Background. Globally, prematurity is the leading cause of neonatal mortality, and hypothermia is one of its contributing factors. The goal of this study was to determine the association between hypothermia and mortality. Methods. A prospective, multi-center, descriptive clinical study was conducted in 5 hospitals in Ethiopia. Axillary temperatures were taken at the time of admission to the newborn intensive care units (NICU) and followed during the NICU stay. Results. A total of 3852 premature neonates (<37 weeks) were admitted to the NICUs from July 2016 to May 2018. Of these infants, 1109 (28.8%) died and 2991 (79.6%) had hypothermia. Hypothermia was associated with perinatal asphyxia (89.5%), RDS (86.2%), and resuscitation at birth (82.7%). Admission temperatures in preterm newborns were inversely associated with mortality and morbidity. Conclusion. Hypothermia at admission is associated with neonatal mortality in premature neonates in Ethiopia. RDS and perinatal asphyxia were the main factors associated with hypothermia. The very high prevalence and association with mortality warrants quality improvement interventions.

What is already known on this topic?► Worldwide, about one-sixth of all newborns are low birth weight (LBW, <2500 g), which is the single most important underlying risk factor for neonatal death. ► In resource-limited settings, tools to identify LBW and premature newborns are often not readily available. ► Foot length, chest circumference mid-upper arm circumference can be used to identify LBW babies at birth, cut-offs vary by country and ethnic group. What this study adds?► The optimal cut-offs identified to diagnose LBW in Ethiopia were ≤7.7 cm for foot length, ≤31.2 cm for chest circumference and ≤9.8 cm for mid-upper arm circumference. ► Comparable diagnostic ability was observed when these measurements were taken on day 5 of age. ► The Eregie model for gestational age estimation gives similar results to the New Ballard Score method. AbsTrACTObjective To investigate foot length (FL), chest circumference (CHC) and mid-upper arm circumference (MUAC) as predictors of low birth weight (LBW) or prematurity, and to describe the agreement between the gestational age (GA) assessments ascertained by the New Ballard Score (NBS) and the Eregie model. Methods A hospital-based cross-sectional study with community follow-up in a subset was conducted in Jimma University Medical Center, Ethiopia. GA (NBS and Eregie model), weight, FL, CHC and MUAC were measured at birth. Anthropometrics were repeated at 5 days of age. results The optimal cut-offs indicative of LBW were ≤7.7 cm for FL; ≤31.2 cm for CHC and ≤9.8 cm for MUAC. CHC, MUAC and FL identified LBW with sensitivities (95% CI) of 91.6 (86.9 to 95), 83.7 (77.8 to 88.5) and 84.2 (78.4 to 88.9), and specificities (95% CI) of 85.4 (83.3 to 87.4), 90.2 (88.4 to 91.9) and 73.9 (71.3 to 76.4), respectively. CHC, MUAC and FL identified prematurity with sensitivities of 83.8 (76.7 to 89.4), 83.1 (75.9 to 88.9) and 81.7 (74.3 to 87.7), and specificities of 81.1 (78.9 to 83.3), 63.4 (60.7 to 66.1) and 77.0 (74.6 to 79.3), respectively. The cut-offs identified have comparable diagnostic ability for LBW and prematurity when measurements are repeated on day 5 of age. The GA assessment by the NBS and the Eregie model gave similar results, with the mean difference of 1.2 weeks. Conclusion CHC, MUAC and FL taken on day 1 and 5 after birth could be used as diagnostic tools for LBW or prematurity. The Eregie model for GA estimation gives similar results to the NBS.

Background. Hyperbilirubinemia is prevalent and protracted in preterm infants. This study assessed the pattern of hyperbilirubinemia in preterm infants in Ethiopia. Methods. This study was part of multi-centered prospective, cross-sectional, observational study that determined causes of death among preterm infants. Jaundice was first identified based on clinical visual assessment. Venous blood was then sent for total and direct serum bilirubin level measurements. For this study, a total serum bilirubin level ≥5 mg/dL was taken as the cutoff point to diagnose hyperbilirubinemia. Based on the bilirubin level and clinical findings, the final diagnoses of hyperbilirubinemia and associated complications were made by the physician. Result. A total of 4919 preterm infants were enrolled into the overall study, and 3852 were admitted to one of the study’s newborn intensive care units. Of these, 1779 (46.2%) infants were diagnosed with hyperbilirubinemia. Ten of these (0.6%) developed acute bilirubin encephalopathy. The prevalence of hyperbilirubinemia was 66.7% among the infants who were less than 28 weeks of gestation who survived. Rh incompatibility ( P = .002), ABO incompatibility ( P = .0001), and sepsis ( P = .0001) were significantly associated with hyperbilirubinemia. Perinatal asphyxia ( P-value = 0.0001) was negatively associated with hyperbilirubinemia. Conclusion. The prevalence of hyperbilirubinemia in preterm babies admitted to neonatal care units in Ethiopia was high. The major risk factors associated with hyperbilirubinemia in preterm babies in this study were found to be ABO incompatibility, sepsis, and Rh isoimmunization.

Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants’ clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P < .001) and (OR = 5.06, 95% CI = 3.23-7.87; P < .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often ( P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.