Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda

Abstract

Introduction Preterm neonatal mortality contributes substantially to the high neonatal mortality globally. In Uganda, preterm neonatal mortality accounts for 31% of all neonatal deaths. Previous studies have shown variability in mortality rates by healthcare setting. Also, different predictors influence the risk of neonatal mortality in different populations. Understanding the predictors of preterm neonatal mortality in the low-resource setting where we conducted our study could guide the development of interventions to improve outcomes for preterm neonates. We thus aimed to determine the incidence and predictors of mortality among preterm neonates born at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda. Methods We prospectively enrolled 538 live preterm neonates born at MRRH from October 2019 to September 2020. The neonates were followed up until death or 28 days, whichever occurred first. We used Kaplan Meier survival analysis to describe preterm neonatal mortality and Cox proportional hazards regression to assess predictors of preterm neonatal mortality over a maximum of 28 days of follow up. Results The cumulative incidence of preterm neonatal mortality was 19.8% (95% C.I: 16.7–23.5) at 28 days from birth. Birth asphyxia (adjusted hazard ratio [aHR], 14.80; 95% CI: 5.21 to 42.02), not receiving kangaroo mother care (aHR, 9.50; 95% CI: 5.37 to 16.78), delayed initiation of breastfeeding (aHR, 9.49; 95% CI: 2.84 to 31.68), late antenatal care (ANC) booking (aHR, 1.81 to 2.52; 95% CI: 1.11 to 7.11) and no ANC attendance (aHR, 3.56; 95% CI: 1.51 to 8.43), vaginal breech delivery (aHR, 3.04; 95% CI: 1.37 to 5.18), very preterm births (aHR, 3.17; 95% CI: 1.24 to 8.13), respiratory distress syndrome (RDS) (aHR, 2.50; 95% CI: 1.11 to 5.64) and hypothermia at the time of admission to the neonatal unit (aHR, 1.98; 95% CI: 1.18 to 3.33) increased the risk of preterm neonatal mortality. Attending more than 4 ANC visits (aHR, 0.35; 95% CI: 0.12 to 0.96) reduced the risk of preterm neonatal mortality. Conclusions We observed a high cumulative incidence of mortality among preterm neonates born at a low-resource regional referral hospital in Uganda. The predictors of mortality among preterm neonates were largely modifiable factors occurring in the prenatal, natal and postnatal period (lack of ANC attendance, late ANC booking, vaginal breech delivery, birth asphyxia, respiratory distress syndrome, and hypothermia at the time of admission to the neonatal unit, not receiving kangaroo mother care and delayed initiation of breastfeeding). These findings suggest that investment in and enhancement of ANC attendance, intrapartum care, and the feasible essential newborn care interventions by providing the warm chain through kangaroo mother care, encouraging early initiation of breastfeeding, timely resuscitation for neonates when indicated and therapies reducing the incidence and severity of RDS could improve outcomes among preterm neonates in this setting.

Clinical outcome and associated factors of respiratory distress syndrome among preterm neonates admitted to the neonatal intensive care unit of Adama Hospital and Medical College

“…Likewise, similar findings were observed in Orotta Pediatric Hospital of Eritrea and New Haven Hospital United States. 53,56,57 Convergence of the findings could be because the lower their gestational age the weaker their body sustains the sequela of RDS.…”

Incidence and Predictors of Preterm Mortality in Ethiopia: A Systematic Review and Meta-analysis

“…We also found that preterm neonates having a history of respiratory distress syndrome had a 1.81 times higher risk of death than those who do not have it, which is supported by studies in Uganda and Rwanda. 37,41 In addition, those having hyaline membrane disease had almost three times higher hazard of death compared to those who do not have it. It might be because the immaturity of the lung fails to produce a liquid called surfactant, which hinders the full expansion of the lungs and leads to a shortage of oxygen.…”

“…The pooled incidence proportion of preterm mortality was 30%, which is higher than findings from India, Pakistan, England, and Uganda. [35][36][37] The discrepancy might be due to the difference in socio-economic status and infrastructure for caring the sick neonates. This finding is lower than the findings of a study conducted in the United States, 38 which might be due to the clinical condition difference, where preterm neonates in a study done in the United States had a comorbid congenital diaphragmatic hernia, which reduces survival probability and because the study design differs.…”

“…40, 41 Furthermore, compared to their counterparts, preterm neonates with birth asphyxia had twice the risk of dying; which is supported by studies in Uganda and Nigeria. 37, 39 This might be due to oxygen deficit during delivery leading to severe hypoxia of vital organs and becoming a double burden, which is an implication for close labor follow-up.…”

Health Care Workers’ Experiences, Challenges of Obstetric Referral Processes and Self-Reported Solutions in South Western Uganda: Mixed Methods Study

“…The facility has a full-time operating theatre with a caesarean section rate of 40%. 19 The hospital offers specialized obstetric and gynecological operations, it also has an active pediatric ward with special care units for pre-matures and neonates. Mothers are referred to MRRH in search for specialized services which are lacking at the health centre IVs.…”