Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study

Abstract

Background Although the survival of preterm neonates has improved, thanks to advanced and specialized neonatal intensive care, it remains the main reason for neonatal admission, death, and risk of lifelong complication. In this study, we assessed time to death and its predictors among preterm neonates admitted to neonatal intensive care units (NICU) at public hospitals in southern Ethiopia. Methods A hospital based retrospective cohort was conducted among preterm neonates admitted to NICU at public hospitals in west Guji and Borena zones, Oromia National Regional State, southern Ethiopia. Simple random sampling technique was used to select records of preterm neonates admitted to both major hospitals in the study area. Data on neonatal condition, obstetric information, and status at discharge were collected from admission to discharge by trained research assistant through review of their medical records. Kaplan Meir curve and Log rank test were used to estimate the survival time and compare survival curves between variables. Cox-Proportional Hazards model was used to identify significant predictors of time to death at p<0.05. Result Of 510 neonates enrolled, 130(25.5%; 95% CI: 22–29) neonates died at discharge or 28days. The median survival time was 18 days with an interquartile range of (IQR = 6, 24). The overall incidence of neonatal mortality was 47.7 (95% CI: 40.2–56.7) per 1000 neonatal days. In the multivariable cox-proportional hazard analysis, lack of antenatal care (AHR: 7.1; 95%CI: 4–12.65), primipara (AHR: 2.3; 95% CI: 1.16–4.43), pregnancy complications (AHR: 3.4; 95% CI: 1.94–6.0), resuscitation at birth (AHR: 2.1, 95% CI: 0.28–0.77) and not receiving Kangaroo mother care (AHR: 9.3, 95% CI: 4.36–19.9) were predictors of preterm neonatal death. Conclusion Despite admission to NICU for advanced care and follow up, mortality of preterm neonates was found to be high in the study settings. Addressing major intrapartum complications is required to improve survival of neonates admitted to NICU.

Incidence and Predictors of Mortality Among Preterm Neonates Admitted to Jimma University Medical Center, Southwest Ethiopia: a Retrospective Follow-Up Study

“…In this study, preterm neonates born from mothers who had an obstetric complication during their current pregnancy had a higher hazard of neonatal death compared to their counterparts. This finding is comparable with studies reported from Addis Ababa [ 12 ] and Southern Ethiopia [ 17 ]. This might be explained by the fact that obstetric complications affect the pregnancy status and placental blood transfusion, and can result in preterm delivery with subsequent preterm-related life-threatening complications which might increase the hazard of neonatal death.…”

“…Partly, this disparity might result from a difference in sample size, study design, and those reported studies were multicenter studies. Conversely, this study finding is lower than studies reported from India 33.5% [ 33 ], Southern Ethiopia 47.7 deaths per 1,000 neonatal days [ 17 ], Mizan Tepi 62.15 deaths per 1,000 neonate-days [ 13 ] and Jimma, Ethiopia 34.9% [ 28 ]. This discrepancy might result from variation in study design as a study reported from India was a multicenter prospective study conducted on a large sample size.…”