Time to death and predictors of mortality among asphyxiated neonates in southwest Ethiopia, 2022: prospective cohort study

Belete Fenta Kebede; Tsegaw Biyazin Tesfa; Aynalem Yetwale Hiwot; Kassa Kindie Mulu; Emebet Adugnaw; Esmelalem Mihretu; Enatfenta Sewmehone; Yalemtsehay Dagnaw Genie

doi:10.1136/bmjopen-2023-077943

Time to death and predictors of mortality among asphyxiated neonates in southwest Ethiopia, 2022: prospective cohort study

BMJ Open. 2024 Jan 18;14(1):e077943. doi: 10.1136/bmjopen-2023-077943.

Authors

Belete Fenta Kebede¹, Tsegaw Biyazin Tesfa², Aynalem Yetwale Hiwot², Kassa Kindie Mulu³, Emebet Adugnaw⁴, Esmelalem Mihretu⁵, Enatfenta Sewmehone⁶, Yalemtsehay Dagnaw Genie³

Affiliations

¹ School of Midwifery, Jimma University, Jimma, Ethiopia belete121wy@gmail.com.
² School of Midwifery, Jimma University, Jimma, Ethiopia.
³ Nursing, Mizan-Tepi University, Mizan Teferi, Ethiopia.
⁴ Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia.
⁵ Pediatrics and Child Health, Debre Markos University, Debre Markos, Ethiopia.
⁶ Nursing, Jimma University, Jimma, Ethiopia.

Abstract

Objective: This study aimed to determine the time to death and predictors of mortality among asphyxiated neonates admitted to public hospitals in the southwest region of Ethiopia.

Design: An institution-based prospective cohort study was conducted.

Setting: Public hospitals in southwest Ethiopia.

Participants: A total of 144 asphyxiated neonates, who were admitted to the neonatal intensive care unit, and their mothers participated from March 2022 to 30 September 2022. Data were entered into EpiData V.4.4.2.1 and exported to STATA V.16 for analysis. The Cox proportional hazards model using bivariate (p<0.25) and multivariate (p<0.05) analyses was used to identify the predictors of mortality. The median survival time was estimated using Kaplan-Meier survival estimates.

Primary outcome: Time to death from asphyxia and its predictors in neonates.

Results: The mortality incidence rate of asphyxiated neonates was 9.1 deaths per 1000 person-days of observation (95% CI: 7.11 to 11.52) with a median survival time of 8 days, and 45.83% (95% CI: 37.81% to 54.08%) of asphyxiated neonates died. Being male (adjusted HR (AHR) 0.32 (95% CI: 0.14 to 0.76)), neonatal sepsis (AHR 0.321 (95% CI: 0.13 to 0.77)), not receiving kangaroo mother care (AHR 0.16 (95% CI: 0. 07 to 0.39)) and vaginal delivery (AHR 0.39 (95% CI: 0.16 to 0.95)) were independent predictors of mortality of asphyxiated neonates.

Conclusions: In this study, asphyxiated neonates had a higher incidence of mortality with a median survival time of only 8 days. Being male, vaginal delivery, not receiving kangaroo mother care and comorbidities such as neonatal sepsis were independent predictors of mortality among asphyxiated neonates. Therefore, healthcare providers and other stakeholders should provide timely initiation of advanced diagnosis and appropriate therapeutic interventions for neonates with asphyxia to reduce neonatal mortality.

Keywords: INTENSIVE & CRITICAL CARE; NEONATOLOGY; Paediatric intensive & critical care.

MeSH terms

Asphyxia
Child
Ethiopia / epidemiology
Female
Humans
Infant Mortality
Infant, Newborn
Infant, Newborn, Diseases*
Kangaroo-Mother Care Method*
Male
Neonatal Sepsis*
Prospective Studies
Retrospective Studies