Improving Neonatal Care

Ehret, Danielle; Patterson, Jacquelyn; Bose, Carl

doi:10.1016/j.clp.2017.05.002

Cited by 33 publications

(16 citation statements)

References 46 publications

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“…The vast majority of neonatal deaths occur in sub-Saharan Africa and Southern Asia [ 3 , 4 ]. The main causes of neonatal mortality are prematurity (35%), intrapartum-related events (24%) and infections (15%) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting

Cavallin

Bonasia

Yimer³

et al. 2020

BMC Pregnancy Childbirth

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Background Although under-5 mortality has decreased in the last two decades, neonatal mortality remains a global health challenge. Despite achieving notable progress, Ethiopia has still one of the highest neonatal mortality rates worldwide. We aimed to assess the risk factors for mortality among neonates admitted to a special care unit in a referral hospital in rural Ethiopia. Methods This was a retrospective observational study including all 4182 neonates admitted to the special care unit of the St. Luke Wolisso Hospital (Ethiopia) from January 2014 to December 2017. Data were retrieved from hospital charts and entered in an anonymized dataset. A logistic regression model was applied to identify predictors of mortality and effect sizes were expressed as odds ratios with 95% confidence intervals. Results Proportion of deaths was 17% (709/4182 neonates). Neonates referred from other health facilities or home (odds ratio 1.52, 95% confidence interval 1.21 to 1.91), moderate hypothermia at admission (odds ratio 1.53, 95% confidence interval 1.09 to 2.15) and diagnosis of late-onset sepsis (odds ratio 1.63, 95% confidence interval 1.12 to 2.36), low birthweight (odds ratio 2.48, 95% confidence interval 2.00 to 3.09), very low birthweight (odds ratio 11.71, 95% confidence interval 8.63 to 15.94), extremely low birthweight (odds ratio 76.04, 95% confidence interval 28.54 to 263.82), intrapartum-related complications (odds ratio 4.69, 95% confidence interval 3.55 to 6.20), meconium aspiration syndrome (odds ratio 2.34, 95% confidence interval 1.15 to 4.43), respiratory distress (odds ratio 2.25, 95% confidence interval 1.72 to 2.95), other infections (odds ratio 1.92, 95% confidence interval 1.31 to 2.81) or malformations (odds ratio 2.32, 95% confidence interval 1.49 to 3.57) were associated with increased mortality. Being admitted in 2017 vs. 2014 (odds ratio 0.71, 95% confidence interval 0.52 to 0.97), and older age at admission (odds ratio 0.95, 95% confidence interval 0.93 to 0.97) were associated with decreased likelihood of mortality. Conclusions The majority of neonatal deaths was associated with preventable and treatable conditions. Education on neonatal resuscitation and postnatal management, and the introduction of an on-call doctor for high-risk deliveries might have contributed to the reduction in neonatal mortality over time.

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Section: Introductionmentioning

confidence: 99%

Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting

Cavallin

Bonasia

Yimer³

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Though tremendous progress in child survival has been made over the past two decades, mortality in neonates remains disproportionately high. Globally, of the deaths that occur in the first five years, about half of them occur within the first 28 days of birth [2], and more than 90% of them are from developing countries [3]. Neonatal death occurring in developing countries is largely from preventable infectious causes like sepsis [4,5].…”

Section: Introductionmentioning

confidence: 99%

Neonatal septicemia at intensive care unit, Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia: Bacteriological profile, drug susceptibility pattern, and associated factors

et al. 2020

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Background Neonatal septicemia is a life threatening medical emergency that requires timely detection of pathogens with urgent rational antibiotics therapy. Methods A cross-sectional study was conducted between March 2017 to September 2018 among 317 septicemia suspected neonates at neonatal intensive care unit, Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, North Ethiopia. A 3 mL of blood was collected from each participant. Identification of bacterial species was done using the standard microbiological techniques. Antibiotic sensitivity test was done using disk diffusion method. Data were entered and analyzed using computer software SPSS version 22. Bivariate and multivariate regression analysis was applied to determine the association between variables. Results Of the 317 (190 male and 127 female) neonates, 116 (36.6%) were found to be with culture proven septicemia. Klebsiella species were the predominant etiologic agents. Length of hospital stay (AOR (adjusted odds ratio) = 3.65 (2.17-6.13), p < 0.001) and low birth weight (AOR = 1.64 (1.13-2.78), p = 0.04) were the factors associated with neonatalsepticemia. Most isolates showeda frightening drug resistance rate to the commonly used antimicrobial drugs. K. pneumoniae, E. coli, Enterobacter and Citrobacter species were 57% to100% resistant to ceftazidime, ceftriaxone, gentamycin, amoxacillin-clavulunic acid and ampicillin.

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“…However, mortality in neonates (under 28 days of age) and infants (under 1 year of age) remains disproportionately high, representing over two-thirds of under-5 deaths in children below 5 years of age ( 2 ). Of these deaths, 90% occur in developing countries ( 3 ), with the highest neonatal mortality rates occurring in Sub-Saharan Africa. Thus, interventions among neonates and infants are urgently needed in these countries if the recent UN Sustainable Development Goals are to be achieved, targeting to decrease under-5 mortality to < 25 per 1,000 live births and neonatal mortality to < 12 per 1,000 live births by 2030 ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…Although no consensus has been made, some studies suggest preterm birth, intrapartum complications, and sepsis are leading causes of death among neonates ( 7 ). The relative risk of death from these events ranges from 10 to 36 times greater in LMICs, as compared to high income countries ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review

et al. 2018

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Background: Neonates and infants comprise the majority of the 6 million annual deaths under 5 years of age around the world. Most of these deaths occur in low/middle income countries (LMICs) and are preventable. However, the clinical identification of neonates and infants at imminent risk of death is challenging in developing countries.Objective: To systematically review the literature on clinical risk factors for mortality in infants under 12 months of age hospitalized for sepsis or serious infections in LMICs.Methods: MEDLINE and EMBASE were systematically searched using MeSH terms through April 2017. Abstracts were independently screened by two reviewers. Subsequently, full-text articles were selected by two independent reviewers based on PICOS criteria for inclusion in the final analysis. Study data were qualitatively synthesized without quantitative pooling of data due to heterogeneity in study populations and methodology.Results: A total of 1,139 abstracts were screened, and 169 full-text articles were selected for text review. Of these, 45 articles were included in the analysis, with 21 articles featuring neonatal populations (under 28 days of age) exclusively. Most studies were from Sub-Saharan Africa and South Asia. Risk factors for mortality varied significantly according to study populations. For neonatal deaths, prematurity, low birth-weight and young age at presentation were most frequently associated with mortality. For infant deaths, malnutrition, lack of breastfeeding and low oxygen saturation were associated with mortality in the highest number of studies.Conclusions: Risk factors for mortality differ between the neonatal and young infant age groups and were also dependant on the study population. These data can serve as a starting point for the development of individualized predictive models for in-hospital and post-discharge mortality and for the development of interventions to improve outcomes among these high-risk groups.

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Improving Neonatal Care

Cited by 33 publications

References 46 publications

Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting

Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting

Neonatal septicemia at intensive care unit, Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia: Bacteriological profile, drug susceptibility pattern, and associated factors

Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review

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