A Prospective Observational Study of the Causes of Death in Preterm Infants in a Low Resource Setting (original) (raw)
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SSRN Electronic Journal, 2018
Background Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia. Methods We did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data. Findings Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28-31 weeks (512 [54%] of 952), 32-34 weeks (349 [18%] of 1975), and 35-36 weeks (159 [8%] of 1888). Interpretation Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death. Funding Bill & Melinda Gates Foundation.
The Lancet Global Health, 2019
Background Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia. Methods We did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data. Findings Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28-31 weeks (512 [54%] of 952), 32-34 weeks (349 [18%] of 1975), and 35-36 weeks (159 [8%] of 1888). Interpretation Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death. Funding Bill & Melinda Gates Foundation.
Global Pediatric Health
Aim. To determine the risk factors for death among preterm neonates. Methods and materials. The data set used was derived from a prospective, multi-center, observational clinical study conducted in 5 tertiary hospitals in Ethiopia from July, 2016 to May, 2018. Subjects were infants admitted into neonatal intensive care unit. Results. Risk factors were determined using statistical model developed for this study. The mean gestational age was 32.87 (SD ± 2.42) weeks with a range of 20 to 36 weeks. There were 2667 (70.69%) survivors and 1106 (29.31%) deaths. The significant risk factors for preterm death were low gestational age, low birth weight, being female, feeding problem, no antenatal care visits and vaginal delivery among mothers with higher educational level. Conclusions. The study identified several risk factors for death among preterm neonates. Most of the risk factors are preventable. Thus, it is important to address neonatal and maternal factors identified in this study thro...
2020
Background Birth-related complications are the single most direct cause of national neonatal death, 35% of the world's 3.1 million deaths a year and the second most common cause of under-five deaths associated with the cost of living worldwide. To achieve the goals of designing an effective strategy to manage the problem assessing proportion and factor of death among preterm neonates are important. Methods An Institution-based cognitive research study was conducted at Aksum Referral and General specialty hospital, Northern Ethiopia. All pre-natal isolates that were allowed to enter into a high-growth union during childbirth. The data collected will be cleared and entered into the Epi-info version 7 and exported to STATA version 12 for further analyses. bivariable and multivariable analysis performed to determine the relationship between baseline and explanatory variables. Variables with a p-value of less than 0.05 will be the cutoff point. Result overall mortality rate was 22.2%, with 95% CI (17.9-26.9), of which 18 (23.4%) died within the 1 st 48 hrs and 59(76.6%) died the 1 st 7 days of life. Place of delivery(AOR:5.13(3.46-10.04)), Birth weight times higher than in developed countries, eight times higher than in developed countries [2]. Premature birth can have serious health consequences for the child, and many of the surviving children, often at the expense of family and community, are respiratory problems, mental illness, and mental disorders neurological problems[3, 20]. Globally in 2016, 2.6 million newborns were killed. Of these, 99% of maternal deaths occur in low-income and middle-income countries. 39% were reported in South Asia, 39% in South Africa. Ethiopia is one of the five countries that have died in infants, children, Pakistan, Nigeria, and the Democratic Republic of the Congo [5]. May according to the 2016 Ethiopian demographic health survey, the death to all from childbirth is 29 out of 1000 births [6]. Studies reported that preterm neonatal mortality in Ethiopia there is regional variation 28.28%
BMC Research Notes, 2018
Objective: Neonatal mortality accounts for 43% of under-five child mortality in Ethiopia where preterm is the second leading cause of neonatal death and steadily increased in low-income countries. Therefore, assessing the proportion of death and associated factors among preterm neonates has a paramount importance in designing an effective strategy to intervene and achieve sustainable development goal. Results: In this study proportion of preterm neonatal death in this study was 28.8% [95% CI (25.1, 32.9)]. Complications during index pregnancy [AOR = 1.92, 95% CI (1.09, 3.38)], gestational age [AOR = 0.78, 95% CI (0.69, 0.91)], small for gestational age [AOR = 2.42, 95% CI (1.33, 4.38)], APGAR score at birth < 7 [AOR = 2.39, 95% CI (1.34, 4.27)], hyaline membrane disease [AOR = 5.15, 95% CI (2.83, 9.36)], neonatal respiratory distress at admission [AOR = 1.93, 95% CI (1.13, 3.31)], presence of jaundice [AOR = (3.39, 95% CI (1.90, 6.05)], received kangaroo mother care [AOR = 0.13, 95% CI (0.05, 0.35)], and hypoglycemia at admission [AOR = 3.86, 95% CI (2.12, 7.06)] were statistically significant. The proportion of preterm neonatal death was high. Ministry of health and responsible organizations should give special attention for preterm neonates to prevent life-threatening complications.
Reproductive health, 2018
With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study. This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will doc...
Ethiopian Journal of Health Sciences, 2021
Background Prematurity is the most frequent cause of neonatal death and the second leading cause of under-five mortality. Preterm related complications accounts for 35 % of neonatal deaths within the first week after birth. So far, most studies done in Ethiopia have focused on estimating the prevalence and determinant factors of premature neonatal death. The current study aimed to assess the incidence and predictors of mortality among preterm neonates admitted to neonatal intensive care unit at Debre Markos Referral Hospital. Methods An institution-based retrospective follow up study was conducted among premature neonates admitted to Neonatal Intensive Care Unit at Debre Markos Referral Hospital from July 2019 to October 2019. Around 498 patients were selected randomly. A multivariable cox proportional hazards model was fitted to identify predictors of mortality. Results A total of 498 preterm babies were followed, and the mean age for follow up at the time of admission to NICU was ...
BMJ Open, 2021
ObjectiveThis study aimed to assess the magnitude of preterm neonatal mortality in hospitals and associated factors in northern Ethiopia.DesignInstitutional-based cross-sectional study.SettingComprehensive specialised hospitals in the Tigray region, northern Ethiopia.ParticipantsPreterm neonates admitted in Ayder and Aksum comprehensive specialised hospitalsPrimary outcomeMagnitude of preterm neonatal mortality.Secondary outcomeFactors associated with preterm neonatal mortalityResultThis study was conducted from 1 April 2019 to 15 May 2019 among 336 participants with a response rate of 96.8%. The magnitude of preterm neonatal mortality was 28.6% (95% CI: 24.0 to 33.7). In multivariable logistic regression, respiratory distress syndrome (adjusted odd ratio (AOR)=2.85; 95% CI: 1.35 to 6.00), apnoea of prematurity (AOR=5.45; 95% CI: 1.32 to 22.5), nulli parity (AOR=3.63; 95% CI: 1.59 to 8.24) and grand parity (AOR=3.21; 95% CI: 1.04 to 9.94) were significant factors associated with pre...
Clinics in Mother and Child Health, 2018
Background: Neonatal death is loss of the newborn with in the first twenty eight days of life. In many societies, neonatal deaths and stillbirths are not perceived as a problem, largely because they are very common. However, it is remains untold grief for the mother especially in developing countries likes Ethiopia where its magnitude is very high. Because of the high magnitude of the problem and its direct linkage with the quality of health services during pregnancy, peripartum and in the first month of the neonates' life, neonatal mortality rate are used as an important indicators of the health status of a country. Therefore, this study will have a role in fighting against neonatal death through gathering information about neonatal death and its possible causes in the study area.
Scientific Reports, 2023
Early neonatal mortality occurs when a newborn dies within the first seven days of life. Despite interventions, neonatal mortality remains public health problem over time in Ethiopia (33 per 1000 live births). Determinants varies on level of neonatal mortality. The study's goal was to determine magnitude of early newborn death, as well as its determinants and causes in Newborn Intensive Care Unit of Referral hospital in Ethiopia's Somali region. Health facility based retrospective study review was conducted between May 2019 to May 2021 in Shiek Hassan Yabare Referral Hospital of Jigjiga University of Ethiopia. All neonates admitted at neonatal intensive care unit (NICU) with complete data and get registered using the new NICU registration book from May 2019 to May 2021 were included. Kobo toolkit was used for data collection and analyzed in SPSS 20. The magnitude of early neonatal mortality rate was defined as death between 0 and 7 days. Logistic regression model was used to estimate maternal and neonatal characteristics as a determinant variables on neonatal mortality. The statistical significance was considered at P-value < 0.05. The magnitude of early neonatal mortality rate of Ethiopia's Somali region is estimated to be 130 per 1000 live birthsthat is say 130 newborn couldn't celebrate their seventh day in every 1000 live births. Hypothermia, prematurity, maternal death at birth and shorter length of stay in NICU were increasing the chance of neonatal mortality at early stage while neonatal resuscitation had shown protective effect against neonatal mortality. Similarly birth asphyxia, preterm, sepsis, and congenital abnormalities were major causes of admission and death in the NICU. The magnitude of early neonatal mortality is considerable and most of the determinants are preventable. Enhancing quality of intra-partum and NICU care including infection prevention, managing hypothermia and neonatal resuscitation as per the national standard within the first golden hour is key. Abbreviations NICU Neonatal intensive care unit RDS Respiratory Distress Syndrome CS Cesarean section KMC Kangaroo mother care LBW Low birth weight SHYRH Shiek Hassan Yabare Referral Hospital (SHYRH) of Jigjiga University Early neonatal mortality occurs when a newborn dies within the first seven days of life 1. Neonatal mortality continues to be the highest (17%) among children under the age of five worldwide, with Sub-Saharan Africa accounting for the largest share 2. Low-income countries continue to have higher rates of neonatal death 3,4 .