Neonatal deaths in rural Karnataka, India 2014-2018: a prospective population-based observational study in a low-resource setting

Maternal age and adverse pregnancy outcomes among Meitei women of Manipur, Northeast India: A cross-sectional study

OBJECTIVE

The study examines the outcomes of pregnancies conceived at advanced maternal age (AMA) and maternal complications after childbirth among Meitei women of Northeast India.

METHOD

A total of 760 women participants were included in this study and compared among women aged ≥35 years, with a reference group of women aged 20-34 years. Data on obstetric characteristics were collected after obtaining consent. The data were compared using chi-square analysis, and the results were adjusted using a logistic regression model. Decision trees were developed to predict the potential variables associated with preterm delivery and postpartum complication.

RESULTS

In the study, 18.95% of AMA women experienced one or more adverse pregnancy outcomes (APOs). Women with AMA are at significantly increased risk of placenta previa (adjusted odds ratio [AOR] = 4.89, 95% confidence interval [CI]: 2.78-8.57), induction of labor (AOR = 3.69, 95%CI: 2.48-5.50), and caesarean section (AOR = 3.42, 95%CI: 2.28-5.12). Moreover, AMA women have a 1.86-2.76 AOR for developing gestational diabetes, pregnancy-induced hypertension, urinary tract infections, preterm delivery, and postpartum complications. Decision tree analysis revealed that AMA and urban residence independently predict preterm delivery and postpartum complications.

CONCLUSION

The study's findings confirm the adverse impact of AMA on pregnancy outcomes and postpartum complications. Such issues should be addressed, and counseling on the risk of AMA should be provided, particularly for those in the high-risk group. Further prospective studies are needed to understand other potential risk factors of APOs and the impact of AMA complications to prevent the associated burden.

Ten- vs. 14-day antibiotic therapy for culture-positive neonatal sepsis

BACKGROUND

Neonatal sepsis is a major determinant of neonatal mortality. There is a scarcity of evidence-based guidelines for the duration of antibiotics in culture-positive sepsis.

OBJECTIVES

The aim of this study was to compare the efficacy of 10- and 14-day antibiotic therapies in the management of culture-positive neonatal sepsis.

METHODS

This randomized controlled trial was conducted in the neonatal intensive care unit of a tertiary care center among the neonates suffering from culture-positive sepsis (with signs of clinical remission on day 9 of antibiotic) between January 2023 and May 2023. Newborns with major congenital anomaly, deep-seated infections, multi-organ dysfunction, associated fungal infections/infection by multiple organisms and severe birth asphyxia were excluded. Two hundred and thirty-four newborns were randomized into two groups-study (received 10 days of antibiotics) and control (received 14 days of antibiotics). Treatment failure, hospital stay and adverse effects were compared between the two groups. p < 0.05 was taken as the limit of statistical significance.

RESULTS

Median [interquartile range (IQR)] birth weight and gestational age of the study population (53.8% boys) were 2.424 kg (IQR: 2.183-2.695) and 37.3 weeks (IQR: 35.5-38.1), respectively. Acinetobacter was the most commonly isolated species (56, 23.9%). The baseline characteristics of both groups were almost similar. Treatment failure was similar in the study and control groups (3.8% vs. 1.7%, p = 0.40), with a shorter hospital stay [median (IQR): 14 (13-16) vs. 18 (17-19) days, p < 0.001].

CONCLUSION

Ten-day antibiotic therapy was comparable with 14-day antibiotic therapy in efficacy, with a shorter duration of hospital stay and without any significant increase in adverse effects.

Risk factors for mortality in a hospitalised neonatal cohort in Botswana

OBJECTIVES

A disproportionate number of neonatal deaths occur in low/middle-income countries, with sepsis a leading contributor of mortality. In this study, we investigate risk factors for mortality in a cohort of high-risk hospitalised neonates in Botswana. Independent predictors for mortality for infants experiencing either a sepsis or a non-sepsis-related death are described.

METHODS

This is a prospective observational cohort study with infants enrolled from July to October 2018 at the neonatal unit (NNU) of Princess Marina Hospital (PMH) in Gaborone, Botswana. Data on demographic, clinical and unit-specific variables were obtained. Neonates were followed to death or discharge, including transfer to another hospital. Death was determined to be infectious versus non-infectious based on primary diagnosis listed on day of death by lead clinician on duty.

RESULTS

Our full cohort consisted of 229 patients. The overall death rate was 227 per 1000 live births, with cumulative proportion of deaths of 22.7% (n=47). Univariate analysis revealed that sepsis, extremely low birth weight (ELBW) status, hypoxic ischaemic encephalopathy, critical illness and infants born at home were associated with an increased risk of all-cause mortality. Our multivariate model revealed that critical illness (HR 3.07, 95% CI 1.56 to 6.03) and being born at home (HR 4.82, 95% CI 1.76 to 13.19) were independently associated with all-cause mortality. Low birth weight status was independently associated with a decreased risk of mortality (HR 0.24, 95% CI 0.11 to 0.53). There was a high burden of infection in the cohort with more than half of infants (140, 61.14%) diagnosed with sepsis at least once during their NNU admission. Approximately 20% (n=25) of infants with sepsis died before discharge. Our univariate subanalysis of the sepsis cohort revealed that ELBW and critical illness were associated with an increased risk of death. These findings persisted in the multivariate model with HR 3.60 (95% CI 1.11 to 11.71) and HR 2.39 (95% CI 1 to 5.77), respectively.

CONCLUSIONS

High rates of neonatal mortality were noted. Urgent interventions are needed to improve survival rates at PMH NNU and to prioritise care for critically ill infants at time of NNU admission, particularly those born at home and/or of ELBW.

Neonatal Mortality Rate and Its Determinants: A Community-Based Panel Study in Ethiopia

Background

The Sustainable Development Goals specifically target a reduction in neonatal mortality rates. However, the highest neonatal mortality rates occur in sub-Saharan Africa, including Ethiopia. Although several factors contributing to these high rates have been explored, there continues to be a general dearth of studies and inconsistencies of factors to understand the problem. Therefore, this study aimed to identify the prevalence and factors associated with neonatal mortality in Ethiopia.

Methods

A panel study was conducted among 2,855 pregnant or recently postpartum women selected using the multistage cluster sampling technique from October 2019 to September 2020. Data were collected by experienced and trained female resident enumerators and coded, cleaned, and analyzed using STATA version 16.1 software. We used the Kaplan-Meier survival curve to show the pattern of neonatal deaths during the first 28 days of life. Frequencies and rates were reported along with the percentages and using a 95% confidence interval, respectively. The Cox proportional hazard regression model was used to explore the association of explanatory and outcome variables. Finally, an adjusted hazard ratio with a 95% confidence interval was used to report the results, with a p < 0.05 to declare statistical significance.

Results

The neonatal mortality rate was 26.84 (95% CI: 19.43, 36.96) per 1,000 live births. Neonates born to rural resident mothers (AHR = 2.18, 95% CI: 1.05, 4.54), mothers of advanced age (AHR = 2.49, 95% CI: 1.19, 5.21), and primipara mothers (AHR = 3.16, 95% CI: 1.52, 6.60) had a higher hazard of neonatal mortality. However, neonates born to women who attended technical and vocational level education (AHR = 0.08, 95% CI: 0.01, 0.62) had a lower hazard of neonatal mortality.

Conclusions

The neonatal mortality rate in Ethiopia is high, with increased risk among specific subsets of the population. The findings highlight that neonatal survival can be improved through tailored interventions for rural residents, emerging regions, and primipara women by improving female education and avoiding pregnancy at an advanced maternal age to achieve Sustainable Development Goal target 3.2.

Birth asphyxia is under-rated as a cause of preterm neonatal mortality in low- and middle-income countries: A prospective, observational study from PURPOSe

OBJECTIVE

To assess respiratory distress syndrome (RDS) compared with birth asphyxia as the cause of death in preterm newborns, assigned by the neonatal intensive care unit (NICU) physician at the time of death and assigned by a panel with complete obstetric history, placental evaluation, tissue histology and microbiology.

DESIGN

Prospective, observational study.

SETTINGS

Study NICUs in India and Pakistan.

POPULATION

Preterm infants delivered in study facility.

METHODS

A total of 410 preterm infants who died in the NICU with cause of death ascertained by the NICU physicians and independently by expert panels. We compared the percentage of cases assigned RDS versus birth asphyxia as cause of death by the physician and the panel.

MAIN OUTCOME MEASURES

RDS and birth asphyxia.

RESULTS

Of 410 preterm neonatal deaths, the discharging NICU physicians found RDS as a cause of death among 83.2% of the cases, compared with the panel finding RDS in only 51.0%. In the same neonatal deaths, the NICU physicians found birth asphyxia as a cause of death in 14.9% of the deaths, whereas the panels found birth asphyxia in 57.6% of the deaths. The difference was greater in Pakistan were the physicians attributed 89.7% of the deaths to RDS and less than 1% to birth asphyxia whereas the panel attributed 35.6% of the deaths to RDS and 62.7% to birth asphyxia.

CONCLUSIONS

NICU physicians who reported cause of death in deceased preterm infants less often attributed the death to birth asphyxia, and instead more often chose RDS, whereas expert panels with more extensive data attributed a greater proportion of deaths to birth asphyxia than did the physicians.

Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of Millennium Development Goal in Eastern Ethiopia

Background

Although Ethiopia was applauded for achieving the Millennium Development Goal (MDG) target of reducing child mortality, whether the gains sustained beyond the MDG era was rarely studied. In this study, we reported the trends and determinants of under-five mortality (U5M) from 2015 to 2020 in a population based cohort under the Kersa Health and Demographic Surveillance System (HDSS), eastern Ethiopia.

Methods

We followed pregnant women and their pregnancy outcomes from 2015 to 2020. Each year, data related to death and live births among the follow up population was retrieved. Automated verbal autopsy (InterVA-4) was used to assign the cause of death and Stata 14 was used for analysis. U5M rate was calculated as death among under five children divided by all live births during the study period and described per 1000 live births along with 95% Confidence Interval (CI). A multivariable Cox proportional regression model was used to identify determinant of U5M using adjusted hazard ratio (AHR). Finally, P value <0.05 was considered for declaring statistically significant association.

Results

From January 2015 to December 2020, a total of 28 870 live births were registered under the Kersa HDSS, of whom 1335 died before their fifth birthday. The overall U5M rate was 46.3 per 1000 live births (95% confidence interval (CI) = 43.79-48.79), with significant increase from 27.9 in 2015 to 54.7 in 2020 (P < 0.041). Diarrheal diseases, acute respiratory tract infection including pneumonia, meningitis and encephalitis, and HIV related deaths were the leading causes of U5M. The hazard of death was higher among children born to poor household (AHR = 1.52; 95% CI = 1.27-1.81), rural residents (AHR = 6.0; 95% CI = 3.65-9.91), born to adolescent mothers (AHR = 1.41; 95% CI = 1.02-1.95), whose mother didn’t receive antenatal care (AHR = 1.43; 95% CI = 1.21-1.69), were born preterm (AHR = 14.1; 95% CI = 9.96-19.89) and had low birth-weight (AHR = 1.74; 95% CI = 1.39-2.18).

Conclusion

We found high level of U5M rate with an increasing trend in the aftermath of the praised MDG4 achievement. Achieving the ambitious U5M of 25 per 1000 live births by 2030 requires addressing diarrheal disease, and respiratory tract infections, and HIV/AIDS. Reasons behind the persistent increase over the study period require further inquiry.

A 12 Years Neonatal Mortality Rate and Its Predictors in Eastern Ethiopia

Introduction. Surviving and thriving of newborn is essential to ending extreme poverty. However, the surviving and thriving of new born is depends on where neonates are born. The true feature of neonatal mortality rate and trends is not well known in the study area. Thus, we aimed to estimate a neonatal mortality incidence in each year, and determine factors associated though pregnancy observation cohort study in Eastern Ethiopia. Methods. The study was conducted in Kersa Health Demographic Surveillance System (KHDSS) among 36 kebeles. We extracted all events (38 541 live birth and 776 neonatal death) occurred between January 1, 2008 and December 30, 2019. Neonatal mortality rate was presented by neonatal death per 1000 live birth with 95% confidence interval in each years, and trends of neonatal morality was described with line regression. Cox proportional regression model was used to assess predictors and presented with an adjusted hazard ratio (AHR) and 95% CI. Results. The estimated cumulative average of neonatal mortality rate in this study was 20.3 (95% CI: 18.9-21.8) per 1000 live births. The rate was decline with regression coefficient β = -1.60. Risk of neonatal death was found to be significantly associated with neonate born to mother living in rural Kersa (AHR = 5.31; 95% CI: 3.07-9.18), born to mother not receiving antenatal care (AHR = 1.43; 95% CI: 1.15-1.78), low birthweight (AHR = 2.59; 95% CI: 2.05-3.27), and preterm newborn (AHR = 12.10; 95% CI: 9.23-15.86). Conclusion. Neonatal mortality in the study site is far from reaching the national and global target goals.

The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies

BACKGROUND

Adverse pregnancy outcomes are risk factors for neonatal mortality and morbidity. While some studies have demonstrated notable associations between influenza and adverse pregnancy outcomes, the findings have contrasted with other studies. This meta-analysis was conducted to assess the effect of influenza infection on pregnancy outcomes.

METHODS

We searched PubMed, Embase, Cochrane Library and Web of Science from inception to 4 November 2020. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects or fixed-effects models.

RESULTS

A total of 17 studies involving 2,351,204 participants were included. Influenza infection increased the risk of stillbirth (RR = 3.62, 95% CI: 1.60-8.20), with no significant effect on preterm birth (RR = 1.17, 95%CI: 0.95-1.45), fetal death (RR = 0.93, 95%CI: 0.73-1.18), small for gestational age (SGA) (RR = 1.10, 95%CI: 0.98-1.24) and low birth weight (LBW) (RR = 1.88, 95%CI: 0.46-7.66). In a subgroup analysis of LBW, the association was evident in studies conducted during the 2009 H1N1 pandemic (RR = 2.28, 95%CI: 1.81-2.87), with no evidence of an association in pre-pandemic or post-pandemic studies.

CONCLUSIONS

Influenza virus infection was associated with an increased risk of stillbirth, but its effect on preterm birth, fetal death, SGA and LBW is still uncertain.