Reduction In Neonatal Mortality Research Articles

Impact of iron-folic acid supplementation on maternal and neonatal outcomes: A systematic review & meta-analysis.

Background & Aims: Iron-folic acid (IFA) supplementation is widely recommended as both a preventive and therapeutic measure for pregnant women. Despite its widespread use, there is limited research exploring adherence to IFA supplementation during pregnancy and its impact on maternal and neonatal outcomes. This study aims to assess the effectiveness of IFA supplementation in improving pregnancy and neonatal outcomes. Methods: A comprehensive search on PubMed, Google Scholar, EMbase and Trip databases was conducted for relevant studies published up to May 31, 2024. Outcomes measured were preterm birth (PTB), low birth weight (LBW), neonatal mortality, perinatal mortality, small for gestational age (SGA) and stillbirth. Pooled risk ratios (RRs) with 95% confidence intervals (CIs), sensitivity analysis, publication bias, trial sequential analysis and quality assessment of the included studies were performed. Results: Eleven studies involving a total of 42,458 pregnant women who received IFA supplementation and 16,351 women who received folic acid (FA) alone or Control (no supplementation) were included. A significant reduction in overall neonatal mortality (RR = 0.73, 95% CI: 0.61-0.87) as well as in subgroup analyses (IFA vs. control and IFA vs. FA) was observed. However, a decrease in incidence of LBW was noted only in IFA vs. control group (RR = 0.79, 95% CI: 0.69-0.90). No significant association was found for overall LBW (RR = 0.48, 95% CI: 0.08-2.76), PTB (RR = 0.56, 95% CI: 0.09-3.50), perinatal mortality (RR = 0.85, 95% CI: 0.69-1.04), SGA (RR = 0.98, 95% CI: 0.86-1.12) and stillbirth (RR = 0.75, 95% CI: 0.48-1.16) when comparing to IFA vs. control and IFA vs. FA group. Conclusions: Our findings provide strong evidence supporting the effectiveness of IFA supplementation in reducing neonatal mortality and LBW among pregnant women, highlighting its importance in prenatal care.

Improving Post-discharge Weight Gain Among Neonates received Kangaroo Mother Care: Two Years Experience of a Tertiary Care Hospital in Dhaka, Bangladesh

Background: “Kangaroo Mother Care” is an effective alternative care strategy for preterm and low birth weight babies. It also causes substantial reduction of neonatal mortality due to hypothermia. Objective: To observe the status of ongoing kangaroo mother care service in a tertiary care hospital and its outcome. Material and method: This retrospective study was carried out over the period of 1st July 2020 to 30th June 2022. Newborns who received kangaroo mother care in neonatal intensive care unit and postnatal ward of Bangabandhu Sheikh Mujib Medical University, Dhaka during the study period, were enrolled in this study. Results: A total of 384 (97% of eligible candidates) newborn received kangaroo mother care. Kangaroo mother care was provided both in Neonatal intensive care unit (86% of total admission) and also in the postnatal ward. Mean gestational age was 32.02+2.85 weeks (28 weeks-41 weeks) and mean weight of starting KMC was 1367.48 g (730 g – 1970 g). Average age of initiating KMC was 6 days (ranging from 1 to 13 days of age). Mean duration of providing KMC was 6 hours and 50 minutes. More than two third (74.4%) patients came for follow up. During each follow up, an increasing trend was observed regarding weight gain and mean weight gain was 15.9+1.2 g/ kg/day. Conclusion: Kangaroo mother care was provided to most of the eligible patients and persistent weight gain was observed among all KMC candidates after discharge.

Determinants of dropout from the maternal continuum of care in Ethiopia, multilevel analysis of the 2016 demographic and health survey.

Over the past two decades (2000-2020), Ethiopia achieved significant reductions in maternal and neonatal mortality, with a 72% and 44%, respectively. However, low maternal health service utilization and dropout from the maternal continuum of care remain major health system challenges. This study aimed to investigate individual and community-level determinants of dropout from the maternal continuum of care. We used the recent, 2016 Ethiopian Demographic and Health Survey (EDHS) data. In the maternal continuum of care pathway, i) less than four antenatal care (ANC) attendance, ii) subsequent dropout from skilled birth attendance (SBA) after 4 or more ANC, and iii) dropout from postnatal care (PNC) after attendance of facility delivery were the outcomes for dropout. A Multilevel logistic regression analysis of individual and community level factors (e.g., place of residence, geographical regions) were included in the model. The variation in the outcomes were presented by odds ratio (OR), 95% confidence interval and intra-cluster correlation coefficient (ICC). In the maternal continuum of care pathway higher dropouts were observed from SBA to PNC (85%) and from 4+ ANC to SBA (43.4%). Poorest wealth quantile (AOR = 2.31, 95% [CI = 1.69,3.16]), having no health insurance coverage (AOR = 1.44, 95% [CI = 1.01,2.06]), and high community poverty (AOR = 1.28, 95% [CI = 1.01,1.63]) were associated with having < 4 ANC attendance. Perceived distance from health facility as a big problem (AOR = 1.45, [95% = CI, 1.12,1.88), lower community media exposure (AOR = 1.6, 95% [CI = 1.14,2.23]) and rural residency (AOR = 3.03, 95% [CI = 1.75,5.26]) increased the odds of dropout from SBA after 4+ ANC visits. The dropout from the maternal continuum of care was higher in Ethiopia and postnatal care were the most affected maternal care. Oromia and Somali regions were associated with dropouts from all levels of care. Policy strategies should prioritize geopolitical regions with higher dropout levels. In addition to improving access and quality of institutional health services, designing an alternative strategy for targeted outreach for ANC visits and postnatal checkups is recommended.

The effect of birth timing manipulation around carnival on birth indicators in Brazil.

This paper studies the patterns and consequences of birth timing manipulation around the carnival holiday in Brazil. We document how births are displaced around carnival and estimate the effect of displacement on birth indicators. We show that there is extensive birth timing manipulation in the form of both anticipation and postponement that results in a net increase in gestational length and reductions in neonatal and early neonatal mortality, driven by postponed births that would otherwise happen through scheduled c-sections. We also find a reduction in birthweight for high-risk births at the bottom of the weight distribution, driven by anticipation. Therefore, restrictions on usual delivery procedures due to the carnival holiday can be both beneficial and detrimental, raising a double-sided issue to be addressed by policymakers.

Neonatal Resuscitation and Delivery Room Care: A Changing Global Landscape.

With 98% of neonatal deaths occurring in low- and middle-income countries (LMICs), leading health organizations continue to focus on global reduction of neonatal mortality. The presence of a skilled clinician at delivery has been shown to decrease mortality. However, there remain significant barriers to training and maintaining clinician skills and ensuring that facility-specific resources are consistently available to deliver the most essential, evidence-based newborn care. The dynamic nature of resource availability poses an additional challenge for essential newborn care educators in LMICs. With increasing access to advanced neonatal resuscitation interventions (ie, airway devices, code medications, umbilical line placement), the international health-care community is tasked to consider how to best implement these practices safely and effectively in lower-resourced settings. Current educational training programs do not provide specific instructions on how to scale these advanced neonatal resuscitation training components to match available materials, staff proficiency, and system infrastructure. Individual facilities are often faced with adapting content for their local context and capabilities. In this review, we discuss considerations surrounding curriculum adaptation to meet the needs of a rapidly changing landscape of resource availability in LMICs to ensure safety, equity, scalability, and sustainability.

The nursing-midwifery workforce size significantly influences the reduction of neonatal mortality rate

PurposeThis study aimed to quantify the confounded and independent role of nursing-midwifery workforce size (NMWS) in protecting against neonatal mortality (NMR) globally and regionally. MethodsScatter plots, bivariate correlation, partial correlation, and multiple linear regression analyses were conducted to assess the correlations between NMWS and NMR. This cross-sectional study fully accounted for potential confounding effects of economic affluence, total fertility rate, and urbanization on this relationship. Countries were categorized to explore regional variations in the protective role of NMWS in reducing NMR. ResultsExplaining 55.76% of NMR variance worldwide, NMWS correlated to NMR negatively and significantly. NMWS still significantly correlated to NMR, but only explained 9.12% of NMR variance when the confounding effects of economic affluence, total fertility rate and urbanization were removed in partial correlation. Linear stepwise regression identified NMWS as the third most significant variable influencing NMR variance worldwide. NMWS correlated to NMR significantly and consistently in different country groupings, especially in developing countries. This suggested that nursing shortage is a significant global issue, but worse in developing countries. ConclusionsNMWS appears to have been a protective factor against NMR globally, particularly in developing nations. This protective effect remained significant even after adjusting for economic affluence, total fertility rate, and urbanization. The consistent negative correlations observed between NMWS and NMR, both globally and regionally, highlight the importance of addressing the chronic shortage of nursing and midwifery personnel, prompting healthcare authorities to prioritize this issue.

Neonatal Resuscitation Online Registry in Shenzhen: protocol for a prospective, multicentre, open, observational cohort study

IntroductionPreterm birth complications and neonatal asphyxia are the leading causes of neonatal mortality worldwide. Surviving preterm and asphyxiated newborns can develop neurological sequelae; therefore, timely and appropriate neonatal resuscitation is...

Income inequality as a determinant of neonatal mortality in the Americas during 2000–2019: implications for the attainment of Sustainable Development Goal target 3.2

BackgroundThe work of the WHO Commission on the Social Determinants of Health has been fundamental to provide a conceptual framework of the social determinants of health. Based on this framework, this study assesses the relationship of income inequality as a determinant of neonatal mortality in the Americas and relates it to the achievement of the Sustainable Development Goal target 3.2 (reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births). The rationale is to evaluate if income inequality may be considered a social factor that influences neonatal mortality in the Americas.MethodsYearly data from 35 countries in the Americas during 2000–2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques.ResultsA positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country’s Gini index during 2000–2019 is associated with a 0.27 (95% CI [− 0.04, 0.57], P =.09) increase in the neonatal mortality rate.ConclusionThe analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000–2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance.

Caesarean delivery and neonatal mortality: evidence from selected slums in and around Dhaka city, Bangladesh- A prospective cohort study

BackgroundThis study examined the neonatal mortality for newborn of women who delivered by caesarean section or vaginally using a prospective cohort.MethodsA total of 6,989 live births registered from 2016 to 2018, were followed for neonatal survival from the selected slums of Dhaka (North and South) and Gazipur city corporations, where icddr,b maintained the Health and Demographic Surveillance System (HDSS). Neonatal mortality was compared by maternal and newborn characteristics and mode of delivery using z-test. Logistic regression model performed for neonatal mortality by mode of delivery controlling selected covariates and reported adjusted odd ratios (aOR) with 95% confidence interval (CI).ResultsOut of 6,989 live births registered, 27.7% were caesarean and the rest were vaginal delivery; of these births, 265 neonatal deaths occurred during the follow-up. The neonatal mortality rate was 2.7 times higher (46 vs. 17 per 1,000 births) for vaginal than caesarean delivered. Until 3rd day of life, the mortality rate was very high for both vaginal and caesarean delivered newborn; however, the rate was 24.8 for vaginal and 6.3 per 1,000 live births for caesarean delivered on the 1st day of life. After adjusting the covariates, the odds of neonatal mortality were higher for vaginal than caesarean delivered (aOR: 2.63; 95% CI: 1.82, 3.85). Additionally, the odds were higher for adolescent than elderly adult mother (aOR: 1.60; 95% CI: 1.03, 2.48), for multiple than singleton birth (aOR: 5.40; 95% CI: 2.82, 10.33), for very/moderate (aOR: 5.13; 95% CI: 3.68, 7.15), and late preterm birth (aOR: 1.48; 95% CI: 1.05, 2.08) than term birth; while the odds were lower for girl than boy (aOR: 0.74; 95% CI: 0.58, 0.96), and for 5th wealth quintile than 1st quintile (aOR: 0.59, 95% CI: 0.38, 0.91).ConclusionOur study found that caesarean delivered babies had significantly lower neonatal mortality than vaginal delivered. Therefore, a comprehensive delivery and postnatal care for vaginal births needed a special attention for the slum mothers to ensure the reduction of neonatal mortality.

Health reforms, facility-based delivery, and newborn's health: evidence from Rwanda

Abstract Since 2006, Rwanda has experienced a substantial rise in the facility-based delivery (FBD) rate, attributed to various health initiatives. This paper investigates the impact of multiple health reforms on maternal service utilization and neonatal mortality rates. Employing a difference-in-differences framework utilizing geographical variation in the baseline FBD rate, our estimates indicate a 10–17 percentage point increase in FBD and a 0.15–0.18 times increase in the number of antenatal care visits. While our analysis indicates some evidence of a reduction in neonatal mortality rates, the findings are inconclusive. Nevertheless, our results suggest that the effect of the reforms on neonatal mortality rates was weakly intensified for those residing near district hospitals providing care for complicated pregnancies.

Impact of scaling up of kangaroo mother care on neonatal mortality among babies born with birth weight

ObjectiveTo assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Design,...

Effective multi-sectoral approach for rapid reduction in maternal and neonatal mortality: the exceptional case of Bangladesh

BackgroundBangladesh experienced impressive reductions in maternal and neonatal mortality over the past several decades with annual rates of decline surpassing 4% since 2000. We comprehensively assessed health system and non-health...

Morbidity and Mortality among Premature New-borns Admitted in the Nursery Unit of Al-Kuwait University Hospital in Sanaa-Yemen

Introduction: The incidence of preterm births is increasing worldwide, and Asia and Africa are the major contributors to the global preterm burden. Preterm babies have increased the risk of morbidity and mortality which is inversely related to both gestational age and birth weight. Objectives: To determine the common morbidities and mortalities of premature new-borns admitted to the nursery unit at Al-Kuwait hospital, Sana'a. Materials and Methods: This is a retrospective descriptive study of Morbidities and mortalities of premature new-borns admitted to Al-Kuwait hospital Sana'a, Yemen from January 2014 to December 2015. Results: Preterm babies contribute 35.3 % of the total admissions. Among the 244 preterm babies admitted, 74 (30.3%) babies were admitted due to low birth weight only, 57 (23.4) babies were IUGR, 59(24.2%) babies were admitted with respiratory problems and only 23 (9.4%) babies were admitted with infection Among the preterm babies admitted, (62.7%) were improved and discharged, (29.5%) were dead, (6.9%) were lift against medical advice (LAMA) and only (0.9%) babies were referred to another hospital. Out of 72 preterm babies who died, 44 babies were delivered low birth weight contributing 65.2% of the total preterm babies’ death and the second cause of death was a respiratory problem with 14 that contributing 19.4 % of the total preterm babies’ death, but only 5 preterm babies dead from an infection that contributing 6.9 % of the total preterm babies’ death. Conclusions: Preterm babies contribute a significant percentage of the total new-born admissions in the nursery unit at AlKuwait hospital, Sana'a. Without improving the preterm care reduction of neonatal mortality rate and thereby IMR will be a dream unaccomplished.

Umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis.

Placental management strategies such as umbilical cord milking and delayed cord clamping may provide a range of benefits for the newborn. The aim of this review was to assess the effectiveness of umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia. Three databases and five clinical trial registries were systematically reviewed to identify randomised controlled trials comparing umbilical cord milking or delayed cord clamping with control in term and preterm infants. The primary outcome was neonatal hypoglycaemia (study defined). Two independent reviewers conducted screening, data extraction and quality assessment. Quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB-2). Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis using a random effect model was done using Review Manager 5.4. The review was registered prospectively on PROSPERO (CRD42022356553). Data from 71 studies and 14 268 infants were included in this review; 22 (2 537 infants) compared umbilical cord milking with control, and 50 studies (11 731 infants) compared delayed with early cord clamping. For umbilical cord milking there were no data on neonatal hypoglycaemia, and no differences between groups for any of the secondary outcomes. We found no evidence that delayed cord clamping reduced the incidence of hypoglycaemia (6 studies, 444 infants, RR = 0.87, CI: 0.58 to 1.30, p = 0.49, I2 = 0%). Delayed cord clamping was associated with a 27% reduction in neonatal mortality (15 studies, 3 041 infants, RR = 0.73, CI: 0.55 to 0.98, p = 0.03, I2 = 0%). We found no evidence for the effect of delayed cord clamping for any of the other outcomes. The certainty of evidence was low for all outcomes. We found no data for the effectiveness of umbilical cord milking on neonatal hypoglycaemia, and no evidence that delayed cord clamping reduced the incidence of hypoglycaemia, but the certainty of the evidence was low.

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.

Antenatal corticosteroids reduce neonatal mortality in settings without assisted ventilatory support: a retrospective cohort study of early preterm births on the Thailand-Myanmar border.

Prematurity is the highest risk for under-five mortality globally. The aim of the study was to assess the effect of antenatal dexamethasone on neonatal mortality in early preterm in a resource-constrained setting without assisted ventilation. This retrospective (2008-2013) cohort study in clinics for refugees/migrants on the Thai-Myanmar border included infants born <34 weeks gestation at home, in, or on the way to the clinic. Dexamethasone, 24 mg (three 8 mg intramuscular doses, every 8 hours), was prescribed to women at risk of preterm birth (28 to <34 weeks). Appropriate newborn care was available: including oxygen but not assisted ventilation. Mortality and maternal fever were compared by the number of doses (complete: three, incomplete (one or two), or no dose). A sub-cohort participated in neurodevelopmental testing at one year. Of 15,285 singleton births, 240 were included: 96 did not receive dexamethasone and 144 received one, two or three doses (56, 13 and 75, respectively). Of live-born infants followed to day 28, (n=168), early neonatal and neonatal mortality/1,000 livebirths (95%CI) with complete dosing was 217 (121-358) and 304 (190-449); compared to 394 (289-511) and 521 (407-633) with no dose. Compared to complete dosing, both incomplete and no dexamethasone were associated with elevated adjusted ORs 4.09 (1.39 to 12.00) and 3.13 (1.14 to 8.63), for early neonatal death. By contrast, for neonatal death, while there was clear evidence that no dosing was associated with higher mortality, adjusted OR 3.82 (1.42 to 10.27), the benefit of incomplete dosing was uncertain adjusted OR 1.75 (0.63 to 4.81). No adverse impact of dexamethasone on infant neurodevelopmental scores (12 months) or maternal fever was observed. Neonatal mortality reduction is possible with complete dexamethasone dosing in pregnancies at risk of preterm birth in settings without capacity to provide assisted ventilation.

Risk factors associated with neonatal mortality among neonates admitted to neonatal intensive care unit of the University Teaching Hospital in Lusaka

Globally, several children die shortly after birth and many more of them within the first 28 days of life. Sub-Sharan Africa accounts for almost half (43%) of the global neonatal death with slow progress in reduction. These neonatal deaths are associated with lack of quality care at or immediately after birth and in the first 28 days of life. This study aimed to determine the trends and risk factors of facility-based neonatal mortality in a major referral hospital in Lusaka, Zambia. We conducted retrospective analysis involving all neonates admitted in the University Teaching Hospital Neonatal Intensive Care Unit (UTH-NICU) in Lusaka from January 2018 to December 2019 (N = 2340). We determined the trends and assessed the factors associated with facility-based neonatal mortality using Generalized Linear Models (GLM) with a Poisson distribution and log link function. Overall, the facility-based neonatal mortality was 40.2% (95% CI 38.0–42.0) per 1000 live births for the 2-year period with a slight decline in mortality rate from 42.9% (95% CI 40.0–46.0) in 2018 to 37.3% (95% CI 35.0–40.0) in 2019. In a final multivariable model, home delivery (ARR: 1.70, 95% CI 1.46–1.96), preterm birth (ARR: 1.59, 95% CI 1.36–1.85), congenital anomalies (ARR: 1.59, 95% CI 1.34–1.88), low birthweight (ARR: 1.57, 95% CI 1.37–1.79), and health centre delivery (ARR: 1.48, 95% CI 1.25–1.75) were independently associated with increase in facility-based neonatal mortality. Conversely, hypothermia (ARR: 0.36, 95% CI 0.22–0.60), antenatal attendance (ARR: 0.76, 95% CI 0.68–0.85), and 1-day increase in neonatal age (ARR: 0.96, 95% CI 0.95–0.97) were independently associated with reduction in facility-based neonatal mortality. In this hospital-based study, neonatal mortality was high compared to the national and global targets. The improvement in neonatal survival observed in this study may be due to interventions including Kangaroo mother care already being implemented. Early identification and interventions to reduce the impact of risks factors of neonatal mortality in Zambia are important.

FIGO Preconception Checklist: Preconception care for mother and baby.

The preconception period is a unique and opportunistic time in a woman's life when she is motivated to adopt healthy behaviors that will benefit her and her child, making this time period a critical "window of opportunity" to improve short- and long-term health. Improving preconception health can ultimately improve both fetal and maternal outcomes. Promoting health before conception has several beneficial effects, including an increase in seeking antenatal care and a reduction in neonatal mortality. Preconception health is a broad concept that encompasses the management of chronic diseases, including optimal nutrition, adequate consumption of folic acid, control of body weight, adoption of healthy lifestyles, and receipt of appropriate vaccinations. Use of the FIGO Preconception Checklist, which includes the key elements of optimal preconception care, will empower women and their healthcare providers to better prepare women and their families for pregnancy.

Factors associated with perinatal and neonatal deaths in Sao Tome & Principe: a prospective cohort study.

Neonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome & Principe (STP), the smallest Central Africa country. Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life (n = 194) for identification of neonatal death-outcome (n = 22) and alive-outcome groups (n = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A p value <0.05 was considered statistically significant. The mean gestational age of the death-outcome and alive-outcome groups was 36 (SD = 4.8) and 39 (SD = 1.4) weeks, respectively. Death-outcome group (n = 22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95% CI: 1.18-7.22], meconium-stained fluid [cOR 4.38, 95% CI: 1.74-10.98], prolonged rupture of membranes [cOR 4.84, 95% CI: 1.47-15.93], transfer from another unit [cOR 6.08, 95% CI:1.95-18.90], and instrumental vaginal delivery [cOR 8.90, 95% CI: 1.68-47.21], were factors significantly associated with deaths. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95% CI: 0.14-1.00] and birth weight of more than 2,500 g [cOR 0.017, 95% CI: 0.002-0.162] were found to be protective factors. Factors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental-assisted vaginal delivery increased 4- to 9-fold the risk of stillbirth and neonatal deaths. Thus, avoiding delays in prompt intrapartum care is a key strategy to implement in Sao Tome & Principe.

Nomogram to predict risk of neonatal mortality among preterm neonates admitted with sepsis at University of Gondar Comprehensive Specialized Hospital: risk prediction model development and validation

BackgroundMortality in premature neonates is a global public health problem. In developing countries, nearly 50% of preterm births ends with death. Sepsis is one of the major causes of death in preterm neonates. Risk prediction model for mortality in preterm septic neonates helps for directing the decision making process made by clinicians.ObjectiveWe aimed to develop and validate nomogram for the prediction of neonatal mortality. Nomograms are tools which assist the clinical decision making process through early estimation of risks prompting early interventions.MethodsA three year retrospective follow up study was conducted at University of Gondar Comprehensive Specialized Hospital and a total of 603 preterm neonates with sepsis were included. Data was collected using KoboCollect and analyzed using STATA version 16 and R version 4.2.1. Lasso regression was used to select the most potent predictors and to minimize the problem of overfitting. Nomogram was developed using multivariable binary logistic regression analysis. Model performance was evaluated using discrimination and calibration. Internal model validation was done using bootstrapping. Net benefit of the nomogram was assessed through decision curve analysis (DCA) to assess the clinical relevance of the model.ResultThe nomogram was developed using nine predictors: gestational age, maternal history of premature rupture of membrane, hypoglycemia, respiratory distress syndrome, perinatal asphyxia, necrotizing enterocolitis, total bilirubin, platelet count and kangaroo-mother care. The model had discriminatory power of 96.7% (95% CI: 95.6, 97.9) and P-value of 0.165 in the calibration test before and after internal validation with brier score of 0.07. Based on the net benefit analysis the nomogram was found better than treat all and treat none conditions.ConclusionThe developed nomogram can be used for individualized mortality risk prediction with excellent performance, better net benefit and have been found to be useful in clinical practice with contribution in preterm neonatal mortality reduction by giving better emphasis for those at high risk.