Does neonatal resuscitation associated with neonatal death in low-resource settings? A follow-up study

Abstract

Background

The newborn period is the most vulnerable phase for a child’s survival, with around half of all under-five deaths worldwide occurring during this time. Despite existing policies and measures, Ethiopia ranks among the top 10 African countries in terms of newborn mortality. In spite of many studies being carried out in the country, the incidence and predictors of neonatal mortality in the Pastoralist and agro-pastoralist parts of the country’s southern still remain unidentified. Therefore, this study aimed to identify the predictors of neonatal mortality in selected public Hospitals in southern Ethiopia.

Materials and methods

An institution-based retrospective cohort study was conducted among 568 neonates admitted to the neonatal intensive care unit at Bule Hora University teaching Hospital and Yabelo General Hospital, Southern Ethiopia from 1 January 2020–31 December 2021. A simple random sampling technique was used to select records of neonates. Data entry was performed using Epidata version 3.1 and the analysis was performed using STATA version 14.1 Kaplan Meir curve and Log-rank test were used to estimate the survival time and compare survival curves between variables. 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 neonatal death.

Results

Out of 565 neonates enrolled, 54(9.56%) neonates died at the end of the follow-up period. The overall incidence rate of death was 17.29 (95% CI: 13.24, 22.57) per 1000 neonatal days with a restricted mean follow-up period of 20 days. Of all deaths, 64.15% of neonates died within the first week of life. In the multivariable cox-proportional hazard model, neonatal age < 7 days (AHR: 9.17, 95% CI: (4.17, 20.13), place of delivery (AHR: 2.48, 95% CI: (1.38, 4.47), Initiation of breastfeeding after 1 h of birth (AHR: 6.46, 95% CI: (2.24, 18.59), neonates’ body temperature <36.5 °C (AHR: 2.14, 95% CI: (1.19, 3.83), and resuscitated neonates (AHR: 2.15, 95% CI: (1.20, 3.82) were independent predictors of neonatal death.

Conclusion

In the research setting, the incidence of neonatal death was high, especially during the first week of life. The study found that neonatal age < 7 days, place of delivery, Initiation of breastfeeding after 1 h of birth, neonates’ body temperature <36.5 °C, and resuscitated neonates were predictors of neonatal death. To improve newborn survival, significant neonatal problems, improved resuscitation, and other relevant factors should be addressed.

Keywords:

• Resuscitation
• nICU
• neonates
• Bule Hora
• Ethiopia

Acknowledgments

First, the authors thank Bule Hora University for supporting our data collection. The authors also like to thank facilities heads, data collectors, and supervisors for their invaluable support and cooperation throughout the data collection.

Ethical approval and consent to participate

Ethical clearance was obtained from the Institutional Review Board of Bule Hora University with Ref.no BHU/RPD/817/13. The necessary explanation regarding the purpose of the study was informed to data collectors and the concerned official body in the hospital. Confidentiality of the information was assured by not recording any personal identifiers from the chart. Furthermore, the research procedures were conducted in accordance with the principle expressed in the World Medical Association’s Declaration of Helsinki.

Authors’ contributions

AA, SA, DJ, AE, and EA conceived the idea and designed the study, led the data analysis and interpretation, developed the first draft of the manuscript, and made all revisions. AA and AE critically revised the manuscript for important intellectual content and ensured that the requirements for submission of the manuscript were met. AA, SA, DJ, AE, and EA contributed to the analysis and data interpretation and revised and edited the manuscript. AA and AE reviewed the expert opinions and revised the manuscript for important intellectual content. AA, SA, DJ, AE, and EA supervised the study design and wrote the manuscript. All the authors have read and agreed to the final version of the manuscript for publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data analyzed during this study are included in the manuscript.

Additional information

Funding

No funding was obtained for this study.