalities (Table 3). A diaphragmatic hernia was the most crucial direct cause of death in the specific diagnosis group, at 55.6% (Table 3).

Regarding birth weight, 89.2% of those infants weighing <1,000 g died due to prematurity and its complications. These causes were more apparent in lower birth weight infants compared to higher birth weight infants (Table 4).


Discussion

Statistical analyses of the comprehensive data regarding neonatal and post-neonatal mortality rates and causes of death in the NICU can provide us with valuable information regarding the performance of NICU care. This study addressed neonatal and post-neonatal mortality rates and causes of death in the NICU for five years (2012 to 2017) at The Security Forces Hospital, Riyadh region.

Figure 1. Distribution of neonatal and post-neonatal deaths according to gestational age at Security Forces Hospital, Riyadh (2012–2017).

Table 1. Characteristics of neonatal and post neonatal deaths at Security Forces Hospital in Riyadh (2012–2017).

Variables Total = 204 N. of Deaths (%) Total = 173 Neonatal deaths <28 days N (%) Total = 31 Post neonatal deaths >28 days N (%)
Gender
Male 106 (52.0) 86 (49.7) 20 (64.5)
Female 98 (48.0) 87 (50.3) 11 (35.5)
Weight (g)
<1,000 65 (31.9) 60 (34.7) 5 (16.1)
1,001–2,000 59 (28.9) 50 (28.9) 9 (29.0)
2,001–3,000 57 (27.9) 46 (26.6) 11 (35.5)
>3,001 23 (11.3) 17 (9.8) 6 (19.4)
Length (cm)
<45 121 (59.3) 107 (61.8) 14 (45.2)
45–60 76 (37.3) 60 (34.7) 16 (51.6)
<60 7 (3.4) 6 (3.5) 1 (3.2)
APGAR score 1st minute
Abnormal (1–6) 133 (65.2) 120 (69.4) 13 (41.9)
Normal (7–10) 71 (34.8) 53 (30.6) 18 (58.1)
APGAR score 5th minute
Abnormal (1–6) 81 (39.7) 75 (43.4) 6 (19.4)
Normal (7–10) 123 (60.3) 98 (56.6) 25 (80.6)
Amniotic fluid abnormality
Anhydramnios 26 (12.7) 24 (13.9) 2 (6.5)
Oligohydramnios 15 (7.4) 14 (8.1) 1 (3.2)
Polyhydramnios 23 (11.3) 17 (9.8) 6 (19.4)

Table 2. Causes of neonatal and postneonatal death in the NICU at Security Forces Hospital in Riyadh (2012–2017).

Group Total deaths N (%) Neonate N (%) Postneonate N (%)
Prematurity and its complications 105 (51.5) 90 (52) 15 (48.4)
Sepsis 53 (50.5) 40 (44.4) 13 (86.7)
RDS 46 (43.8) 44 (48.9) 2 (13.3)
Other 6 (5.7) 6 (6.7) 0 (0.0)
Congenital malformations 68 (33.3) 59 (34.1) 9 (29)
Specific diagnosis 27 (13.2) 23 (13.3) 4 (12.9)
Birth asphyxia 4 (2.0) 1 (0.6) 3 (9.7)
Total (%) 204 (100) 173 (84.8) 31 (15.2)

Table 3. Cause of death in the congenital malformation group and in the specific diagnosis group at the Security Forces Hospital in Riyadh (2012–2017).

Causes of death in the congenital malformation group: N (%)
Multiple congenital abnormalities 16 (23.5)
Chromosomal anomalies 14 (20.6)
pulmonary hypoplasia 16 (23.5)
Congenital heart defect (CHD) 13 (19.1)
CNS (meningomyelocele, anecephaly) 3 (4.4)
Inborn Error of metabolism 2 (2.9)
Pulmonary interstitial emphysema 1 (1.5)
Meckel gruber syndrome 1 (1.5)
Seckel syndrome 1 (1.5)
Thanatophoric dysplasia 1 (1.5)
Causes of death in the specific diagnosis group:
Diaphragmatic hernia 15 (55.6)
Others* 12 (44.4)

*1 (3.7%) Renal agenesis/MCDK 1 (3.7%) Hydrops fetalis 1 (3.7%) Pulmonary hemorrhage 1 (3.7%) Necrotizing enterocolitis 1 (3.7%) Hemophagocytic syndrome 1 (3.7%) Citrullinemia 1 (3.7%) Panhypopituitarism 1 (3.7%) twin-twin transfusion syndrome 4 (14.8%) CNS problem.

Table 4. Distribution of causes of death according to birth weight at Security Forces Hospital, Riyadh (2012–2017).

Cause of death Birth weight in gram N (%) Total N (%)
≥3,000g 2,000–2,999g 1,000–1,999g <1,000g
Prematurity and its complication 4 (17.4) 13 (22.8) 30 (50.8) 58 (89.2) 105 (51.5)
Sepsis 1 (25.0) 10 (76.9) 14 (46.7) 28 (48.3) 53 (50.5)
RDS 3 (75.0) 3 (23.1) 16 (53.3) 24 (41.4) 46 (43.8)
Other 0 (0) 0 (0) 0 (0) 6 (10.3) 6 (5.7)
Congenital abnormality 12 (52.2) 31 (54.4) 22 (37.3) 3 (4.6) 68 (33.3)
Specific diagnosis 6 (26.1) 11 (19.3) 6 (10.2) 4 (6.2) 27 (13.2)
Birth asphyxia 1 (4.3) 2 (3.5) 1 (1.7) 0 (0.0) 4 (2.0)
Total N. (%) 23 (11.3) 57 (27.9) 59 (28.9) 65 (31.9) 204 (100)

The neonatal and post-neonatal mortality rate in the NICU was 7.2% of the total number of admissions. This is slightly higher than the 5.7% reported by the Armed Forces Hospital’s Khamis Mushayt [12]. However, other data from the southern region of Saudi Arabia showed higher mortality, at 22.4% [13]. Worldwide, mortality rates ranged from as low as 3.8%, 4%, and 5.7% in South Africa [14], Canada [15], and Portugal [16], respectively, to as high as 26%–29% in Uganda [17]. It was stated the severity of disease on admission and the level of care provided were probable explanations of this wide variation [13].

Preterm birth, which is estimated to be as frequent as 1 out of 10 deliveries worldwide [18], has been associated with higher mortality in neonates. In our study, 63.7% of all deaths were in preterm infants, similar to the 62% reported by others [12]. Moreover, preterm birth also related to lower birth weight, with infants weighing <1,000 g constituting approximately 31.9% of the total deaths in this study, and 1,000–1,999 g for about 28.9% of deaths. However, the poor survival in this group could be reduced by antenatal care and prolonged gestation. It was found that the survival of very low birth weight newborns depends mainly on gestational age and birth weight: it is 29% at 500–599 g, 87% at 900–999 g, 33% at 24 weeks, and 100% at 28 weeks [19].

This study showed that the most common cause of death among the 204 cases was prematurity and its complications, which represented 51.5%. Comparable figures of 53% and 61% were observed in The Military Hospital in Saudi Arabia from 1995–2004 [11] and The Armed Forces Hospital in Khamis Mushayt from January 1, 2001, to December 31, 2006 [12]. A systematic analysis of global, regional, and national causes of child mortality in 2008 identified the same prominent cause of death, which was found in the above two studies [20]. However, congenital malformations constituted most causes of death in Canada 34% [15]. One-third of infants’ deaths in the present study were due to congenital disabilities (second most common). Multiple congenital abnormalities and pulmonary hypoplasia each constituted 23.5% of all congenital causes.

In this study, infants weighing less than 1,000 g died most often because of prematurity and its complications (89.2%). Sepsis represented 48.3%, followed by respiratory distress syndrome RDS with 41.4% of all deaths in this category. This distribution may be correlated with a longer NICU stay, as the Canadian study quoted above showed that, out of infants weighing less than 1,000 g, 50% died due to sepsis after day six. Only 4.5% died earlier, while respiratory failure was the most common cause (45%) of early deaths [15]. A remarkably different distribution of causes of death was found in the present study, in infants weighing ≥3,000 g: 52.2% died due to congenital abnormalities, and 17.4% died because of prematurity and its complications.

The present study was based on the findings of a single institution and may not be representative of national NICU centers. There is a need for further multi-center studies in the Kingdom of Saudi Arabia to establish the causes of neonatal death. Thereby, NICU performance could be improved to decrease the mortality rate, improve overall outcomes, and provide better neonatal care in Saudi Arabia.


Conclusion

This study found that preterm birth and its complications, congenital malformations, and sepsis were the prevalent causes of death in the NICU at Security Forces Hospital in Riyadh. These results imply that further effort is needed to recognize and prevent the factors conducive to admission to the NICU and subsequent deaths. Particular attention should be directed towards prematurity and its complications. Simultaneously, the frequent assessment of mortality indicators could contribute to improving the quality of care in the NICU. Finally, the findings support the establishment of a national database to evaluate the causes of neonatal mortality in the different parts of the Kingdom.


List of Abbreviations

HIE Hypoxic-ischemic encephalopathy
NICU Neonatal intensive care unit

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Consent for publication is not required for anonymous retrospective studies.


Ethical approval

The Institutional Review Board at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia, approved the study via letter number: 18-299-64, dated: January 20, 2019.


Author details

Abdulrahman Saleh Alrasheed1, Khalid Alhussein2, Mohammed Alsayed2, Waleed Mohammed Alzahrani1, Abdullah Dhaifallah Alotaibi1, Faris Mohammad Alosaimi1, Mohammed Hamad Aldebasi1, Abdulrahman Abdullah Alshuwayrikh1, Saleh Mansoor Alkhonezan1, Mohammed Ali Hassan AlShehri1, Osama Ahmed Alshaya1, Abdulrahman Abdullah Aljethaily1, Abdullah Ibrahim Alasmari1, Mohammed Abdulfttah AlMakhdob1, Abdullah Alfaris2, Mosleh Jabari3

  1. College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
  2. Department of Pediatrics, Security Forces Hospital, Riyadh, Saudi Arabia
  3. Department of Pediatrics, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alrasheed AS, Alhussein K, Alsayed M, Alzahrani WM, Alotaibi AD, Alosaimi FM, Aldebasi MH, Alshuwayrikh AA, Alkhonezan SM, AlShehri MAH, Alshaya OA, Aljethaily AA, Alasmari AI, AlMakhdob MA, Alfaris A, Jabari M. The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017). IJMDC. 2019; 3(10): 65-70. doi:10.24911/IJMDC.51-1562410193


Web Style

Alrasheed AS, Alhussein K, Alsayed M, Alzahrani WM, Alotaibi AD, Alosaimi FM, Aldebasi MH, Alshuwayrikh AA, Alkhonezan SM, AlShehri MAH, Alshaya OA, Aljethaily AA, Alasmari AI, AlMakhdob MA, Alfaris A, Jabari M. The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017). http://www.ijmdc.com/?mno=55681 [Access: October 18, 2019]. doi:10.24911/IJMDC.51-1562410193


AMA (American Medical Association) Style

Alrasheed AS, Alhussein K, Alsayed M, Alzahrani WM, Alotaibi AD, Alosaimi FM, Aldebasi MH, Alshuwayrikh AA, Alkhonezan SM, AlShehri MAH, Alshaya OA, Aljethaily AA, Alasmari AI, AlMakhdob MA, Alfaris A, Jabari M. The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017). IJMDC. 2019; 3(10): 65-70. doi:10.24911/IJMDC.51-1562410193



Vancouver/ICMJE Style

Alrasheed AS, Alhussein K, Alsayed M, Alzahrani WM, Alotaibi AD, Alosaimi FM, Aldebasi MH, Alshuwayrikh AA, Alkhonezan SM, AlShehri MAH, Alshaya OA, Aljethaily AA, Alasmari AI, AlMakhdob MA, Alfaris A, Jabari M. The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017). IJMDC. (2019), [cited October 18, 2019]; 3(10): 65-70. doi:10.24911/IJMDC.51-1562410193



Harvard Style

Alrasheed, A. S., Alhussein, . K., Alsayed, . M., Alzahrani, . W. M., Alotaibi, . A. D., Alosaimi, . F. M., Aldebasi, . M. H., Alshuwayrikh, . A. A., Alkhonezan, . S. M., AlShehri, . M. A. H., Alshaya, . O. A., Aljethaily, . A. A., Alasmari, . A. I., AlMakhdob, . M. A., Alfaris, . A. & Jabari, . M. (2019) The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017). IJMDC, 3 (10), 65-70. doi:10.24911/IJMDC.51-1562410193



Turabian Style

Alrasheed, Abdulrahman Saleh, Khalid Alhussein, Mohammed Alsayed, Waleed Mohammed Alzahrani, Abdullah Dhaifallah Alotaibi, Faris Mohammad Alosaimi, Mohammed Hamad Aldebasi, Abdulrahman Abdullah Alshuwayrikh, Saleh Mansoor Alkhonezan, Mohammed Ali Hassan AlShehri, Osama Ahmed Alshaya, Abdulrahman Abdullah Aljethaily, Abdullah Ibrahim Alasmari, Mohammed Abdulfttah AlMakhdob, Abdullah Alfaris, and Mosleh Jabari. 2019. The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017). International Journal of Medicine in Developing Countries, 3 (10), 65-70. doi:10.24911/IJMDC.51-1562410193



Chicago Style

Alrasheed, Abdulrahman Saleh, Khalid Alhussein, Mohammed Alsayed, Waleed Mohammed Alzahrani, Abdullah Dhaifallah Alotaibi, Faris Mohammad Alosaimi, Mohammed Hamad Aldebasi, Abdulrahman Abdullah Alshuwayrikh, Saleh Mansoor Alkhonezan, Mohammed Ali Hassan AlShehri, Osama Ahmed Alshaya, Abdulrahman Abdullah Aljethaily, Abdullah Ibrahim Alasmari, Mohammed Abdulfttah AlMakhdob, Abdullah Alfaris, and Mosleh Jabari. "The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017)." International Journal of Medicine in Developing Countries 3 (2019), 65-70. doi:10.24911/IJMDC.51-1562410193



MLA (The Modern Language Association) Style

Alrasheed, Abdulrahman Saleh, Khalid Alhussein, Mohammed Alsayed, Waleed Mohammed Alzahrani, Abdullah Dhaifallah Alotaibi, Faris Mohammad Alosaimi, Mohammed Hamad Aldebasi, Abdulrahman Abdullah Alshuwayrikh, Saleh Mansoor Alkhonezan, Mohammed Ali Hassan AlShehri, Osama Ahmed Alshaya, Abdulrahman Abdullah Aljethaily, Abdullah Ibrahim Alasmari, Mohammed Abdulfttah AlMakhdob, Abdullah Alfaris, and Mosleh Jabari. "The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017)." International Journal of Medicine in Developing Countries 3.10 (2019), 65-70. Print. doi:10.24911/IJMDC.51-1562410193



APA (American Psychological Association) Style

Alrasheed, A. S., Alhussein, . K., Alsayed, . M., Alzahrani, . W. M., Alotaibi, . A. D., Alosaimi, . F. M., Aldebasi, . M. H., Alshuwayrikh, . A. A., Alkhonezan, . S. M., AlShehri, . M. A. H., Alshaya, . O. A., Aljethaily, . A. A., Alasmari, . A. I., AlMakhdob, . M. A., Alfaris, . A. & Jabari, . M. (2019) The causes of death in the Neonatal Intensive Care Unit at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia (20122017). International Journal of Medicine in Developing Countries, 3 (10), 65-70. doi:10.24911/IJMDC.51-1562410193