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Lee MH, Lee JH, Chang YS. Neonatologist staffing is related to the inter-hospital variation of risk-adjusted mortality of very low birth weight infants in Korea. Sci Rep 2024; 14:20959. [PMID: 39251660 PMCID: PMC11385627 DOI: 10.1038/s41598-024-69680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 08/07/2024] [Indexed: 09/11/2024] Open
Abstract
This study investigated whether hospital factors, including patient volume, unit level, and neonatologist staffing, were associated with variations in standardized mortality ratios (SMR) adjusted for patient factors in very-low-birth-weight infants (VLBWIs). A total of 15,766 VLBWIs born in 63 hospitals between 2013 and 2020 were analyzed using data from the Korean Neonatal Network cohort. SMRs were evaluated after adjusting for patient factors. High and low SMR groups were defined as hospitals outside the 95% confidence limits on the SMR funnel plot. The mortality rate of VLBWIs was 12.7%. The average case-mix SMR was 1.1; calculated by adjusting for six significant patient factors: antenatal steroid, gestational age, birth weight, sex, 5-min Apgar score, and congenital anomalies. Hospital factors of the low SMR group (N = 10) had higher unit levels, more annual volumes of VLBWIs, more number of neonatologists, and fewer neonatal intensive care beds per neonatologist than the high SMR group (N = 13). Multi-level risk adjustment revealed that only the number of neonatologists showed a significant fixed-effect on mortality besides fixed patient risk effect and a random hospital effect. Adjusting for the number of neonatologists decreased the variance partition coefficient and random-effects variance between hospitals by 11.36%. The number of neonatologists was independently associated with center-to-center differences in VLBWI mortality in Korea after adjustment for patient risks and hospital factors.
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Affiliation(s)
- Myung Hee Lee
- Institute of Biomedical and Clinical Research, MEDITOS, Seoul, Republic of Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Ku, Seoul, 06351, Korea.
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.
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Mihretu E, Genie YD, Adugnaw E, Shibabaw AT. Survival status and predictors of mortality among preterm neonates admitted in Bench Sheko Zone, Sheka Zone and Keffa Zone Governmental Hospitals, Southwest Ethiopia (2021): prospective follow-up study. BMJ Open 2024; 14:e083897. [PMID: 38658009 PMCID: PMC11043718 DOI: 10.1136/bmjopen-2024-083897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Prematurity presents a significant challenge to the global community due to the rapid increase in its incidence and its disproportionate contribution to increased infant mortality rates. OBJECTIVE To assess the survival status and predictors of mortality among preterm neonates. DESIGN A multicentre prospective follow-up study was used. SETTING 625 preterm neonates were admitted to hospitals for secondary level of care. The study covers the Bench Maji Zone, Keffa Zone, Sheka Zone, nearby woredas and portions of the Gambella area in Southwest Ethiopia. PARTICIPANTS 614 preterm neonates with gestational age less than 37 weeks were entered for follow-up and 400 neonates were censored. Neonates with severe fetal malformations and neonates who need urgent referral were excluded from the study. RESULTS Overall, 200 (32.57%) participants died with an incidence rate of 61.69 deaths per 1000 person-day observations (95% CI: 53.71 to 70.86). Poor kangaroo mother care (KMC) services (adjusted HR (AHR)=0.19, 95% CI: 0.12 to 0.29), sex (AHR=0.66, 95%, CI: 0.47 to 0.94), not initiating breast feeding (HR=2.78, 95% CI: 1.8 to 4.28), hypothermia (AHR=0.63, 95% CI: 0.44 to 0.92), anaemia (AHR=6.2, 95% CI: 2.34 to 16.43) and gestational age less than 28 weeks (AHR=9.28, 95% CI: 1.78 to 48.42) were independent predictors. CONCLUSION AND RECOMMENDATION The rate of preterm neonatal mortality was high compared with the Ethiopia Demographic and Health Survey report nationally. Healthcare workers should encourage KMC services and breastfeeding initiation and prevent preterm neonates from being anaemic to increase their chances of survival.
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Affiliation(s)
- Esmelealem Mihretu
- Pediatrics and Child Health Nursing, Debre Markos University, Debre Markos, Ethiopia
| | | | - Emebet Adugnaw
- Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia
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Wondie WT, Zeleke KA, Wubneh CA. Incidence and predictors of mortality among low birth weight neonates in the first week of life admitted to the neonatal intensive care unit in Northwestern Ethiopia comprehensive specialized hospitals, 2022. Multi-center institution-based retrospective follow-up study. BMC Pediatr 2023; 23:489. [PMID: 37759160 PMCID: PMC10523684 DOI: 10.1186/s12887-023-04319-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Globally, a high number of neonatal mortalities occurs in the first week of life, particularly among low birth weight neonates in low-income countries, including Ethiopia. However, there is limited evidence on the early neonatal mortality of low-birth-weight neonates in Ethiopia. Therefore, this study aimed to assess incidence and predictors of mortality among low-birth-weight neonates in their first week of life admitted to the neonatal intensive care unit in Northwestern Ethiopia Comprehensive Specialized Hospitals, 2022. METHODS A multi-center retrospective follow-up study was conducted from March 21, 2020 to March 1, 2022, among 761 early neonates with low birth weight admitted in Northwestern Ethiopia Comprehensive Specialized Hospitals. The study participants were selected using simple random sampling technique. Data were collected using a data abstraction checklist ,and checked for completeness and entered into EPI data version 4.6, then exported to STATA 14 for analysis. Kaplan Meier failure curve and log-rank test were used to estimate and compare the probability of death. Both bivariable and multivariable Weibull regression models were fitted to identify predictors of mortality. Finally, a hazard ratio with 95% CI was computed, and variables having a p-value < 0.05 were considered as a significant predictor of mortality. RESULTS The incidence of mortality among low birth weight neonates in their first week of life was 75.63 per 1000 neonate day observation (95% CI: 66.76-85.67), preeclampsia (AHR = 1.77;95% CI:1.32-2.36s), perinatal asphyxia (AHR = 1.64; 95% CI:1.14-2.36), respiratory distress syndrome (AHR = 1.76 95% CI;1.31-2.34), necrotizing enterocolitis (AHR = 2.78 95% CI;1.79-4.32), prematurity (AHR = 1.86; 95% CI:1.30-2.67), and birth weight < 1000gram (AHR = 3.13;95% CI: 1.91-5.12) and 1000-1499 gram (AHR = 1.99; 95% CI:1.47-2.68) were predictors. CONCLUSION The incidence of early neonatal mortality in low birth weight neonates was incredibly higher than the overall early neonatal mortality in Northwest Ethiopia (Amhara region). Preeclampsia, perinatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis, prematurity, and birth weight were predictors of mortality. Therefore, stakeholders shall give early identification and emphasis on preventable and treatable predictors. Furthermore, the health care provider shall give education about the importance of breastfeeding, and Antenatal and postnatal care.
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Affiliation(s)
- Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Medicine, and Health Science, Ambo University, Ambo, Ethiopia.
| | - Kassaye Ahmed Zeleke
- Department of Neonatal Health Nursing, School of Nursing, College of Medicine, and Health Science, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine, and Health Science, University of Gondar, Gondar, Ethiopia
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Afagbedzi SK, Alhassan Y, Alangea DO, Taylor H. Maternal factors and child health conditions at birth associated with preterm deaths in a tertiary health facility in Ghana: A retrospective analysis. Front Public Health 2023; 11:1108744. [PMID: 36844818 PMCID: PMC9947409 DOI: 10.3389/fpubh.2023.1108744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Background Preterm birth continues to be a leading cause of death for children under the age of 5 globally. This issue carries significant economic, psychological, and social costs for the families affected. Therefore, it is important to utilize available data to further research and understand the risk factors for preterm death. Objective The objective of this study was to determine maternal and infant complications that influence preterm deaths in a tertiary health facility in Ghana. Methods A retrospective analysis of data on preterm newborns was conducted at the neonatal intensive care unit of Korle Bu Teaching Hospital (KBTH NICU) in Ghana, covering the period January 2017 to May 2019. Pearson's Chi-square test of association was used to identify factors that were significantly associated with preterm death after admission at the NICU. The Poisson regression model was used to determine the risk factors of preterm death before discharge after admission to the NICU. Results Of the 1,203 preterm newborns admitted to the NICU in about two and half years, 355 (29.5%) died before discharge, 7.0% (n = 84) had normal birth weight (>2.5 kg), 3.3% (n = 40) had congenital anomalies and 30.5% (n = 367) were born between 34 and 37 gestational week. All 29 preterm newborns between the 18-25 gestational week died. None of the maternal conditions were significant risk factors of preterm death in the multivariable analysis. The risk of death at discharge was higher among preterm newborns with complications including hemorrhagic/hematological disorders of fetus (aRRR: 4.20, 95% CI: [1.70-10.35], p = 0.002), fetus/newborn infections (aRRR: 3.04, 95% CI: [1.02-9.04], p = 0.046), respiratory disorders (aRRR: 13.08, 95% CI: [5.50-31.10], p < 0.001), fetal growth disorders/restrictons (aRRR: 8.62, 95% CI: [3.64-20.43], p < 0.001) and other complications (aRRR: 14.57, 95% CI: [5.93-35.77], p < 0.001). Conclusion This study demonstrate that maternal factors are not significant risk factors of preterm deaths. Gestational age, birth weight, presence of complications and congenital anomalies at birth are significantly associated with preterm deaths. Interventions should focus more on child health conditions at birth to reduce the death of preterm newborns.
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Affiliation(s)
- Seth Kwaku Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Yakubu Alhassan
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Deda Ogum Alangea
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Rodrigues KMD, Zoldan C, Silva CBDO, Santana EFM, Araujo Júnior E, Peixoto AB. Relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:256-260. [PMID: 35239892 DOI: 10.1590/1806-9282.20211239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes in an average city in the state of Minas Gerais, Brazil. METHODS This was a prospective and observational study. The variables analyzed were obtained through a questionnaire administered to postpartum women (between 1 and 48 h postpartum) and information contained in prenatal cards. The pregnant women were classified into three groups: Group I, <3 prenatal care visits; Group II, 3-5 prenatal care visits; and Group III, ≥6 prenatal care visits. RESULTS Group I had a lower median weight (57.0 vs. 64.0 kg, p<0.001), body mass index (22.1 vs. 24.3 kg/m2, p<0.001), and weight gain (9.0 vs. 12 kg, p=0.002) than Group III. The prevalence of admission to the neonatal intensive care unit (11.6 vs. 4.2%, p=0.02) and the newborn mortality rate within the first 72 h of life (2.3 vs. 0%, p<0.001) were higher in Group I than in Group III. Group II had a higher prevalence of admission to the adult intensive care unit (5.7 vs. 0.6%, p<0.001) and a higher newborn mortality rate within the first 72 h of life (1.6% vs. 0%, p<0.001) than Group III. CONCLUSIONS Having ≥6 prenatal care visits was associated with lower rates of admission to the neonatal and adult intensive care unit, as well as a lower newborn mortality rate within the first 72 h of life.
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Affiliation(s)
| | - Camila Zoldan
- Universidade de Uberaba, Mario Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | | | | | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics - São Paulo (SP), Brazil
| | - Alberto Borges Peixoto
- Universidade de Uberaba, Mario Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil.,Universidade Federal de Triângulo Mineiro, Department of Obstetrics and Gynecology - Uberaba (MG), Brazil
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Machine Learning Models for Predicting Mortality in 7472 Very Low Birth Weight Infants Using Data from a Nationwide Neonatal Network. Diagnostics (Basel) 2022; 12:diagnostics12030625. [PMID: 35328178 PMCID: PMC8947011 DOI: 10.3390/diagnostics12030625] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Statistical and analytical methods using artificial intelligence approaches such as machine learning (ML) are increasingly being applied to the field of pediatrics, particularly to neonatology. This study compared the representative ML analysis and the logistic regression (LR), which is a traditional statistical analysis method, using them to predict mortality of very low birth weight infants (VLBWI). We included 7472 VLBWI data from a nationwide Korean neonatal network. Eleven predictor variables (neonatal factors: male sex, gestational age, 5 min Apgar scores, body temperature, and resuscitation at birth; maternal factors: diabetes mellitus, hypertension, chorioamnionitis, premature rupture of membranes, antenatal steroid, and cesarean delivery) were selected based on clinical impact and statistical analysis. We compared the predicted mortality between ML methods—such as artificial neural network (ANN), random forest (RF), and support vector machine (SVM)—and LR with a randomly selected training set (80%) and a test set (20%). The model performances of area under the receiver operating curve (95% confidence interval) equaled LR 0.841 (0.811−0.872), ANN 0.845 (0.815−0.875), and RF 0.826 (0.795−0.858). The exception was SVM 0.631 (0.578−0.683). No statistically significant differences were observed between the performance of LR, ANN, and RF (i.e., p > 0.05). However, the SVM model was lower (p < 0.01). We suggest that VLBWI mortality prediction using ML methods would yield the same prediction rate as the traditional statistical LR method and may be suitable for predicting mortality. However, low prediction rates are observed in certain ML methods; hence, further research is needed on these limitations and selecting an appropriate method.
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Girma B, Berhe H, Mekonnen F, Nigussie J. Survival and predictors of mortality among preterm neonates in Northern Ethiopia: A retrospective follow-up study. Front Pediatr 2022; 10:1083749. [PMID: 36714659 PMCID: PMC9880159 DOI: 10.3389/fped.2022.1083749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In the year 2015, more than one-third of neonatal deaths caused by prematurity was recorded worldwide. Despite different kinds of efforts taken at the global and local levels to reduce neonatal mortality, it remains high with low reduction rates, especially in low- and middle-income countries like sub-Saharan Africa and South Asia. Therefore, this study aims to assess the survival status and predictors of mortality among preterm neonates. METHODS A retrospective follow-up study was conducted on randomly selected 561 preterm neonates. Data were extracted from patient records using a pretested checklist. Data entry and analysis were done using Epi-Data Version 4.4.2.1 and Stata version 14, respectively. The Cox proportional hazard regression model was fitted to identify the predictors of mortality. A hazard ratio with a 95% confidence interval (CI) was estimated and p-values < 0.05 were considered statistically significant. RESULT The proportion of preterm neonatal deaths was 32.1% (180) with an incidence of 36.6 (95% CI: 31.6-42.4) per 1,000 person days. The mean survival time was 18.7 (95% CI: 17.7-19.9) days. Significant predictors for time to death of preterm neonates were respiratory distress syndrome [adjusted hazard ratio (AHR): 2.04; 95% CI: 1.48-2.82], perinatal asphyxia (AHR: 2.13; 95% CI: 1.32-3.47), kangaroo mother care (AHR: 0.14; 95% CI: 0.08-0.24), and gestational age (AHR: 0.85; 95% CI: 0.80-0.90). CONCLUSION Preterm neonatal death is still a major public health concern. Respiratory distress syndrome, perinatal asphyxia, kangaroo mother care, and gestational age were independent significant predictors for time to death, as found in this study. Hence, priority must be given to neonates with the above illnesses and strengthen the management and care of preterm neonates.
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Affiliation(s)
- Bekahegn Girma
- Department of Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Hailemariam Berhe
- School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Furtuna Mekonnen
- School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Jemberu Nigussie
- Department of Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Girma B, Nigussie J. Magnitude of preterm hospital neonatal mortality and associated factors in northern Ethiopia: a cross-sectional study. BMJ Open 2021; 11:e051161. [PMID: 34862286 PMCID: PMC8647539 DOI: 10.1136/bmjopen-2021-051161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study aimed to assess the magnitude of preterm neonatal mortality in hospitals and associated factors in northern Ethiopia. DESIGN Institutional-based cross-sectional study. SETTING Comprehensive specialised hospitals in the Tigray region, northern Ethiopia. PARTICIPANTS Preterm neonates admitted in Ayder and Aksum comprehensive specialised hospitals PRIMARY OUTCOME: Magnitude of preterm neonatal mortality. SECONDARY OUTCOME Factors associated with preterm neonatal mortality RESULT: This study was conducted from 1 April 2019 to 15 May 2019 among 336 participants with a response rate of 96.8%. The magnitude of preterm neonatal mortality was 28.6% (95% CI: 24.0 to 33.7). In multivariable logistic regression, respiratory distress syndrome (adjusted odd ratio (AOR)=2.85; 95% CI: 1.35 to 6.00), apnoea of prematurity (AOR=5.45; 95% CI: 1.32 to 22.5), nulli parity (AOR=3.63; 95% CI: 1.59 to 8.24) and grand parity (AOR=3.21; 95% CI: 1.04 to 9.94) were significant factors associated with preterm neonatal mortality. However, receiving Kangaroo mother care (AOR=0.08; 95% CI: 0.03 to 0.20) and feeding initiated during hospitalisation (AOR=0.07; 95% CI: 0.03 to 0.15) were protective against preterm neonatal mortality. CONCLUSIONS The magnitude of preterm neonatal mortality in hospitals was still high. Interventions geared towards curbing preterm in-hospital neonatal mortality should strengthen early diagnosis and treatment of preterm newborns with respiratory distress syndrome and apnoea of prematurity; while concomitantly reinforcing the implementation of kangaroo care and early feeding initiation is important.
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Affiliation(s)
- Bekahegn Girma
- Department of Nursing, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Jemberu Nigussie
- Department of Nursing, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Bereka B, Demeke T, Fenta B, Dagnaw Y. Survival Status and Predictors of Mortality Among Preterm Neonates Admitted to Mizan Tepi University Teaching Hospital, South West Ethiopia. Pediatric Health Med Ther 2021; 12:439-449. [PMID: 34512074 PMCID: PMC8420788 DOI: 10.2147/phmt.s319774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The main objective of this study was to assess survival status and predictors of mortality among preterm neonates admitted to Mizan Tepi University Teaching Hospital. MATERIALS AND METHODS A retrospective cohort study was conducted on 568 randomly selected neonates. All preterm neonates admitted in NICU from May 9, 2016 to December 30, 2019 were the source population. Data were extracted from medical chart and entered to EpiData version 4.4.2.1 and analyzed by STATA version 14. Descriptive statistics, bivariate and multivariable analyses were done in a Cox regression model. Variables with P-value of <0.05 were considered statistically significant in predicting the preterm mortality. RESULTS Out of 568 preterm neonates, 199 (35%) died with an incidence rate of 62.15 (54.09-71.41) deaths per 1000 person-day-observations with median survival time of 15 days. Vaginal mode of delivery (adjusted hazard ratio, AHR: 1.78, 95%CI: 1.05-3.08), non-cephalic presentation (AHR:1.8, 95%CI: 1.04-3.06), born from mothers with no ANC follow-up (AHR: 1.9, 95%CI: 1.29-3.01), fifth minute APGAR score <7 (AHR: 1.87, 95%CI: 1.31-2.68), RDS (AHR: 1.74, 95%CI: 1.28-2.36), did not receive KMC (AHR: 1.45, (95%CI: 1.06-1.98), did not cry immediately after birth (AHR: 2.81, 95%CI: 2.03-3.93)), VLBW (AHR: 2.67, 95%CI: 1.29-5.53), low birth weight (AHR: 2.24, 95%CI: 1.15-4.39), and hypothermia (AHR: 1.36, 95%CI: 1-1.84) were significantly associated with preterm mortality. CONCLUSION Preterm neonatal mortality was high and the predictors were almost all preventable and treatable. Therefore, emphasis should be given toward prevention and early anticipation, and management of these predictors.
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Affiliation(s)
- Bayisa Bereka
- School of Nursing, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Tigist Demeke
- School of Nursing, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Belete Fenta
- School of Midwifery, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Yalemtsehay Dagnaw
- Department of Nursing, Mizan Tepi University, Mizan Tepi, South Nations, Nationalities and People Region, Ethiopia
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Merscher Alves MB, Conté N, Diallo B, Mamadou M, Delamou A, John O, von Felten S, Diallo IS, Roth-Kleiner M. "Assessing Today for a Better Tomorrow": An observational cohort study about quality of care, mortality and morbidity among newborn infants admitted to neonatal intensive care in Guinea. PLoS One 2021; 16:e0254938. [PMID: 34460846 PMCID: PMC8405010 DOI: 10.1371/journal.pone.0254938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed. Objective To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality. Methods Prospective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models. Results Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42–11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10–3.65, p = 0.023). Conclusion Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.
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Affiliation(s)
- Maria Bea Merscher Alves
- Pediatric and Neonatal Intensive Care Unit, Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - N’Fanly Conté
- Clinic of Neonatology, Institute of Nutrition and Child Health, Conakry, Guinea
| | - Boubacar Diallo
- Clinic of Neonatology, Institute of Nutrition and Child Health, Conakry, Guinea
| | - Moustapha Mamadou
- Clinic of Neonatology, Institute of Nutrition and Child Health, Conakry, Guinea
| | - Albert Delamou
- Clinic of Neonatology, Institute of Nutrition and Child Health, Conakry, Guinea
| | - Oliver John
- Master Program in Biostatistics, University of Zurich, Zurich, Switzerland
| | - Stefanie von Felten
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Matthias Roth-Kleiner
- Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Sheikhtaheri A, Zarkesh MR, Moradi R, Kermani F. Prediction of neonatal deaths in NICUs: development and validation of machine learning models. BMC Med Inform Decis Mak 2021; 21:131. [PMID: 33874944 PMCID: PMC8056638 DOI: 10.1186/s12911-021-01497-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prediction of neonatal deaths in NICUs is important for benchmarking and evaluating healthcare services in NICUs. Application of machine learning techniques can improve physicians' ability to predict the neonatal deaths. The aim of this study was to present a neonatal death risk prediction model using machine learning techniques. METHODS This study was conducted in Tehran, Iran in two phases. Initially, important risk factors in neonatal death were identified and then several machine learning models including Artificial Neural Network (ANN), decision tree (Random Forest (RF), C5.0 and CHART tree), Support Vector Machine (SVM), Bayesian Network and Ensemble models were developed. Finally, we prospectively applied these models to predict neonatal death in a NICU and followed up the neonates to compare the outcomes of these neonates with real outcomes. RESULTS 17 factors were considered important in neonatal mortality prediction. The highest Area Under the Curve (AUC) was achieved for the SVM and Ensemble models with 0.98. The best precision and specificity were 0.98 and 0.94, respectively for the RF model. The highest accuracy, sensitivity and F-score were achieved for the SVM model with 0.94, 0.95 and 0.96, respectively. The best performance of models in prospective evaluation was for the ANN, C5.0 and CHAID tree models. CONCLUSION Using the developed machine learning models can help physicians predict the neonatal deaths in NICUs.
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Affiliation(s)
- Abbas Sheikhtaheri
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zarkesh
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neonatology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Raheleh Moradi
- Family Health Institute, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Kermani
- Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran.
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Fontenele MMFT, Silva CF, Leite ÁJM, Castro ECM, Carvalho FHC, Silva AVSE. SNAPPE II: ANALYSIS OF ACCURACY AND DETERMINATION OF THE CUTOFF POINT AS A DEATH PREDICTOR IN A BRAZILIAN NEONATAL INTENSIVE CARE UNIT. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2020; 38:e2019029. [PMID: 33331559 PMCID: PMC7747781 DOI: 10.1590/1984-0462/2020/38/2019029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the accuracy of the Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II) as a death predictor, to determine the cutoff point for mortality, and to analyze the association of independent variables with death. METHODS Prospective, longitudinal, hospital-based study on newborns admitted to the Neonatal Intensive Care Unit (NICU) for the first time from November 1, 2016 to April 30, 2017. Newborns with less than 12 hours of length of stay at the NICU, out-of-hospital births, major congenital malformations, and inter-hospital transfer were excluded. Variables were grouped according to hierarchical framework, related to maternal characteristics (distal level), prenatal and childbirth care (intermediate level), and birth conditions (proximal level). Descriptive analyses of SNAPPE II score ranges, Receiver Operating Characteristics Curve (ROC curve) to define the cutoff point for mortality, and bivariate analysis by the Wald test and multiple logistic regression were conducted. RESULTS After selection, the sample consisted of 247 newborns. In this study, the SNAPPE II cutoff point for mortality was 27, with sensitivity of 84.1% and specificity of 82.4%. 61% of those with a score ≥27 died. Multiple logistic regression showed an association between death and proximal-level variables: sepsis (Odds Ratio [OR] 10.68; 95% confidence interval [95%CI] 2.82-40.48; p<0.001); SNAPPE II ≥27 (OR 5.85; 95%CI 1.90-18.05; p=0.002); birth weight 750-999 g (OR 4.15; 95%CI 1.06-16.14; p=0.040); and nonuse of surfactant (OR 0.159; 95%CI 0.04-0.53; p=0.003). CONCLUSIONS Neonatal mortality was directly proportional to increase in SNAPPE II. Score≥27 increased the odds of dying by six times compared with neonates with lower scores. The proximal variables related to health conditions and neonatal care were associated with death.
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Dessu S, Habte A, Mesele M. The Kaplan Meier estimates of mortality and its predictors among newborns admitted with low birth weight at public hospitals in Ethiopia. PLoS One 2020; 15:e0238629. [PMID: 32915835 PMCID: PMC7485805 DOI: 10.1371/journal.pone.0238629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/20/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Globally, every year greater than twenty million newborns are born weighing less than 2500grams, of which over 96% of them were in developing countries. It contributes to sixty to eighty percent of all neonatal deaths, annually. These infants weighing less than 2500gram will have a poor immune system and are at risk of morbidity and mortality. This study was aimed to investigate the survival status and predictors of mortality among neonates admitted with low birth weight at public hospitals in Ethiopia. METHOD A prospective cohort study was conducted among selected 216 newborns admitted with low birth weight who were admitted in neonatal intensive care unit at Arba Minch General hospital, Sawla General Hospital and Chencha district hospital from 1st March 2018 to 28st February 2019. Data were entered into Epi data version 3.02 and exported to STATA V 14 for analysis. The Kaplan Meier survival curve together with log rank test was used to estimate the survival time of the newborns. Variables which had p-value <0.05 in multivariable analysis using the cox proportional hazard model were declared as statistically significant. RESULT The cumulative proportion of surviving at the end of third days was 99.01% (95%CI: 96.11, 99.75). Similarly it was 97.81% (95%CI: 94.25, 99.18), 96.27% (95%CI: 91.76, 98.33) and 94.33% (95%CI: 88.72, 97.19) at the end of fourth, fifth and sixth day respectively. The overall mean survival time was 17.13 days (95%CI: 12.76, 21.49). The incidence of mortality among neonates admitted with low birth weight was 83 per 1000 live births. Mothers with DM (AHR:4.79; 95%CI:1.15, 19.8), maternal HIV infection(AHR:6.47;95%CI:1.43,29.3), not keeping the newborn under KMC(AHR:13.0;95%CI:3.42, 49.5) and initiating exclusive breast feeding within one hour(AHR:0.19;95%CI:0.04, 0.95) were statistically significant in multivariable cox regression analysis. CONCLUSION The risk of mortality among neonates admitted with low birth weight was high at the early admission period and the incidence of mortality was high. Maternal history of diabetes mellitus, HIV/AIDS infection, keeping the newborn under kangaroo mother care and exclusive breast feeding initiation were statistically significant predictors of mortality. Special emphasis should be given for neonates with low birth weight at the early follow up periods and Kangaroo mother care practice should be a usual practice.
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Affiliation(s)
- Samuel Dessu
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Aklilu Habte
- Department of Public Health, College of Medicine and Health Sciences, Wachamo University, Hossana, Ethiopia
| | - Molalegn Mesele
- Department of Midwifery, College of Medicine and Health Sciences, Wolaita Soddo University, Wolaita Soddo, Ethiopia
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Gebremeskel AT, Fantaye AW, Faust LE, Yaya S. Systematic review protocol examining sex differences in survival among low birthweight newborns and infants in sub-Saharan Africa. BMJ Open 2020; 10:e036645. [PMID: 32595162 PMCID: PMC7322278 DOI: 10.1136/bmjopen-2019-036645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In sub-Saharan African countries, low birthweight (LBW) accounts for three-quarters of under-five mortality and morbidity. However, there is no systematic evidence of sex differences in LBW survival risk. The aim of this protocol is to outline the methodological process of a systematic review that will gather qualitative and quantitative data on sex differences in survival among LBW newborns and infants in sub-Saharan Africa. METHODS This protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols reporting guidelines. We will conduct a systematic review to retrieve all qualitative and quantitative studies. Electronic search strategies are being finalised on 24 February 2020 for Ovid Medline and EMBASE, and on 28 February 2020 for CINAHL, Scopus and Global Health in collaboration with a Health Sciences librarian. The primary outcome of interest is indicating sex differences in survival among LBW newborns and infants. Secondary outcomes are sex-disaggregated differences in morbidity among LBW newborns and infants. Screening, data extraction and assessments of risk of bias will be performed independently. Narrative synthesis and a meta-analysis will be conducted with studies that are compatible based on population and outcome. The systematic review is focused on the analysis of secondary data and does not require ethics approval. ETHICS AND DISSEMINATION As it will be a systematic review, without human participants' involvement, there will be no requirement for ethical approval. The systematic review will present key evidence of sex-disaggregated differences in mortality and morbidity among LBW newborns and infants in sub-Saharan Africa. Programme managers, policy-makers and researchers can use the findings to evaluate LBW health outcomes in different sexes. The final manuscript will be disseminated through a peer-reviewed journal and scientific conferences. PROSPERO REGISTRATION NUMBER CRD42020163470.
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Affiliation(s)
- Akalewold T Gebremeskel
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Arone W Fantaye
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lena E Faust
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, University of Oxford, Oxford, UK
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Inadequate Prenatal Visit and Home Delivery as Determinants of Perinatal Outcomes: Does Parity Matter? J Pregnancy 2019; 2019:9024258. [PMID: 31093374 PMCID: PMC6481024 DOI: 10.1155/2019/9024258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/31/2019] [Indexed: 02/08/2023] Open
Abstract
Background Adverse perinatal outcomes are still high in developing countries. Contradicting evidences were reported about the effect of parity on adverse perinatal outcomes. The aim of this study was to compare perinatal outcomes in grand multiparous and low multiparity women in Hawassa University Comprehensive Specialized Hospital and Adare General Hospital of Ethiopia. Methods Comparative cross-sectional study design was employed to include 461 mothers from February to June 2018. Data were collected by structured questionnaire using interview and from patient charts. Data were entered using EPI-DATA version 4.4.2.0. Descriptive statistics and logistic regression analyses were computed using STATA version 14 computer software. Results Of all study participants, 24.9% (95% Confidence interval: 21.1%-29.1%) had at least one adverse perinatal outcome. Stillbirth (38.9), low Apgar score (51.9%), and congenital malformation (3.70%) were frequently occurred complications in grand multiparas compared to low multiparous women. Nevertheless, meconium aspiration, need for resuscitation, and macrosomia were higher in low multiparous women (9.84%, 14.75%, and 57.38%, respectively). Less than four prenatal visits (AOR: 1.74; 95% CI: 1.04, 2.92) and previous home delivery (AOR: 1.87; 95% CI: 1.04, 3.33) were independent predictors of adverse perinatal outcomes. However, parity did not show statistically significant difference in perinatal outcomes. Conclusion This finding underscores the fact that frequency of antenatal care and place of delivery are significant predictors of perinatal outcomes. However, parity did not show statistically significant difference in perinatal outcomes. Women empowerment, promoting health facility delivery, and early, comprehensive antenatal care are needed.
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Garcia LP, Fernandes CM, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. J Pediatr (Rio J) 2019; 95:194-200. [PMID: 29444451 DOI: 10.1016/j.jped.2017.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/15/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate. METHOD Data were extracted from a historical cohort with 15,879 live births. A model was used that included socioeconomic, behavioral, and health service use risk factors, as well as the Apgar score and biological factors. Risk factors were analyzed by hierarchical logistic regression. RESULTS Based on the multivariate analysis, socioeconomic factors showed no association with death. Insufficient prenatal consultations showed an OR of 3.25 (95% CI: 1.70-6.48) for death. Low birth weight (OR 8.42; 95% CI: 3.45-21.93); prematurity (OR 5.40; 95% CI: 2.22-13.88); malformations (OR 4.42; 95% CI: 1.37-12.43); and low Apgar score at the first (OR 6.65; 95% CI: 3.36-12.94) and at the fifth (OR 19.78; 95% CI: 9.12-44.50) minutes, were associated with death. CONCLUSION Differing from other studies, socioeconomic conditions were not associated with neonatal death. Insufficient prenatal consultations, low Apgar score, prematurity, low birth weight, and malformations showed an association, reinforcing the importance of prenatal access universalization and its integration with medium and high-complexity neonatal care services.
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Affiliation(s)
- Leandro Pereira Garcia
- Universidade do Sul de Santa Catarina (UNISUL), Departamento de Ciências da Saúde, Palhoça, SC, Brazil.
| | - Camila Mariano Fernandes
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil
| | - Jefferson Traebert
- Universidade do Sul de Santa Catarina (UNISUL), Departamento de Ciências da Saúde, Palhoça, SC, Brazil
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Garcia LP, Fernandes CM, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mortality in the first 24h of very low birth weight preterm infants in the Northeast of Brazil. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 26726002 PMCID: PMC4795729 DOI: 10.1016/j.rppede.2015.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Castro ECMD, Leite ÁJM, Guinsburg R. [Mortality in the first 24h of very low birth weight preterm infants in the Northeast of Brazil]. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2016; 34:106-13. [PMID: 26726002 PMCID: PMC4795729 DOI: 10.1016/j.rpped.2015.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/17/2015] [Accepted: 05/21/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate factors associated with neonatal death within 24 hours after birth in very low birth weight preterm newborns. METHODS Prospective cohort of live births with gestational age of 23(0/7)-31(6/7) weeks, birth weight of 500-1499g without malformations, in 19 public maternity hospitals in nine capitals in northeastern Brazil from July to December 2007. The 19 hospitals were assessed in relation to physical resources, equipment, human resources and aiming at quality in care initiatives. Hospital, maternal and neonatal characteristics, neonatal morbidity, neonatal procedures and interventions were compared between preterm newborns that died or survived up to 24 hours of life. The variables associated with death within 24 hours after birth were determined by logistic regression. RESULTS Of the 627 newborns enrolled in the study, 179 (29%) died within 168 hours after birth, of which 59 (33%) up to 24 hours and 97 (54%) up to 48 hours after birth. The variables associated with death <24h were: weight <1000g (2.94; 1.32-6.53), 5(th) minute Apgar <7 (7.17; 3.46-14.88), male gender (2.99; 1.39-6.47). A better hospital structure was a protective factor for early neonatal death (odds ratio: 0.34; 95% confidence interval: 0.17-0.71). CONCLUSIONS The high neonatal mortality on the first day of life in capital cities of Northeast Brazil is associated with biological variables such as weight and gender of the newborn, as well as low vitality at birth and a worse infrastructure of the hospital where the birth occurred.
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Affiliation(s)
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
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