Preterm Neonatal Mortality and its predictors in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

BACKGROUND፡ Preterm neonatal death is a global problem. In Ethiopia, it is still high, and the trend in reduction is slower as compared to child mortality. Preterm neonatal birth is the leading cause. The magnitude and associated factors are also not well documented. Therefore, this study aimed to estimate the incidence of mortality and its predictors among preterm neonates in Tikur Anbesa Specialized Hospital (TASH).METHODS: An institution-based retrospective cohort study was conducted among 604 preterm neonates admitted to Tikur Anbesa Specialized Hospital. Data were collected by reviewing patient charts using systematic sampling with a checklist. The data entry was done using EpiData version 4.2, and analysis was done using Stata Version 14.1. Kaplan-Meier and log-rank tests were used to estimate the survival time and to compare it. Cox proportional hazard was also fitted to identify major predictors. Hazard Ratios (HRs) with 95% Confidence Intervals (CI) were used to assess the relationship between factors associated with the occurrence of death. Finally, statistical significance was declared at p-value < 0.05.RESULTS: In this study, a total of 604 patient charts were reviewed; of these, 571 met the inclusion criteria and were recruited to the study. A total of 170(29.7%) preterm neonates died during the follow-up period. The median follow-up time of preterm neonate under the cohort was 21 days (IQR: 4, 27). The incidence rate was 39.1 per 1000-person day. Rural residency (AHR: 1.45 (95% CI: 1.1,4.8)), Maternal diabetic Mellitus (AHR:2.29 (95%CI: 1.43,3.65), neonatal sepsis (AHR:1.62 (95% CI: 1.11,2.37), respiratory distress (AHR:1.54 (95% CI:1.03,2.31), extreme prematurity (AHR:2.87 (95% CI:1.61, 5.11), and low APGAR score (AHR:3.11 (95% CI:1.79, 5.05) was found to be predictors .CONCLUSION: The rate of preterm neonatal mortality is still an important problem. Having maternal gestational Diabetic Mellitus, neonatal sepsis, respiratory distress, and low Apgar score were major predictors for preterm neonatal mortality. Therefore, efforts have to be made to reduce the incidence of death and for timely management of mothers with Diabetic Mellitus. Healthcare professionals should also work on early diagnosis and treatment of preterm neonate with sepsis, respiratory distress, and low Apgar score

Incidence of respiratory distress and its predictors among neonates admitted to the neonatal intensive care unit, Black Lion Specialized Hospital, Addis Ababa, Ethiopia

Background Although respiratory distress is one of the major causes of neonatal morbidity and mortality throughout the globe, it is a particularly serious concern for nations like Ethiopia that have significant resource limitations. Additionally, few studies have looked at neonatal respiratory distress and its predictors in developing countries, and thus we sought to investigate this issue in neonates who were admitted to the Neonatal Intensive Care Unit at Black Lion Specialized Hospital, Ethiopia. Methods An institution-based retrospective follow-up study was conducted with 571 neonates from January 2013 to March 2018. Data were collected by reviewing patients’ charts using a systematic sampling technique with a pretested checklist. The data was then entered using Epidata 4.2 and analyzed with STATA 14. Median time, Kaplan-Meier survival estimation curves, and log-rank tests were then computed. Bivariable and multivariable Gompertz parametric hazard models were fitted to detect the determinants of respiratory distress. The hazard ratio with a 95% confidence interval was subsequently calculated. Variables with reported p-values < 0.05 were considered statistically significant. Results The proportion of neonates with respiratory distress among those admitted to the Black Lion Specialized Hospital neonatal intensive care unit was 42.9% (95%CI: 39.3–46.1%) The incidence rate was 8.1/100 (95%CI: 7.3, 8.9). Significant predictors of respiratory distress in neonates included being male [Adjusted hazard ratio (HR): 2.4 (95%CI: 1.1, 3.1)], born via caesarean section [AHR: 1.9 (95%CI: 1.6, 2.3)], home delivery [AHR: 2.9 (95%CI: 1.5, 5,2)], maternal diabetes mellitus (AHR: 2.3 (95%CI: 1.4, 3.6)), preterm birth [AHR: 2.9 (95%CI: 1.6, 5.1)], and having an Apgar score of less than 7 [AHR: 3.1 (95%CI: 1.8, 5.0)]. Conclusions In this study, the proportion of respiratory distress (RD) was high. Preterm birth, delivery by caesarean section, Apgar score < 7, sepsis, maternal diabetes mellitus, and home delivery were all significant predictors of this condition. Based on our findings this would likely include encouraging more hospital births, better control of diabetes in pregnancy, improved neonatal resuscitation and addressing ways to decrease the need for frequent caesarean sections

Multivariable logistic regression analysis for factors associated with adverse perinatal outcomes.

Multivariable logistic regression analysis for factors associated with adverse perinatal outcomes.</p

Socio-demographic factors & maternal health service utilization characteristics among mothers who gave twin birth at AHMC, Ethiopia.

Socio-demographic factors & maternal health service utilization characteristics among mothers who gave twin birth at AHMC, Ethiopia.</p

Obstetrics characteristics of the twin-births recorded at AHMC, Ethiopia.

Obstetrics characteristics of the twin-births recorded at AHMC, Ethiopia.</p

Percentage distribution of adverse perinatal outcomes.

Percentage distribution of adverse perinatal outcomes.</p