Predictors Of Neonatal Mortality Research Articles

Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia

BackgroundDespite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the top 10 nations with the highest number of neonatal deaths in 2020 alone. This staggering amount makes it difficult to achieve the SDG (Sustainable Development Goals) target that calls for all nations to work hard to meet a neonatal mortality rate target of ≤ 12 deaths per 1,000 live births by 2030. We evaluated neonatal mortality and it’s contributing factors among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Hawassa University Comprehensive Specialized Hospital (HUCSH).MethodsA hospital-based retrospective cross-sectional study on neonates admitted to the NICU from May 2021 to April 2022 was carried out at Hawassa University Comprehensive Specialized Hospital. From the admitted 1044 cases over the study period, 225 babies were sampled using a systematic random sampling procedure. The relationship between variables was determined using bivariate and multivariable analyses, and statistically significant relations were indicated at p-values less than 0.05.ResultsThe magnitude of neonatal death was 14.2% (95% CI: 0.099–0.195). The most common causes of neonatal death were prematurity 14 (43.8%), sepsis 9 (28.1%), Perinatal asphyxia 6 (18.8%), and congenital malformations 3 (9.4%). The overall neonatal mortality rate was 28 per 1000 neonate days. Neonates who had birth asphyxia were 7.28 times more probable (AOR = 7.28; 95% CI: 2.367, 9.02) to die. Newborns who encountered infection within the NICU were 8.17 times more likely (AOR = 8.17; 95% CI: 1.84, 36.23) to die.ConclusionThe prevalence of newborn death is excessively high. The most common causes of mortality identified were prematurity, sepsis, perinatal asphyxia and congenital anomalies. To avert these causes, we demand that antenatal care services be implemented appropriately, delivery care quality be improved, and appropriate neonatal care and treatment be made available.

Predictors of neonatal mortality in Ethiopia: Cross sectional study using 2005, 2010 and 2016 Ethiopian demographic health survey datasets.

Ethiopia is among the countries that have highest neonatal mortality in the world. Despite efforts to reduce neonatal mortality, the country has faced challenges in achieving national and global targets. The study aims to determine the trends and predictors of change in neonatal mortality in Ethiopia for the past 15 years. The study used Ethiopian Demographic Health Survey Datasets (EDHS) from 2005, 2011, and 2016. All live births of reproductive-age women in Ethiopia were included in the study. Multivariate decomposition analysis for the nonlinear response variable (MVDCMP) based on the logit link function was employed to determine the relative contribution of each independent variable to the change in neonatal mortality over the last 15 years. The neonatal mortality rate has decreased by 11 per 1,000 live births, with an annual reduction rate of 2.8% during the survey period. The mortality rate increased in the pastoralist regions of the country from 31 per 1,000 live births to 36 per 1,000 live births, compared to the city and agrarian regions. Maternal ANC visits in 2005 and 2016 (AOR [95%CI] = 0.10 [0.01, 0.81]; 0.01 [0.02, 0.60]) were significantly associated with decreased neonatal mortality. In addition, the decomposition analysis revealed that increased birth interval of more than 24 months and early breastfeeding initiation contributed to the reduction of neonatal mortality by 26% and 10%, respectively, during the survey period. The study found that neonatal mortality is a public health problem in the country, particularly in pastoralist communities. Tailor made maternal and child healthcare interventions that promote early breastfeeding initiation, increased birth intervals and ANC utilization should be implemented to reduce neonatal mortality, particularly in pastoralist communities.

Sick Neonate Score as Predictor of Neonatal Mortality and Duration of Hospital Stay

Abstract Background: Sick neonate score (SNS) is a simple clinical score that requires minimal basic equipment and expertise. It is utilized for the prediction of mortality among neonates. Objective: The objective of this study was to study the correlation of SNS with mortality and duration of hospital stay of admitted neonates. Methodology: This hospital-based observational descriptive study was conducted in a tertiary care hospital in Jaipur, Rajasthan. A total of 404 outborn transported neonates were enrolled. Baseline characteristics and SNS were recorded and analyzed. Categorical data were presented in numbers and percentages, whereas continuous data in mean and standard deviation. The Chi-square test and unpaired t-test were used for analysis. Receiver operating characteristics curve analysis was used to estimate the cutoff value of SNS determining the mortality and duration of hospital stay of the patient. Results: Out of 404 neonates 243 (60%) were tachypneic, 242 (59%) had oxygen saturation <92% and 216 (53%) were hypothermic. A cutoff of SNS ≤8 with a sensitivity of 93% and specificity is 53.4% was found for prediction of mortality among neonates. A significantly higher number of patients with SNS score ≤8 had expired within 3 days. Among discharged patients, a significantly higher number of patients with SNS score ≤8 had a duration of stay in hospital >7 days. Conclusion: SNS has a good negative correlation with mortality. Neonate with SNS ≤8 either expired early or was discharged with a higher duration of hospital stay.

Base excess as a predictor of neonatal mortality in neonatal sepsis

Background: Neonatal sepsis is responsible for approximately 15% of all neonatal deaths in the world. Despite of availability in advanced medical healthcare facilities for mother and neonates, incidence of mortality secondary to sepsis especially in developing countries like India is more common. Metabolic acidosis is the most common form of acid base imbalance in neonatal sepsis which can be analyzed with increased levels of base excess. Hence early diagnosis of neonatal sepsis can be done by determining base excess. Methods: This is a prospective observational study conducted in NICU at Cheluvamba Hospital, Mysore. 73 term neonates with suspected sepsis were enrolled in the study who were on regular follow-up and treatment till death/discharged from NICU. Base excess value is obtained from the arterial blood gas analysis from each subject and it was compared with survivor and non-survivor group along with other study parameter Results: Out of 73 subjects, incidence of non survivors group with severe increase in base excess is 75%. To predict the mortality, we compared it with standard base excess which showed the prediction of more than 60%, with significant AOC (0.827) of very near to one in ROC curve, with statistically significant (p<0.001) sensitivity of 92.59%, specificity of 63.04%, positive predictive value of 59.5%, negative predictive value of 93.5%. Conclusions: In present study we have proved that base excess is an important parameter for the early diagnosis and for early intervention in neonatal sepsis.

Neonatal mortality and its predictors among neonates in Jabitehnan district, Northwest Ethiopia: A single-arm retrospective cohort study.

Neonatal period is the most vulnerable time in which children face the greatest risk of death. Worldwide, each year, millions of newborns died in the first month of life. Sub-Saharan Africa, Ethiopia, in particular, is largely affected. However, there is a dearth of information regarding the survival status of neonates and determinants of their mortality in the study area. Therefore, this study was aimed at investigating neonatal mortality and its predictors in Jabitehnan district, Northwest Ethiopia. A single-arm community-based retrospective cohort study was conducted in March 2021 among 952 neonates born between August 2020 and February 2021. Data were collected by a semi-structured questionnaire, and a multistage stratified sampling technique was employed to select one urban and 10 rural kebeles from the district. Then, the total sample size was proportionally allocated to these selected kebeles. Neonatal death was ascertained by community diagnosis. Kaplan-Meier curve was used to estimate survival time. Cox regression was used to identify factors, the hazard ratio was estimated, and a p-value < 0.05 was considered statistically significant. The neonatal mortality rate was 44 (95% confidence interval [CI]: 33-60) per 1000 live births; and the incidence rate was 1.64 (95% CI: 1.21-2.23) per 1000 neonate days. Three-quarters of deaths occurred in the first week of life. Medium household wealth index (adjusted hazard ratio [AHR] = 3.54; 95 CI: 1.21-10.35), increased number of pregnancies (AHR = 1.22; 95%CI: 1.01-1.47), being male (AHR = 2.45, 95% CI: 1.12-5.35) and not starting breastfeeding in the first hour of life (AHR = 4.00; 95% CI: 1.52-11.10) were found to be predictors of neonatal mortality. Neonatal mortality was high compared to the national target. Wealth, number of pregnancies, sex of the neonate, and breastfeeding initiation were factors associated with neonatal death. Hence, strengthening interventions such as providing sexual education in the population, considering households with a medium wealth index in the exemption service, and counseling mothers about early breastfeeding initiation would improve neonatal survival.

Predictors of neonatal mortality in Ghana: evidence from 2017 Ghana maternal health survey

BackgroundNeonatal mortality contributes about 47% of child mortality globally and over 50% of under-5 deaths in Ghana. There is limited population level analysis done in Ghana on predictors of neonatal mortality.ObjectivesThe objective of the study was to examine the predictors of neonatal mortality in Ghana.MethodThis study utilizes secondary data from the 2017 Ghana Maternal Health Survey (GMHS). The GMHS survey focuses on population and household characteristics, health, nutrition, and lifestyle with particular emphasis on topics that affect the lives of newborns and women, including mortality levels, fertility preferences and family planning methods. A total of 10,624 respondents were included in the study after data cleaning. Descriptive statistical techniques were used to describe important background characteristics of the women and Pearson’s Chi-squares (χ2) test used to assess association between the outcome (neonatal death) and independent variables. Multivariate logistic regression analysis was done to estimate odd ratios and potential confounders controlled. Confidence level was held at 95%, and a p < 0.05 was considered statistically significant. Data analysis was done using STATA 15.ResultsThe prevalence of neonatal mortality was 18 per 1000 live births. ANC attendance, sex of baby, and skin-to-skin contact immediately after birth were predictors of neonatal mortality. Women with at least one ANC visit were less likely to experience neonatal mortality as compared to women with no ANC visit prior to delivery (AOR = 0.11; CI = 0.02–0.56, p = 0.01). Girls were less likely (AOR = 0.68; CI = 0.47–0.98; p = 0.03) to die during the neonatal period as compared to boys. Neonates who were not put skin-to-skin contact immediately after birth were 2.6 times more likely to die within the neonatal period than those who were put skin-to-skin contact immediately after birth (AOR = 2.59; CI = 1.75–3.83, p = 0.00).ConclusionNeonatal mortality remains a public health concern in Ghana, with an estimated rate of 18 deaths per 1,000 live births. Maternal and neonatal factors such as the sex of the newborn, the number of antenatal care visits, and skin-to-skin contact between the newborn and mother immediately after birth are the predictors of neonatal mortality in Ghana.

Predictors of Mortality in Acute Bacterial Meningitis in Outborn Neonates with Late Onset Sepsis

ABSTRACT Introduction: Neonatal bacterial meningitis (NBM) is the most devastating complication of late-onset sepsis with incidence ranging from 12.5% to 61.11% with a mortality rate of 16-45.5% and disability rate of 25-50%. Objectives: To estimate the clinical and laboratory predictors of mortality in outborn neonates with NBM. Methods: A prospective observational study was carried out on 150 outborn neonates with late-onset sepsis and with clinically diagnosed meningitis; and CSF biochemical abnormalities with or without CSF culture positivity at a tertiary care teaching hospital in central India over a period of 2 years. Data on demographic, maternal, neonatal, and socio-cultural factors were recorded and analyzed using a univariate and multiple regression model. Results: Distance travelled more than 150 km (OR 1.01, CI 1.0-1.02, P = 0.04), transport duration &gt;3 hrs (OR 4.58, CI 2.07-10.11, P &lt; 0.0001), premature rupture of membrane &gt;24 hours (OR 9.68, CI 2.14-43.70, P &lt; 0.0001), transaminitis (SGPT &gt;40IU/L) (OR 0.93, CI 0.88-0.97, P &lt; 0.003), CSF turbidity (OR 16.70, CI 4.45-62.70, P &lt; 0.0001), raised CSF protein (OR 8.81, CI 1.45-53.34, P = 0.018), and low CSF sugar (OR 20.48, CI 4.18-100.26, P &lt; 0.0001) were independent predictors of mortality in neonatal meningitis on multivariate analysis. Conclusion: Anticipation, early recognition, and prompt treatment of maternal, neonatal, socio-cultural, and laboratory risk factors are important to reduce the mortality of devastating complication of late-onset sepsis.

Predictors of neonatal mortality with congenital heart disease

Link of Video Abstract : https://youtu.be/Vi3785NsB1A Introduction: Congenital heart disease (CHD) is the leading cause of birth defect-associated infant illness and death. In developing countries, the mortality related to CHD increased by up to 25%, but the data about predictors of mortality are limited. The purpose of this study was to investigate the predictors of mortality in neonates with CHD. Methods: We conducted a case-control study of neonatal mortality with CHD from January 2018 to October 2022. Data were collected from the neonatal registry in Prof Ngoerah Hospital, Bali. Characteristics and clinical risk of mortality were analyzed. Chi-square and logistic regression analysis was carried out to determine the potential predictor of mortality. Results: A total of 288 neonatal with CHD were analyzed. Neonatal morbidities such as extremely low birth weight (ELBW) were found in 7.6%, asphyxia in 50.7%, multiple congenital anomalies (MCA) in 13.2%, pulmonary hypertension (PH) in 13.5%, sepsis in 66.3%, and severe form of CHD in 50.7%. Patent ductus arteriosus (PDA) was the most acyanotic CHD (35%). Mortality resulting from CHD was 27%. ELBW, severe and moderate asphyxia, MCA, PH, sepsis, and severe form of CHD were significant mortality predictors (p&lt;0.05) with (OR; 95%CI) were (6.21; 1.24-31.12), (4.13; 1.93-8.81), (3.20;1.69-6.08), (2.70; 1.17-6.24), (2.54;1.10-5.84), (2.33; 1.28-4.22), (2.00; 1.15-3.49) respectively. Conclusion: ELBW, severe and moderate asphyxia, MCA, PH, sepsis, and severe forms of CHD are predictors of neonatal mortality with CHD.

Predictors of Neonatal Mortality: A Retrospective Cross-Sectional Study From the Special Newborn Care Unit of a Tertiary Care Hospital.

Background In India, a significant number of newborns die each year, with Madhya Pradesh having the highest neonatal mortality rate. However, there is a lack of information on factors that can predict neonatal mortality. Objective This study aimed to examine the factors influencing neonatal mortality among neonates admitted to a tertiary care centre's special newborn care unit (SNCU). Methods This retrospective record-based observational study was done at a tertiary care centre, where data from the special newborn care unit (SNCU) from 1st January 2021 to 31st December 2021 was used. We included data of all newborns who were treated in SNCU during the said period and excluded those who got referred or left against medical advice. We abstracted data on age at admission, gender, category, maturity status, birth weight, place of delivery, mode of transport, type of admission, indication of admission, duration of stay and outcome. Qualitative variables were described using frequency and percentage. The chi-square test was used to find out the association of different variables with the outcome, while multivariate logistic regression was conducted to identify risk factors of neonatal mortality. A p-value of <0.05 was considered significant. Results We finalized data of 1052 neonates for analysis. Among them, 846 neonates were successfully discharged while 206 neonates were deceased. The major cause of admission was perinatal asphyxia followed by prematurity. The major cause of mortality in this study was sepsis followed by respiratory distress syndrome, birth asphyxia, and prematurity. Mortality of neonates was significantly associated with maturity status, birth weight, place of delivery, age during admission and duration of stay. Prematurity (OR=3.762, 95% CI:1.93-7.33), birth weight 1000-1499g (OR=4.78, 95% CI:2.21-10.32), birth weight <1000g (OR=25.11, 95% CI:5.71-110.24), age at admission <1-day (OR=2.312, 95% CI:1.03-5.19), duration of stay 1-3-days (OR=12.98, 95% CI:7.48-22.52) and <1-day (OR=1271.88, 95% CI:121.39-13325.69) were significant predictors of mortality in our study. Conclusion Our study emphasizes monitoring and addressing risk factors like maturity status, birth weight, and age at admission to reduce neonatal mortality, with a focus on early management of preterm births and low birth weight.

Survival Status, Length of Stay, and Predictors of Mortality Among Neonates Admitted in the Neonatal Intensive Care Unit of Gurage Zone Public Hospitals.

Many countries need to accelerate their progress to achieve the sustainable development goal target of neonatal death. It is still high in Ethiopia. Thus, this study aimed to assess the mortality predictors and length of hospital stay among Neonates admitted to the Neonatal Intensive Care Unit of Gurage zone public Hospitals. In this study, a facility-based retrospective follow-up study was applied among 375 neonates admitted to the NICU of selected public hospitals in the Gurage zone from June 1, 2019 to June 30, 2021. The researchers used Epi-Data entry 3.1 for the data entry and then exported it to STATA version 14 for analysis. The Kaplan-Meier survival curve and log-rank test were used to estimate and compare the survival time of categorical variables, respectively. The researchers observed about 85 (22.7% with 95%CI: 18.7, 27.2) deaths from the 2305 person-days follow-up. The median survival time was 14 days. The overall incidence density rate was 36.9 per 1000 person-days observed (95%CI: 29.8, 45.6). Perinatal asphyxia (AHR: 2.9[CI: 1.8; 4.8]), cesarean section as a mode of delivery (AHR: 1.1[CI; 1.01; 1.15]), maternal age of greater or equal to 35 years (AHR: 1.1[95% CI: 1.01, 1.15]), and twin pregnancy (AHR: 2.3[95% CI: 1.2, 4.3]) were predictors of neonatal mortality. The survival rate of neonates was higher compared to other studies. So, to reduce the burden of neonatal mortality, health care providers should give special attention to twin pregnancies, neonates delivered via cesarean section, and neonates with a problem of perinatal asphyxia.

Demographic, Clinical Profile and Outcomes of Neonates Admitted to Neonatal Intensive Care Unit of Dekemhare Hospital, Eritrea

BackgroundNinety-six percent of the world’s 3 million neonatal deaths occur in developing countries where the majority of births occur outside health facility. The objective of this study was to evaluate the demographic, clinical profile and outcome of neonates admitted to Neonatal Intensive Care Unit of Dekemhare Hospital of Eritrea.MethodsThe study was a retrospective register-based review of all neonates admitted from January 2018 to December 2021 to Dekemhare Hospital. Overall, 509 neonates were enrolled in this study. Data were collected from neonatal register book from January 5 to February 5, 2022 by general practitioners using a predesigned data collection tool. Data entry was done using CSpro 7.3 and analyzed through SPSS version 22. Results were presented in frequencies, percent and odds ratio. Univariable and multivariable analysis was done to measure the association between the variables.ResultsThree quarter (75.6%) of the neonates had normal birth weight and 80.0% were term. Majority (75.4%) of the neonates was delivered vaginally and 92.7% were delivered at health facility. Neonatal infection (33.0%), birth asphyxia (20%) and prematurity (14.3%) were the top three primary causes of neonatal admission to the Neonatal Intensive Care Unit. Furthermore, 31% of neonatal deaths occurred during 24-72 hours of their life and the mortality rate was 16.3%. Multivariable analysis indicated that low birth weight (AOR: 7.28; 95%CI: 2.85-18.55) increased neonatal mortality. Whereas delivery at health facility (AOR: 0.17; 95%CI: 0.06–0.47), hospital stay 4-7 days (AOR: 0.06; 95% CI: 0.02-0.23) and above 8 days (AOR: 0.06; 95%CI: 0.02-0.23) were showing protective effect on neonatal mortality.ConclusionCongenital abnormality, prematurity and birth asphyxia had higher case fatality rate. And, low birth weight, delivery at health facility and hospital stay were found to be predictors of neonatal mortality. Training of health professionals on neonatal resuscitation, further improvement on the diagnostic setup, treatment tools, infrastructure and raising community awareness to deliver at health facility are crucial to decrease the neonatal mortality in Eritrea.

Clinical Value of Serum Interleukin-18 in Neonatal Sepsis Diagnosis and Mortality Prediction.

Previous studies have demonstrated that interleukin-18 (IL-18) levels were elevated in adult patients with sepsis. However, its role in neonatal sepsis remains unknown. The current research was conducted to assess the clinical value of serum IL-18 level as a candidate biomarker in neonatal sepsis diagnosis and prediction of mortality. From July 2022 to September 2022, we prospectively enrolled 91 septic neonates and 31 non-sepsis neonates in the intensive care unit of neonates at Henan Children's Hospital in Zhengzhou, China. Neonatal peripheral blood serum was collected at admission and levels of serum IL-18 were assessed. Employing multivariate logistic regression analysis, the evaluation of the potential of IL-18 as an independent biomarker for sepsis was executed. Furthermore, employing the receiver operating characteristic (ROC) curve analysis, the diagnostic value of IL-18 in sepsis and the ability of IL-18 in predicting the mortality of neonatal sepsis was measured. The statistical package SPSS 24.0 was employed to conduct all statistical analyses. Serum IL-18 levels in neonates in the sepsis group were elevated compared to the control group, reaching the highest levels in the non-survival sepsis group (P < 0.001). Correlation analysis exhibited a positive relationship between IL-18 levels and age, body temperature, respiratory rate, and C-reactive protein levels. IL-18 was identified as an independent biomarker in identifying sepsis (OR = 4.747, 95% CI 1.493-15.092, P = 0.008) by multiple logistic regression. ROC curve analysis exhibited that IL-18 was good in identifying neonatal sepsis (area under curve (AUC) = 0.77, 95% CI = 0.68-0.85, P < 0.001) and predicting neonatal mortality (AUC = 0.80, 95% CI = 0.63-0.96, P = 0.003). IL-18 was a potential biomarker for identifying neonatal sepsis and neonatal mortality prediction.

Association of Lactate Clearance with Morbidity and Mortality in Neonates with Sepsis and Septic Shock at RECEP Tayyip Erdogan Hospital Muzaffargarh

Objective: to determine the association of lactate clearance with morbidity and mortality in neonates with sepsis and septic shock at neonatology department of Recep Tayyip Erdogan Hospital Muzaffargarh. Methods: This prospective cohort study was carried out at department of neonatology of Recep Tayyip Erdogan Hospital Muzaffargarh from January 2021 to June 2021. Term neonates, aged less than 28 days and diagnosed as the cases of sepsis, were included. After taking demographic information, a detailed medical history was obtained, and a complete clinical examination was done. Blood samples were taken from all the patients and sent to the Hospital diagnostic laboratory to evaluate the CBC, liver function test, serum creatinine level, coagulation profile, CRP, blood culture, and serum lactate level. All the data were collected by using structured study proforma, and SPSS version 26 was used for the purpose of data analysis. Results: A total of 56 septic neonates were studied, their mean age was 13.14+7.79 days. Females were 51.8% and males were 48.2%. Blood culture was positive in 75.0% of the cases, and CRP was positive in 98.2% of the cases. Overall average of serum lactate at baseline was 2.67+1.73, at 6 hours was 1.91+0.98 and at 24 hours average of serum lactate was 0.21+0.10. 50% of the cases had AKI, 50.0% had AHI, cardiac failure was in 26.8% of the cases, 30.4% of the cases had need of ventilation, and the mortality rate was 35.7%. Septic neonatal morbidity and mortality were statistically insignificant according to serum lactate at baseline and at 24 hours (p &gt;0.05). Despite the fact that serum lactate at 6 hours was significantly associated with mortality and the need for ventilation (p 0.05), Conclusion: As per the study conclusion, neonatal sepsis and septic shock are highly responsible for neonatal morbidity and mortality. Lactate clearance at six hours was found to be significantly related to neonatal mortality and the need for ventilation. Although lactate clearance at 6 hours is observed to be a predictor of neonatal mortality in neonates with sepsis and septic shock, Keywords: Neonatal sepsis, lactate clearance, morbidity, mortality

Birth weight distribution in Golden and Labrador retriever dogs: A similar morphotype with a different trend. Preliminary data.

Birth weight (bW) is considered an indicator of neonatal maturity and a predictor of neonatal mortality. According to its importance, many efforts have been made so far to identify physiological body weight ranges at birth. Due to the high heterogeneity among breeds, optimal bW is difficult to define in dogs. The aim of this study was to carefully analyze the shape and pattern of the bW distribution in dogs. Furthermore, the role of breed on bW determination was specifically investigated in relation to maternal (age, weight, height, diet, season, litter size) and neonatal (sex, malformations, assistance at birth) aspects. For these purposes two canine breeds with very similar phenotypic characteristics, Golden and Labrador retrievers, were selected. An accurate statistical model to explore bW distribution and compare it between Goldens and Labradors was developed. At birth most of the Golden and Labrador pups (estimated 95th percentile) weighed up to 630 g and 500 g, respectively. The estimated 5th percentile of bW distributions was 295 g in Golden and 290 g in Labrador pups. These lowest values could be indicative cut-offs of underweight pups. The probability of neonatal mortality within 1 week of life decreased with increasing bW (P = 0.031) and was higher in Golden than Labrador pups even though this difference was not significant. In conclusion, our results suggest that genetics have a relevant influence on the determination of birth weight which is confirmed to be closely associated with neonatal mortality.

Clinical Risk Index Score (CRIB II) as a Predictor of Neonatal Mortality among Premature Babies

Aim: To determine predictive accuracy of CRIB II score in predicting mortality among premature with low birth weight neonates. Study design: Cross-sectional study. Place and duration of study: Paediatric NICU, Services Hospital Lahore from 2nd June 2017 to 2nd December 2017. Methodology: Two hundred and forty preterm new-born born before 32 weeks and birth weight from 600-1500grams were enrolled. Temperature was measured using rectal thermometer. Arterial blood gas sample was taken using standard sampling technique for base excess. Premature infants were evaluated for CRIB-II Score within 1 hour of arrival. Neonates were followed for 28 days to assess for their survival status. Results: The mean CRIB-II score was 10.95±2.79, mean gestational age was 29.16±1.58 weeks and mean weight was 1111.13±202.28 grams. There were 123(51.25%) males and 117(48.75%) were females. Actual neonatal mortality was 82(34.17%). Predictive accuracy of CRIB II score in predicting mortality among premature and very low birth weight neonates admitted to NICU was 92.68% for sensitivity, 94.94% specificity, 90.48% positive predictive value and 96.15% had negative predictive value. Conclusion: The predictive accuracy of CRIB II score is higher in prediction of mortality among premature and very low birth weight neonates. Keywords: Neonates, Premature, Very low birth weight, Mortality, CRIB II score, Prediction

Time to death and its predictors among neonates who were admitted to the neonatal intensive care unit at tertiary hospital, Addis Ababa, Ethiopia: Retrospective follow up study.

BackgroundsNeonatal death is the major problem in developing world. Burden and predictors of neonatal mortality vary across countries and even among regions of a country, so understanding the problem concerning these factors is essential to overcome the problem. Therefore, this study aimed to determine time to death and its predictors of neonatal mortality among neonates who were admitted to the neonatal intensive care unit of Tertiary Hospital, Addis Ababa, Ethiopia.MethodsA hospital-based retrospective cohort study was employed among 434 neonates admitted in Tertiary hospital, Addis Ababa, Ethiopia. A Kaplan Meier curve and a log-rank test were used to estimate the survival time and compare survival curves between variables. The cox proportional hazard model was also fitted to identify predictors.ResultsA total of 434 neonates included in the study, 11.1% of which were died, and the incidence rate was 19.2 per 1000 live births. The time to death of neonates was 17 days. Independent predictors of neonatal mortality were incomplete maternal antenatal follow up[AHR: 3.7 (95% CI:1.86,7.60)], low(Appearance, Pulse, Grimily, Activity, and Respiration(APGAR)score[AHR:5.0 (95%CI:1.51–15.04)], perinatal asphyxia [AHR:5.2 (95%CI:1.92–14.30)], preterm 4.2 (95%CI: 1.32–8.83)]. Moreover, small for gestational age [AHR:4.8 (95%CI:2.33–9.72)], respiratory distress[AHR: 2.5 (95%CI: 1.24–5.09)], sepsis [AHR: 3.4 (95%CI: 1.71–4.01)], low birth weight[AHR: 7.3 (95%CI:2.69,1.91)], and tracheoesophageal fistula [AHR: 2.2 (95%CI: 1.13–4.32)].ConclusionThe overall incidence rate was 19.2 deaths per 1,000 live births. Emphasis should be given to incomplete Antenatal care follow up, small for gestation, preterm, low birth weight, low 5th min APGAR score, neonatal sepsis, respiratory distress, perinatal asphyxia, and tracheoesophageal fistula.

Survival status and predictors of neonatal mortality among neonates admitted to Neonatal Intensive care Unit (NICU) of Wollega University referral hospital (WURH) and Nekemte Specialized hospital, Western Ethiopia: A prospective cohort study.

The neonatal period is the most vulnerable time for survival in which children face the highest risk of dying in their lives. Neonatal mortality (NM) remains a global public concern, especially in sub-Saharan African (SSA) countries. Although, better progress has been made in reducing NM before 2016, Ethiopia is currently one of the top ten countries affected by NM. Studies are limited to secondary data extraction in Ethiopia which focus only on survival status during admission, and no study has been conducted in the study area in particular. To assess the survival status and predictors of neonatal mortality among neonates admitted to the NICU of WURH and Nekemte Specialized Hospital, Western Ethiopia. An institution-based prospective cohort study was conducted among a cohort of 412 neonates admitted to the NICU of WURH and Nekemte Specialized Hospital from September 1, 2020 to December 30, 2020. All neonates consecutively admitted to the NICU of the two hospitals during the study period were included in the study. Data entry was performed using Epidata version 3.0 and the analysis was performed using STATA version 14. A Kaplan Meier survival curve was constructed to estimate the cumulative survival probability. A cox proportional hazards regression model was used to identify the predictors of NM. Hazard Ratios with 95% CI were computed and all the predictors associated with the outcome variable at p-value ≤ 0.05 in the multivariable cox proportional hazards analysis were declared as a significant predictor of NM. A total of 412 neonates were followed for a median of 27 days with an IQR of 22-28 days. During the follow-up period, a total of 9249 person day observations (PDO) were detected. At the end of follow-up, 15.3% of neonates died with an overall incidence rate of death 6.81/1000 PDO. The median time to death was 10 days, and the highest incidence rate of death was observed during the first week of the neonatal period. The study found that rural residence (AHR = 2.04, 95%CI: 1.14, 3.66), lack of ANC visits (AHR = 7.77, 95%CI: 3.99, 15.11), neonatal hypothermia (AHR = 3.04, 95%CI: 1.36, 6.80), and delayed initiation of breastfeeding (AHR = 2.26, 95% CI: 1.12, 4.56) as independent predictors of NM. However, a decreased number of pregnancies decrease the risk of NM. The incidence rate of neonatal death was high particularly in the first week of life in the study area. The study found that lack of ANC visit, neonatal hypothermia, increased number of pregnancies, rural residence, and delayed initiation of breastfeeding positively predicted NM. Therefore, there is a need to encourage programs that enhance ANC visits for pregnant mothers and community-based neonatal survival strategies, particularly for countryside mothers.

Study of Some Predictors of Neonatal Mortality among Preterm Newborn at Zagazig University Hospital

Study of Some Predictors of Neonatal Mortality among Preterm Newborn at Zagazig University Hospital

Predictors of Neonatal Mortality in Ethiopia: A Comprehensive Review of Follow-Up Studies.

Background Neonatal mortality remains a prominent public health problem in developing countries. Particularly, Ethiopia has a higher neonatal mortality rate than the average sub-Saharan African countries. Hereafter, this review article was aimed at synthesizing existing predictors of neonatal mortality in Ethiopia. Methods A systematic search and review of peer-reviewed articles were conducted on the predictors of neonatal mortality in Ethiopia. A search of key terms across different databases including Web of Science, SCOPUS, Cochrane Library, PubMed, EMBASE, Hinari, and Google Scholar was conducted, supplemented by reference screening. The SANRA tool was used to critically appraise studies included in the review. Results After removing duplicates and applying the eligibility criteria, 14 of the 64 initially identified articles were included in the final review. These were original articles published between 2011 and 2021. The identified predictors were narrated and presented under different domains. Accordingly, sociodemographic predictors such as residence, distance from the health facility, and maternal age; service delivery-related predictors such as no ANC follow-up, not taking iron-folic acid supplementation during pregnancy, and no PNC visit; neonate-related predictors such as low birth weight, extreme prematurity/preterm, and low APGAR score; pregnancy and childbirth-related predictors such as birth interval < 18 months, twin pregnancy, and time of rupture of membrane > 12 hours; and maternal-related predictors such as maternal HIV infection, maternal childbirth-related complications, and maternal near-miss were stated to increase a likelihood of newborn death in Ethiopia. Conclusion Public health interventions directed at decreasing neonatal mortality should address the rural residents, mothers not having ANC follow-up, low birth weight, twin pregnancy, and maternal HIV infection. The wealth of data gathered during primary research should not only lead to identification of predictors, but should also provide guidance for health system intervention strategies in a country aiming to reduce neonatal mortality.

Determinants of neonatal mortality among preterm births in Black Lion Specialized Hospital, Addis Ababa, Ethiopia: a case–cohort study

BackgroundPreterm neonatal death is a global burden in both developed and developing countries. In Ethiopia, it is the first and fourth cause of newborn and under-5 deaths, respectively. From 2015...