Predictors of mortality among neonates hospitalized with neonatal sepsis: a case control study from southern Ethiopia

Bekele, Tadele; Merga, Hailu; Tesfaye, Tamiru; Asefa, Henok

doi:10.1186/s12887-021-03049-5

Cited by 21 publications

(11 citation statements)

References 21 publications

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“…Prematurity had shown a significant association with the risk of sepsis-related neonatal mortality with the hazard of death 2 times higher among neonates born before 37 completed weeks of gestation compared to term neonates. This result is consistent with studies conducted in, Durame southern Ethiopia ( 27 ), Pakistan ( 1 ), Mexico ( 24 ), and India ( 23 ). It is well known that premature neonates face numerous physiologic challenges and fatal conditions as they adjust to extrauterine life and may not respond to treatments.…”

Section: Discussionsupporting

confidence: 92%

“…Neonates with respiratory distress syndrome were two times more likely to die of neonatal sepsis. This finding is comparable with previous studies conducted in Ethiopia ( 22 , 27 ) and Nigeria ( 31 ). This could be because babies with respiratory distress don’t have surfactant that helps to prevent the collapse of small air sacs in the lungs which increases the risk of neonatal mortality.…”

Section: Discussionsupporting

confidence: 92%

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Incidence of death and its predictors among neonates admitted with sepsis in referral hospitals, northwest Ethiopia, a prospective cohort study

et al. 2023

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BackgroundEach year, approximately 2.7 million neonates die in their first month of life worldwide, and the majority of these deaths occur in low-income countries. According to the Global Burden of Disease estimation, 1.3 million annual incident cases of neonatal sepsis were reported worldwide, resulting in 203,000 sepsis-attributable deaths. Little is known about the time to death of neonates and predictors after admission with a diagnosis of sepsis. This study aimed to assess the incidence and predictors of death among neonates admitted to the neonatal intensive care unit with a diagnosis of sepsis in referral hospitals in Northwest Ethiopia.MethodsA multicenter prospective follow-up study was conducted from November 11 to December 7, 2021. A stratified random sampling technique was employed to select 412 neonates. Neonates admitted with sepsis were followed until they develop event for a maximum of 28 days of age. A face-to-face interview was conducted with the mother of the neonate using a pretested and structured questionnaire, and neonatal charts were reviewed to collect baseline factors. Data were entered into Epi-data version 4.6 and exported to STATA version 14 for analysis. A bivariable and multivariable exponential Cox regression model was fitted to identify predictors of death. The adjusted hazard ratio (AHR) with 95% CI was calculated, and statistical significance was declared at a P-value of 0.05 in the multivariable analysis.ResultsA total of 75 (18.47%) neonates died during the study period, with a 95% CI of 14.82–22.60. The incidence rate of death was 28 (95% CI, 22, 35) per 1,000 person-days of observation, with a total follow-up time of 2,677 person-days of observation. Birth weight (<2,500 g) (AHR = 2.12, 95% CI: 1.01, 4.43), prematurity (AHR = 2.06, 95% CI: 1.02, 4.15), duration of labor >24 h (AHR = 3.89, 95% CI: 1.38, 11.01), breast feeding (AHR = 0.43, 95% CI: 0.23, 0.80), having respiratory distress syndrome (AHR = 1.77, 95% CI: 1.02, 306), oxygen saturation less than 90% (AHR = 2.23, 95% CI: 1.02, 306) were significant predictors of death among neonates admitted with sepsis.Conclusion and recommendationThe incidence of neonatal mortality in this study was high. Early detection and appropriate management of patients’ presentations like respiratory distress syndrome and low oxygen saturation are necessary to reduce neonatal sepsis-related mortality. Special attention should be given to low birth weight and premature neonates and mothers should be encouraged to breastfeed their newborns after delivery.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Incidence of death and its predictors among neonates admitted with sepsis in referral hospitals, northwest Ethiopia, a prospective cohort study

et al. 2023

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“…As the gestational age increases by one week, the newborn is more likely to survive during the early neonatal period. This finding corresponds well with studies conducted in Ethiopia (Gondar, Addis Ababa, Jimma, Durame, and Mekelle) [62][63][64][65][66][67], Ghana [68], China [27], and Brazil [69]. The possible reason might be the fact that gestational age is strongly related to fetal maturity.…”

Section: Plos Onesupporting

confidence: 90%

Cause and risk factors of early neonatal death in Ethiopia

et al. 2022

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Background Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death. Methods The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI. Result More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period. Conclusion The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.

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“…Not surprisingly, low birthweight neonates have a higher risk of mortality than term and normal birthweight neonates. Similar findings were reported in a systematic review and meta-analysis of mortality from neonatal sepsis [ 6 ], and other studies conducted in Brazil [ 14 ], Iraq [ 20 ], Central India [ 21 ], Pakistan [ 22 ], and Ethiopia [ 15 , 23 , 24 ]. This is because low birthweight may relate with prematurity; the immune system of preterm neonates is not well developed.…”

Section: Discussionsupporting

confidence: 88%

Time to Death and Its Predictors among Neonates Hospitalized with Sepsis in Eastern Ethiopia

Jibro,

Desalew,

Ayana

et al. 2024

BioMed Research International

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Background. Although neonatal sepsis is a major public health problem contributing to 30-50% of neonatal deaths in low- and middle-income countries, data on predictors of time to death are limited in Eastern Ethiopia. This study is aimed at determining predictors of time to death among neonates with sepsis admitted in public hospitals in Eastern Ethiopia. Methods. An institutional-based retrospective cohort study was conducted among 415 neonates admitted to referral hospitals in Eastern Ethiopia with sepsis from January 1, 2021, to December 31, 2021. Data were collected from medical records by using structured checklist and entered using EpiData 3.1 and analyzed using Stata 17. The Kaplan-Meier curves and log-rank tests were used to describe survival experience among different categories. The proportional hazard assumption and goodness of fit for the Cox regression model were checked. The Cox regression model was used to identify the significant predictors. Hazard ratios (HRs) with 95% confidence intervals (CI) were calculated. Finally, statistical significance was set at a p value < 0.05 in the Cox regression analysis. Results. Of the 415 neonates with neonatal sepsis, 71 (17.1%) (95% CI: 13.60-21.08) died at discharge, with a median time to death of 14 days. The overall incidence rate of mortality was 36.5 per 1000 neonate days. Low birthweight (AHR=2.50; 95% CI: 1.15-5.44), maternal age≥35 years (AHR=3.17; 95% CI: 1.11, 9.04), low fifth-minute Apgar score (AHR: 2.32; 95% CI: 1.30-4.14), and late initiation of breastfeeding (AHR=4.82; 95% CI: 1.40-16.65) were independent predictors of mortality among neonates with sepsis. Conclusions. Almost one in five neonates with sepsis died at discharge. Low birthweight, maternal age≥35 years, low fifth-minute Apgar score, and late initiation of breastfeeding were predictors of mortality.

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Predictors of mortality among neonates hospitalized with neonatal sepsis: a case control study from southern Ethiopia

Cited by 21 publications

References 21 publications

Incidence of death and its predictors among neonates admitted with sepsis in referral hospitals, northwest Ethiopia, a prospective cohort study

Incidence of death and its predictors among neonates admitted with sepsis in referral hospitals, northwest Ethiopia, a prospective cohort study

Cause and risk factors of early neonatal death in Ethiopia

Time to Death and Its Predictors among Neonates Hospitalized with Sepsis in Eastern Ethiopia

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