Mortality Among Low Birth Weight Neonates on Parenteral Feeding: A Prospective Follow-Up Study

Figures & data

Table 1 Sociodemographic, Medical, and Obstetric Characteristic of Indexed Mothers, Whose Neonates Were Admitted in Selected Hospitals of Addis Ababa, Ethiopia (n = 289)

Variables	Category	Frequency	Percent (%)
Age	≤24	87	30.1
	25–29	110	38.1
	30–34	63	21.8
	≥35	29	10.0
ANC	Not at all	16	5.5
	<4	182	63
	≥4	91	31.5
Parity	Primiparous	127	43.9
	Multiparous	162	56.1
Onset of labor	Spontaneous	192	66.4
	Induction	97	33.6
Mode of delivery	Spontaneous Vaginal Delivery	150	51.9
	Caesarean Delivery	137	47.4
	Instrumental	2	0.7
Place of delivery	Hospital	232	80.3
	Health center	51	17.6
	Home	6	2.1
Obstetric complications	Pregnancy induced hypertension	84	29.1
	Chorioamnionitis	10	3.5
	Premature rupture of Membrane	61	21.1
	Antepartum Hemorrhage	16	5.5
	Gestational Diabetes Mellitus	3	1.0
	Oligo/polyhydramnios	10	3.5
Antenatal steroid exposure	Yes	99	34.3
	No	190	65.7
Type of pregnancy	Single	229	79.2
	Multiple	60	20.8
Comorbid illness*	Yes	54	18.7
	No	235	81.3

Notes: *DM, HTN, Anemia, TB, HIV, COVID 19, Thyroid disorder.

Table 2 Characteristics of Participant Neonates Admitted at NICU in Selected Hospitals of Addis Ababa, Ethiopia, 2023 (n = 289)

Variables	Categories	Frequency	Percent (%)
Sex	Male	154	53.3
	Female	135	46.7
Gestational age in completed weeks	Less than 28 weeks	7	2.4
	28–31 weeks	71	24.6
	32–36 weeks	168	58.1
	Term	43	14.9
Birth Weight in gram	2000–2499	93	32.2
	1500–1999	101	34.9
	1000–1499	86	29.8
	<1000	9	3.1
Age at admission	Within 1 hr.	140	48.4
	1–6 hr.	100	34.6
	6–24 hr.	11	3.8
	After 24 hr.	38	13.1
Weight for age	Small or large for gestational age	79	27.7
	Appropriate for gestational age	209	72.3
APGAR score at admission	1–3	10	3.5
	4–6	62	21.5
	>6	193	66.8
	Unknown	24	8.3

Table 3 Participant Neonates’ Diagnosis and Findings During the Follow-Up at NICU in Selected Hospitals of Addis Ababa, Ethiopia, 2023 (n = 289)

Variables	Categories	Frequency	Percent (%)
Hypothermia	Yes	159	55.0
	No	130	45.0
Respiratory distress	Yes	212	73.4
	No	77	26.6
Early onset sepsis	Yes	97	33.6
	No	192	66.4
Perinatal asphyxia	Yes	32	11.1
	No	257	88.9
Hyper-bilirubinemia	Yes	18	6.2
	No	271	93.8
Meningitis	Yes	2	0.7
	No	287	99.3
Patent Ductus Arteriosus	Yes	2	0.7
	No	287	99.3
Tracheoesophageal fistula	Yes	8	2.8
	No	281	97.2
Other diagnosis at admission	Yes	55	19.0
	No	234	81.0
Follow-up diagnosis	Yes	204	70.6
	No	84	29.4
Hospital acquire infection	Yes	66	22.8
	No	223	77.2
Necrotizing enterocolitis	Yes	17	5.9
	No	272	94.1
Jaundice	Yes	93	32.2
	No	196	67.8
Apnea	Yes	31	10.7
	No	258	89.3
Hypothermia	Yes	14	4.8
	No	275	95.2
Hypoglycemia	Yes	63	21.8
	No	226	78.2
Thrombocytopenia	Yes	90	31.1
	No	199	68.9
Dehydration	Yes	102	35.3
	No	187	64.7
Edematous malnutrition	Yes	27	9.3
	No	262	90.7
Kidney injury	Yes	15	5.2
	No	274	94.8
Fluid and electrolyte imbalance	Yes	34	11.8
	No	255	88.2
Anemia	Yes	34	11.8
	No	255	88.2
Other diagnosis during follow-up	Yes	26	9.0
	No	263	91.0
Neonate was on antibiotics	Yes	254	87.9
	No	35	12.1
Need respiratory support	Yes	232	80.3
	No	57	19.7
Type of respiratory support given (for neonates in need)	CPAP	146	62.9
	Intranasal oxygen	86	37.1
KMC	Yes	92	31.8
	No	197	68.2
Type of KMC	Intermittent	87	30.1
	Continuous	5	1.7
Feeding instruction	Yes	198	68.5
	No	91	31.5
Therapeutic feeding initiated	Yes	207	71.6
	No	82	28.4
Age at initiation	Within 24 hour	63	21.8
	24–48 hours	64	22.1
	48–72 hours	52	18.0
	After 72 hours	28	9.7
Therapeutic feeding type	Human milk	181	62.6
	Formula	24	8.3
	Mixed	2	0.7
Feeding interval	≤3	169	58.5
	4–5	33	11.4
	≥6	5	1.7
Pacifier was used	Yes	13	4.5
	No	267	95.5
Phototherapy given	Yes	92	31.8
	No	197	68.2
Feeding status	FEF achieved	216	74.7
	Censored	73	25.3
Milk type at FEF	Human milk	133	46.0
	Formula	21	7.3
	Mixed	62	21.5
Feeding mode at FEF	Direct	127	43.9
	Tube	41	14.2
	Cup	48	16.6
Censored	Yes	73	25.3
	No	216	74.4
Duration of MF	<7 days	180	62.3
	7–14 days	70	24.2
	15–21 days	24	8.3
	>21 days	15	5.2

Figure 1 Kaplan-Meier Survival curve for mortality among LBW neonates admitted to NICU in selected Hospitals 15.

Figure 2 Kaplan-Meier Survival curve for mortality among LBW neonates admitted to NICU based on their APGAR score on admission 16.

Figure 3 Kaplan-Meier Survival curve for mortality among LBW neonates admitted to NICU based on their birth weight 17.

Figure 4 Kaplan-Meier Survival curve for mortality among LBW neonates admitted to NICU based on oedematous malnutrition status 17.

Figure 5 Kaplan-Meier Survival curve for mortality among LBW neonates admitted to NICU based on their trophic feeding initiation status 18.

Table 4 Bi-Variable and Multivariable Cox Regression Analysis for Predictors of Neonatal Mortality Among LBW Neonates Admitted to NICU in Selected Hospitals

Variables	Categories	Neonatal Status		CHR (95% CI)	AHR (95% CI)	P-value
		Censored	Died
Age	≤24	71	16	1	1
	25–29	78	32	1.530 (0.838, 2.790)	1.194 (0.572, 2.492)	0.636
	30–34	50	13	0.934 (0.448, 1.948)	0.563 (0.209, 1.512)	0.255
	≥35	24	5	0.660 (0.238, 1.834)	0.828 (0.236, 2.900)	0.768
Residence	Urban	180	43	1	1
	Rural	43	23	1.979 (1.188, 3.296)	1.037 (0.451, 2.385)	0.931
Educational level	No formal education	54	29	0.915 (0.503, 1.663)	0.690 (0.272, 1.750)	0.435
	Primary school	60	13	0.503 (0.243, 1.037)	0.587 (0.227, 1.512)	0.270
	Secondary school	47	6	0.483 (0.191, 1.219)	0.462 (0.116, 1.840)	0.274
	College and above	62	18	1	1
ANC	Not at all	11	5	2.810 (1.010, 7.814)	1.778 (0.470, 6.727)	0.396
	<4	136	46	1.593 (0.888, 2.859)	1.958 (0.940, 4.078)	0.073
	≥4	76	15	1	1
Gestational age	<28 weeks	2	5	4.478 (1.726, 11.617)	0.352 (0.076, 1.622)	0.181
	28–32 weeks	46	25	1.256 (0.732, 2.156)	0.916 (0.445, 1.884)	0.813
	33–36 weeks	139	29	1	1
	≥37 weeks	36	7	1.626 (0.710, 3.725)	1.645 (0.973, 6.889)	0.510
Birth Weight (g)	2000–2499	78	15	1	1
	1500–1999	80	21	0.917 (0.470, 1.788)	1.468 (0.638, 3.379)	0.366
	1000–1499	65	21	0.619 (0.316, 1.212)	2.150 (0.827, 5.588)	0.116
	<1000	0	9	5.877 (2.524, 13.682)	9.539 (2.272, 40.038)	0.002*
Labour onset	Spontaneous	141	51	1	1
	Induced	82	15	0.457 (0.256, 0.814)	0.683 (0.297, 1.569)	0.370
PIH	Yes	69	15	0.644 (0.359, 1.153)	0.998 (0.465, 2.140)	0.997
	No	154	51	1	1
Type pregnancy	Single	181	47	1	1
	Multiple	42	19	1.683 (0.981, 2.885)	1.115 (0.511, 2.431)	0.784
Weight for age	SGA/ LGA	71	9	0.462 (0.228, 0.934)	0.567 (0.212, 1.518)	0.259
	AGA	152	57	1	1
Apgar score at admission	1–3	5	5	6.415 (2.443, 16.844)	5.894 (1.320, 26.315)	0.020*
	4–6	38	24	2.060 (1.203, 3.527)	1.006 (0.502, 2.015)	0.986
	≥7	163	30	1	1
	Unknown	17	7	1.558 (0.682, 3.558)	0.884 (0.304, 2.568)	0.821
Respiratory Distress	Yes	154	58	1.730 (0.824, 3.629)	1.726 (0.577, 5.160)	0.329
	No	69	8	1	1
PNA	Yes	21	11	1.844 (0.958, 3.549)	2.204 (0.946, 5.133)	0.067
	No	202	55	1	1
Jaundice	Yes	81	12	0.373 (0.199, 0.698)	0.841 (0.347, 2.034)	0.701
	No	142	54	1	1
Apnea	Yes	12	19	2.324 (1.352, 3.995)	1.493 (0.697, 3.195)	0.301
	No	211	47	1	1
DHN	Yes	60	42	2.163 (1.307, 3.578)	1.117 (0.587, 2.126)	0.734
	No	163	24	1	1
Edematous malnutrition	Yes	17	10	1.597 (0.793, 3.215)	3.389 (1.355,8.474)	0.009*
	No	206	56	1	1
Need for respiratory support	Yes	168	64	4.211 (1.019, 17.404)	4.527 (0.795, 25.775)	0.089
	No	55	2	1	1
KMC	Yes	88	4	0.162 (0.058, 0.445)	0.567 (0.184, 1.747)	0.324
	No	135	62	1	1
On Phototherapy	Yes	81	11	0.317 (0.165, 0.608)	1.000 (0.418, 2.390)	1.000
	No	142	55	1	1
Trophic feeding initiated	Yes	189	18	1	1
	No	34	48	9.489 (5.488, 16.408)	7.324 (3.453, 15.532)	0.000*

Notes: *: significantly associated at a p-value less than 0.05.

Abbreviations: ANC, antenatal care; PIH, pregnancy induced hypertension; PNA, perinatal asphyxia; SGA, small for gestational age; LGA, large for gestational age; DHN, dehydration; KMC, Kangaroo mother care.