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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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Asaye MM, Gelaye KA, Matebe YH, Lindgren H, Erlandsson K. Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis. PLoS One 2023; 18:e0285280. [PMID: 37146028 PMCID: PMC10162561 DOI: 10.1371/journal.pone.0285280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia. METHOD A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05. RESULTS The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes). CONCLUSIONS The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.
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Affiliation(s)
- Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Hailu Matebe
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
- Institution for Health and Welfare, Dalarna University, Solna, Sweden
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Ayele AD, Tenaw LA, Kassa BG, Mihretie GN, Belay HG, Teffera AG, Aychew EW, Yehuala ED, Yimer TS. Knowledge and practice of essential newborn care and associated factors among women in Ethiopia: systematic review and meta-analysis. Reprod Health 2022; 19:172. [PMID: 35927762 PMCID: PMC9351089 DOI: 10.1186/s12978-022-01480-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 06/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background In developing countries, including Ethiopia the risk of neonatal death can be easily prevented and avoided by implementing essential newborn care with simple, low cost, and a short period time immediately after delivery. However, the problem is still persisting due to lack of adequate maternal and newborn care practice. Hence, this review aimed to estimate the pooled prevalence of women’s knowledge and practice of essential newborn care and its associated factors in Ethiopia using systematic review and meta-analysis. Method An intensive literature search was performed from PubMed, Google Scholar, EMBASE, HINARI, Scopus, and Web of Sciences from April 1–30, 2021. Data were extracted by using a pre-tested and standardized data extraction format. The data were analyzed by using STATA 14 statistical software. I2 tests assessed heterogeneity across the included studies. A random-effect model was used to estimate the pooled prevalence of knowledge and practice of essential newborn care. Results From 1275 identified studies, 25 articles were included. The national pooled prevalence of essential newborn care knowledge and practice among women was 55.05% and 41.49% respectively. Secondary education (AOR = 2.75, 95% CI 1.62, 4.66), multiparity (AOR = 2.14, 95% CI 1.41, 3.26), antenatal care (AOR = 2.94; 95% CI 2.03, 4.26), and postnatal follow-up (AOR = 1.64, 95% CI 1.20, 2.23) were significantly associated with knowledge level whereas; primary education (AOR = 7.08, 95% CI 4.79, 10.47), urban residency (AOR = 2.22, 95% CI 1.65, 3.00), attending monthly meetings (AOR = 2.07, 95% CI 1.64, 2.62), antenatal care (AOR = 2.89, 95% CI 1.97, 4.26), advised during delivery (AOR = 2.54, 95% CI 1.80, 3.59), postnatal follow-up (AOR = 7.08, 95% CI 4.79, 10.47) and knowledge (AOR = 2.93; 95% CI 1.81, 4.75) were statistically significant with essential newborn practice. Conclusions The current systematic review and meta-analysis findings reported that the level of knowledge and practice of essential newborn care among Ethiopian women was low. Therefore, improvement of essential newborn through the provision of community-based awareness creation forum, improving antenatal and postnatal care follow up, education on essential newborn care to all pregnant and postnatal women are very important. Trial registration Prospero registration: CRD 42021251521 Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01480-0. Essential newborn care (ENC) is a single most cost-effective intervention to reduce neonatal mortality and morbidity both in developed and developing countries. An intensive electronic search from PubMed, Google Scholar, EMBASE, HINAR, Scopus, and Web of Sciences were performed to identify the primary studies. In this meta-analysis a total of 25 articles were included to estimate the polled prevalence of ENC knowledge and practice among Ethiopian women. Accordingly, the national pooled prevalence of ENC knowledge and practice among women was 55.05% and 41.49% respectively. In the current systematic review and meta-analysis, Secondary education, multiparity, antenatal care, and postnatal follow-up were significantly associated with knowledge level whereas; primary education, urban residency, attending monthly meetings, antenatal care, advised during delivery, postnatal follow-up and knowledge on ENC were found to be statistically significant with essential newborn practice. As per finding the knowledge and practice regarding essential newborn care among women in Ethiopian was significantly low. Hence, improvement of essential newborn through the provision of community-based awareness creation forum, improving antenatal and postnatal care follow up, education on essential newborn care to all pregnant and postnatal women are very important.
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Affiliation(s)
- Alemu Degu Ayele
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Lebeza Alemu Tenaw
- School of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret Mihretie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Gebrehana Belay
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Adanech Getie Teffera
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Eden Workneh Aychew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Enyew Dagnew Yehuala
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigist Seid Yimer
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Mokuolu OA, Adesiyun OO, Ibrahim OR, Suberu HD, Ibrahim S, Bello SO, Mokikan M, Obasa TO, Abdulkadir MB. Appraising Neonatal Morbidity and Mortality in a Developing Country Categorized by Gestational Age Grouping and Implications for Targeted Interventions. Front Pediatr 2022; 10:899645. [PMID: 35712627 PMCID: PMC9196884 DOI: 10.3389/fped.2022.899645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Despite the relatively higher neonatal morbidity and mortality in developing countries, there are limited data on the detailed analysis of the burden in Nigeria. With a database of over 14,000 admissions, this study presents a compelling picture of the current trends disaggregated by their gestational age groups. It provides unique opportunities for better-targeted interventions for further reducing newborn mortality in line with SDG 3, Target 3.2. Methods This prospective observational study involved newborn babies admitted to the Neonatal Intensive Care Unit of the University of Ilorin Teaching Hospital, Kwara State, Nigeria, between January 2007 and December 2018. The outcome was the neonatal mortality rates. The exposure variables included birth weight, gestational age (preterm versus term), and clinical diagnosis. Frequencies were generated on tables and charts, and the trends or associations were determined. Results Of the 14,760 neonates admitted, 9,030 (61.2%) were term babies, 4,847 (32.8%) were preterm babies, and in 792 (5%) of the admissions, the gestational ages could not be determined. Males constituted a higher proportion with 55.9%, and the total number of deaths in the study period was 14.7%. The mortality ratio was highest among babies with a birth weight of less than 1,000 g (38.0%) and gestational age of less than 28 weeks (65.5%). The trend analysis showed that the mortality rate decreased from 17.8 to 13% over the 12 years, p-value < 0.0001. For term babies, mortality decreased by 45%, from 15.7% in 2007 to 8.7% in 2018, while the decline in mortality for preterm babies was 28.4%, from 25.7% in 2007 to 18.4% in 2018. For both categories, p-values were < 0.001. Regarding morbidity in term babies, asphyxia occurred in (1:3), jaundice (1:5), sepsis (1:6), and respiratory disorders (1:6) of admissions. For mortality, asphyxia occurred in (1:2), sepsis (1:5), jaundice (1:8), and respiratory disorders (1:10) of deaths. The leading causes of morbidity among preterm babies were asphyxia (1:4), sepsis (1:5), respiratory disorders (1:9), and jaundice (1.10). For mortality, their contributions were asphyxia (≈1:2); sepsis (1:5); respiratory disorders (1:9), and jaundice (1:10). Conclusion There was a marked improvement in neonatal mortality trends. However, severe perinatal asphyxia, sepsis, hyperbilirubinemia, and respiratory disorders were the leading conditions contributing to 75% of the morbidities and mortalities. Measures to further accelerate the reduction in neonatal morbidity and mortality are discussed.
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Affiliation(s)
- Olugbenga Ayodeji Mokuolu
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Pediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Omotayo Oluwakemi Adesiyun
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Pediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Olayinka Rasheed Ibrahim
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Habibat Dirisu Suberu
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Selimat Ibrahim
- Centre for Malaria and Other Tropical Diseases Care, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Surajudeen Oyeleke Bello
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Moboni Mokikan
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, United States
| | - Temitope Olorunshola Obasa
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Pediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Mohammed Baba Abdulkadir
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Pediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
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The Magnitude of Neonatal Mortality and Its Predictors in Ethiopia: A Systematic Review and Meta-Analysis. Int J Pediatr 2021; 2021:7478108. [PMID: 33679995 PMCID: PMC7906817 DOI: 10.1155/2021/7478108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Although neonatal death is a global burden, it is the highest in sub-Saharan African countries such as Ethiopia. Moreover, there is disparity in the prevalence and associated factors of studies. Therefore, this study was aimed at providing pooled national prevalence and predictors of neonatal mortality in Ethiopia. Methods The following databases were systematically explored to search for articles: Boolean operator, Cochrane Library, PubMed, EMBASE, Hinari, and Google Scholar. Selection, screening, reviewing, and data extraction were done by two reviewers independently using Microsoft Excel spreadsheet. The modified Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute Prevalence Critical Appraisal tools were used to assess the quality of evidence. All studies conducted in Ethiopia and reporting the prevalence and predictors of neonatal mortality were included. Data were extracted using Microsoft Excel spreadsheet software and imported into Stata version 14s for further analysis. Publication bias was checked using funnel plots and Egger's and Begg's tests. Heterogeneity was also checked by Higgins's method. A random effects meta-analysis model with 95% confidence interval was computed to estimate the pooled effect size (i.e., prevalence and odds ratio). Moreover, subgroup analysis based on region, sample size, and study design was done. Results After reviewing 88 studies, 12 studies fulfilled the inclusion criteria and were included in the meta-analysis. Pooled national prevalence of neonatal mortality in Ethiopia was 16.3% (95% CI: 12.1, 20.6, I 2 = 98.8%). The subgroup analysis indicated that the highest prevalence was observed in the Amhara region, 20.3% (95% CI: 9.6, 31.1), followed by Oromia, 18.8% (95% CI: 11.9, 49.4). Gestational age [AOR: 1.32 (95% CI: 1.07, 1.58)], neonatal sepsis [AOR: 1.23 (95% CI: 1.05, 1.4)], respiratory distress syndromes (RDS) [AOR: 1.18 (95% CI: 0.87, 1.49)], and place of residency [AOR: 1.93 (95% CI: 1.13, 2.73)] were the most important predictors. Conclusions Neonatal mortality in Ethiopia was significantly decreased. There was evidence that neonatal sepsis, gestational age, and place of residency were the significant predictors. RDS were also a main predictor of mortality even if not statistically significant. We strongly recommended that health care workers should give a priority for preterm neonates with diagnosis with sepsis and RDS.
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Rohsiswatmo R, Azharry M, Sari TT, Bahasoan Y, Wulandari D. TLR2 and TLR4 expressions in late-onset neonatal sepsis: Is it a potential novel biomarker? J Neonatal Perinatal Med 2020; 14:361-367. [PMID: 33164948 DOI: 10.3233/npm-200411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late-onset neonatal sepsis (LONS) detection is problematic as no single examinations (blood culture, c-reactive protein (CRP), procalcitonin (PCT)) are reliable. Toll-like receptors (TLRs), which detect the presence of pathogen-associated molecular patterns is a promising novel biomarker, but less studied in LONS. This study aimed to determine neutrophils and monocytes TLR2 and TLR4 expression in LONS and their diagnostic value. METHODS A cross-sectional study conducted in May and June 2017 involving 52 neonates with clinical late-onset (>72 hours of age) sepsis. We examine complete blood count, I/T ratio, CRP, PCT, as well as TLR2 and TLR4 expression to compared with blood culture as the gold standard. We classified cases into proven or unproven sepsis. RESULT The incidence of LONS was 32.6% in the subjects. The expression of TLR2 was low in LONS, while TLR4 was high. TLR4 neutrophil expression has 88.2% sensitivity, 20% specificity, 34.9% positive predictive value (PPV), 77.8% negative predictive value (NPV), and an AUC of 0.541. TLR4 monocyte expression has 92.1% sensitivity, 11.4% specificity, 34% PPV, 80% NPV, and an AUC of 0.528. The AUC of CRP is increased from 0.608 to 0.843 after combination with TLR4, comparable with CRP + PCT (AUC 0.829). CONCLUSION The increase in TLR4 expression has good sensitivity but low specificity. TLR4 expression, in combination with CRP, could become a reliable biomarker for the diagnosis of LONS.
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Affiliation(s)
- R Rohsiswatmo
- Department of Child Health, Faculty of Medicine, Universitas Indonesia -Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - M Azharry
- Department of Child Health, Faculty of Medicine, Universitas Indonesia -Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - T T Sari
- Department of Child Health, Faculty of Medicine, Universitas Indonesia -Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Y Bahasoan
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia -Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - D Wulandari
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia -Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Int J Pediatr 2020; 2020:3894026. [PMID: 33123204 PMCID: PMC7586147 DOI: 10.1155/2020/3894026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
Background Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined. Methods Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and Google) were explored. 20 out of 818 studies were included in this study. The IDRs and predictors of neonatal mortality were computed from studies conducted in survival analysis. Fixed and random effect models were used to compute pooled estimates. Subgroup and sensitivity analyses were performed. Results Neonates were followed for a total of 1,095,611 neonate-days; 67142 neonate-days for neonates treated in neonatal intensive care units and 1,028,469 neonate-days for community-based studies. The IDRs of neonatal mortalities in neonatal intensive care units and in the community were 24.53 and 1.21 per 1000 person-days, respectively. The IDRs of early and late neonatal mortalities neonatal intensive care units were 22.51 and 5.09 per 1000 neonate-days, respectively. Likewise, the IDRs of early and late neonatal mortalities in the community were 0.85 and 0.31, respectively. Not initiating breastfeeding within one hour, multiple births, rural residence, maternal illness, low Apgar score, being preterm, sepsis, asphyxia, and respiratory distress syndrome were independent predictors of time to neonatal mortality in neonatal intensive care units and male gender, perceived small size, multiple births, and ANC were predictors of neonatal mortality in the community. Conclusion The incidence density rate of neonatal mortality in Sub-Saharan Africa is significantly high. Multiple factors (neonatal and maternal) were found to be independent predictors. Strategies must be designed to address these predictors, and prospective studies could reveal other possible factors of neonatal mortalities.
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Neonatal near Miss and Its Predictors among Neonates Delivered at Debretabor General Hospital, Northern Ethiopia; A Retrospective Analysis. Int J Pediatr 2020; 2020:1092479. [PMID: 33014076 PMCID: PMC7519192 DOI: 10.1155/2020/1092479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/12/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background In many low-resource countries, the progress of neonatal mortality reduction is very slow. The scenario is notably true in sub-Saharan Africa including Ethiopia. For every neonatal death, there are lots of near missed neonates. Generating evidences on the extent and predictors of neonatal near miss is a key step in neonatal mortality reduction efforts. However, there is limited evidence in this aspect in Ethiopia. Objective This study is aimed at assessing the proportion of neonatal near miss and associated factors among neonates delivered at Debretabor General Hospital, Northern Ethiopia, 2019. Methods An institution-based cross-sectional study was conducted on 422 neonates delivered at Debretabor General Hospital from July 1st, 2018, to June 30th, 2019. Both pragmatic and management criteria of definition of neonatal near miss were utilized. A systematic random sampling technique was used to select the cards of the study participants. Data were extracted with structured and pretested checklist, entered in the EpiData, and then exported to SPSS version 20. Both descriptive and analytical procedures have been done. Descriptive statistics such as frequencies and cross tabulations were carried out. The binary logistic regression model was fitted and variables with p value < 0.20 were entered in the multivariable logistic regression model. Both crude and adjusted odds ratios with the corresponding 95% CI were computed. The level of significance has been claimed based on the adjusted odds ratio with 95% CI and its p value of ≤0.05. Results The proportion of neonates experiencing near miss was obtained to be 32.2% with 95% CI (28, 36). Rural residence (AOR = 4.41; 95% CI: 2.57,7.55), incomplete ANC visit (AOR = 3.16; 95% CI: 1.90,5.25), primiparous (AOR = 2.55; 95% CI: 1.59,4.12), pregnancy-induced hypertension (AOR = 3.23; 95% CI: 1.19,8.78), premature rupture of membrane (AOR = 4.65; 95% CI: 1.70,12,73), cephalic-pelvic disproportion (AOR = 3.05; 95% CI: 1.32,7.01), and antepartum hemorrhage (AOR = 4.95; 95% CI: 1.89,12.96) were the independent predictors of neonatal near-miss. Conclusion and Recommendations. The proportion of neonatal near miss was found to be high in the study setting. Most of the determinants of near miss are modifiable obstetric-related factors. Hence, stakeholders need to consider the aforesaid factors while they design interventions.
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Abstract
OBJECTIVES The objective of this study was to evaluate a new nontraditional value of the red cell distribution width (RDW) in predicting the clinical outcome of neonatal sepsis. METHODS In this retrospective study, data were collected from the medical files of 500 full-term neonates with a diagnosis of early onset or late onset sepsis. Baseline RDW and other traditional biomarkers, including C-reactive protein (CRP), total leucocytic count, and platelet count were analyzed in light of the clinical data. The primary outcome was 30-day mortality. RESULTS Red cell distribution width was significantly higher in nonsurvivors compared with survivors (P < 0.0001). Red cell distribution width was significantly elevated in infants with septic shock compared with those having severe sepsis and those with sepsis (P < 0.0001). A strong positive correlation was found between RDW and CRP (r = 0.8; P <0.0001). Red cell distribution width had an area under the receiver operating characteristic curve of 0.75 for prediction of mortality, which was almost equal to that of CRP and platelet count. Furthermore, logistic regression analysis showed a positive association of RDW with mortality (odds ratio, 1.31; 95% confidence interval, 1.241-1.399). CONCLUSIONS Red cell distribution width is a useful prognostic marker in neonatal sepsis. Larger prospective studies are required to confirm the value of this routinely available marker in this category of patients.
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Mengistu BA, Yismaw AE, Azene ZN, Mihret MS. Incidence and predictors of neonatal mortality among neonates admitted in Amhara regional state referral hospitals, Ethiopia: prospective follow up study. BMC Pediatr 2020; 20:142. [PMID: 32238144 PMCID: PMC7110778 DOI: 10.1186/s12887-020-02031-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Globally, about 2.7 million neonates die annually and more than 99% of these deaths happened in developing countries. Although most neonatal deaths are preventable and attempts had been taken to tackle these deaths, an aggregate of 30 neonatal deaths per 1000 live births had been reported in Ethiopia. In this regard, identifying the predictors could be an important step. However, evidence on the incidence and predictors of neonatal mortality has been limited in Ethiopia, in the study area in particular. Even the available studies were limited in scope and were retrospective or cross section in nature. Thus, this study is aimed at assessing the incidence and predictors of neonatal mortality among neonates admitted in Amhara regional state referral hospitals, Ethiopia.. METHOD A multi center prospective follow up study was conducted on 612 neonates admitted in Amhara region referral hospitals from July 01 to August 30, 2018. A simple random sampling technique was used to select three of all referral hospitals in the study settings and all neonates admitted in the selected hospitals were included. Data were entered into Epi info version 7.0 and exported to STATA 14.0 for analysis. Cox proportional hazard regression model was fitted to identify predictors of neonatal mortality. Crude and Adjusted hazard ratio with 95% confidence interval was computed and variables' statistical significance was declared based on its AHR with 95% CI and p-value ≤0.05. RESULT Overall, 144 (18.6%) neonates died with a total person-time of 4177.803 neonate-days which is equivalent to the neonatal mortality rate of 186 per 1000 admitted neonates with 95% CI (157,219). The incidence rate of neonatal mortality was 27 per 1000 admitted neonates with 95%CI (23, 33). Maternal age ≥ 35 years (AHR = 2.60; 95%CI: 1.44, 4.72), mothers unable to read and write (AHR = 1.40; 95%CI: 1.23, 2.44), multiple pregnancy (AHR = 3.96; 95%CI: 2.10, 7.43) and positive maternal HIV status (AHR = 6.57; 95%CI: 2.53, 17.06) were predictors of neonatal mortality. CONCLUSION In this study, the neonatal mortality rate was higher than the national figure. Its most predictors were found to be modifiable. Thus, the stakeholders would better consider the aforementioned predictors to decrease this higher burden.
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Affiliation(s)
- Banchigizie Adane Mengistu
- Teda Health Science College, Amhara Regional Health Bureau, Department of Midwifery, Po. Box 196, Gondar, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Nigussie Azene
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bogale TN, Worku AG, Yalew AW, Bikis GA, Tigabu Kebede Z. Mothers treatment seeking intention for neonatal danger signs in northwest Ethiopia: A structural equation modeling. PLoS One 2018; 13:e0209959. [PMID: 30596745 PMCID: PMC6312321 DOI: 10.1371/journal.pone.0209959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 12/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neonatal mortality contributes to nearly half of under-five mortality in Ethiopia. Treatment seeking for newborn danger signs remains low despite correlations with neonatal mortality. This study tests a theoretical model of factors affecting mothers' treatment seeking intention for neonatal danger signs in northwest Ethiopia. METHOD A cross sectional study was conducted from March 3-18, 2016 in northwest Ethiopia. A total of 2,158 pregnant women and women who had delivered in the past 6 months were interviewed. Latent variables; knowledge of neonatal danger signs (KDS), household level women empowerment (HLWE) and positive perception toward the behavior of health care providers (PPBHCP) were measured using a Five Point Likert Scale. Socioeconomic status (SES), number of antenatal care attendance, perceived cost of treatment (PCT), average distance to health facilities (ADHF) and treatment seeking intention (TSI) were observed variables in the study. A structural equation modeling was applied to test and estimate the hypothesized model of relationships among latent and observed variables and their direct and indirect effects on TSI. RESULT KDS, PPBHCP, HLWE, and PCT showed direct, positive and significant association with TSI (β = 0.41, p<0.001, β = 0.08, p<0.002, β = 0.18, p<0.001, and β = 0.06, p<0.002, respectively). SES was not directly associated with TSI. However, it indirectly influenced TSI through three pathways; KDS, number of ANC attendance and HLWE (β = 0.05, p<0.05, β = 0.08, p<0.001 and β = 0.13, p<0.001, respectively). Number of antenatal care was not directly associated with TSI. But indirectly, it affected TSI through its direct effect on KDS and PPBHCP (β = 0.05, p<0.05, β = 0.14, p<0.001, respectively). PPBHCP and HLWE also showed indirect association with TSI through their direct effect on KDS (β = 0.37, p<0.001, β = 0.36, p<0.001, respectively). All in all, the model fitted the sample data and explained 31% of the variance in TSI. CONCLUSION PPBHCP, HLWE, PCT and KDS were associated with mothers' TSI for newborn danger signs.
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Affiliation(s)
| | | | | | | | - Zemene Tigabu Kebede
- Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia
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Tran HT, Mannava P, Murray JC, Nguyen PTT, Tuyen LTM, Hoang Anh T, Pham TQN, Nguyen Duc V, Sobel HL. Early Essential Newborn Care Is Associated With Reduced Adverse Neonatal Outcomes in a Tertiary Hospital in Da Nang, Viet Nam: A Pre- Post- Intervention Study. EClinicalMedicine 2018; 6:51-58. [PMID: 31193626 PMCID: PMC6537584 DOI: 10.1016/j.eclinm.2018.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To accelerate reductions in neonatal mortality, Viet Nam rolled out early essential newborn care (EENC) using clinical coaching, quality improvement assessments in hospitals, and updated protocols. Da Nang Hospital for Women and Children, a tertiary referral hospital in central Viet Nam, compared outcomes pre- and post-EENC introduction. METHODS Records of live births and NICU admissions were reviewed pre- (November 2013-October 2014) and post- (November 2014-October 2015) EENC implementation. Delivery room practices, NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics. FINDINGS A total of 13,201 live births were delivered pre- and 14,180 live births post-EENC introduction. Post-EENC, delivery practice scores, rates of early and prolonged skin-to-skin contact and early breastfeeding rose significantly. There was a significant reduction in risk of NICU admissions (relative risk [RR] 0.68; 95% confidence interval [CI] 0.64-0.71; p < 0.0001), hypothermia on NICU admission (RR 0.72; 95% CI 0.65-0.81, p < 0.0001) and sepsis (RR 0.28; 95% CI 0.23-0.35, p < 0.0001). Exclusive breastfeeding rates in NICU increased from 49% to 88% (p < 0.0001) and of kangaroo mother care (KMC) from 52% to 67% (p < 0.0001). Reduced formula use resulted in decreased monthly costs. INTERPRETATION EENC introduction, including staff coaching, quality improvement assessments and changes in hospital protocols and environments, were associated with improved clinical practices, reduced NICU admissions, admissions with hypothermia and sepsis and increased rates of exclusive breastfeeding and KMC in the NICU. FUNDING Data collection was funded by the World Health Organization Western Pacific Regional Office and Newborns Vietnam. OUTSTANDING QUESTIONS •What is the impact of the package of early essential newborn care interventions on newborn mortality?•What are the total direct and indirect cost savings of early essential newborn care implementation?•What is the cost effectiveness of kangaroo mother care for preterm and low birth weight babies?•What strategies can help reduce unnecessary cesarean sections in hospitals?
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Affiliation(s)
- Hoang Thi Tran
- Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam
- Corresponding author at: Neonatal Unit, Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam.
| | - Priya Mannava
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
| | - John C.S. Murray
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
| | | | - Le Thi Mong Tuyen
- Da Nang Hospital for Women and Children, 402 Le Van Hien Street, Da Nang, Viet Nam
| | - Tuan Hoang Anh
- Ministry of Health of Viet Nam, 138A Giang Vo Street, Ha Noi, Viet Nam
| | - Thi Quynh Nga Pham
- World Health Organization Representative Office in Viet Nam, 304 Kim Ma Street, Ha Noi, Viet Nam
| | - Vinh Nguyen Duc
- Ministry of Health of Viet Nam, 138A Giang Vo Street, Ha Noi, Viet Nam
| | - Howard L. Sobel
- World Health Organization Western Pacific Regional Office, United Nations Avenue, 1000 Manila, Philippines
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Weerasinghe NP, Vidanagama D, Perera B, Herath HMM, De Silva Nagahawatte A. Re-exploring the value of surveillance cultures in predicting pathogens of late onset neonatal sepsis in a tertiary care hospital in southern Sri Lanka. BMC Res Notes 2018; 11:340. [PMID: 29843815 PMCID: PMC5975496 DOI: 10.1186/s13104-018-3448-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/21/2018] [Indexed: 01/15/2023] Open
Abstract
Objective To identify the validity of surveillance cultures in predicting causative organism(s) of late onset neonatal sepsis. Results Prospective analytical study was conducted from January to April 2011 at the Neonatal Intensive Care Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka. Fifty neonates were screened on admission and weekly thereafter for colonization with potential pathogens. On suspicion of infection, relevant samples were cultured and tested for antibiotic sensitivity. There were 55 episodes of clinically suspected infections including 33 nosocomial infections. One-third (17/55) of all clinically suspected infections were culture positive. Out of 55, only 33 episodes were clinically suspected nosocomial infections. Clinically suspected nosocomial infection rate was 50/1000 patient-days. Culture proven nosocomial infection rate was 13.61/1000 patient-days. Coliforms were the commonest clinical isolate (76%) and 2/3 of them produced extended spectrum β lactamase. More than 80% of the isolates causing late onset sepsis were sensitive to carbapenems and aminoglycosides. Sensitivity, specificity, positive predictive value and negative predictive value of surveillance cultures were 77.8, 37.5, 31.8 and 81.8%, respectively. Surveillance samples can be used to predict pathogens of late-onset sepsis. Broad-spectrum antibiotics (carbapenems, aminoglycosides) are recommended as empirical therapy for late-onset neonatal sepsis.
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Affiliation(s)
- Nayani Prasangika Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Inland Hill Road, PO Box 70, Galle, Sri Lanka.
| | - Dhammika Vidanagama
- Department of Microbiology, Teaching Hospital, Karapitiya, PO Box 70, Galle, Sri Lanka
| | - Bilesha Perera
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, PO Box 70, Galle, Sri Lanka
| | | | - Ajith De Silva Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Inland Hill Road, PO Box 70, Galle, Sri Lanka
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Bogale TN, Worku AG, Yalew AW, Biks GA, Kebede ZT. Causal Beliefs Affect Treatment Practices and Preferences for Neonatal Danger Signs in Northwest Ethiopia: A Qualitative Study. Am J Trop Med Hyg 2018; 98:1653-1660. [PMID: 29663902 DOI: 10.4269/ajtmh.17-0824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study was conducted to explore the experiences of community members, particularly mothers, concerning their beliefs about the causes, treatment practices, and preferences for World Health Organization-defined neonatal danger signs in northwest Ethiopia. A phenomenological qualitative study was conducted in three districts of north Gondar Zone, Amhara region, Ethiopia, from March 10 to 28, 2016. Twelve focus group discussions were conducted involving 98 individuals. In-depth interviews were conducted with six health extension workers and 30 women who were either pregnant or who delivered in the past 6 months. Six subthemes emerged explaining the causes of neonatal danger signs. The causes varied from danger sign to danger sign and from person to person. Most of the perceived causes of danger signs in neonates do not align with the current biomedical science. Causal assumptions and perceived seriousness of danger signs influenced treatment practices and preferences. Four subthemes also emerged for treatment practices and preferences. In some cases, respondents indicated that non-biomedical sources of treatment were superior in outcome compared with biomedical treatment options. Unsatisfactory outcomes were mentioned as major reasons to opt for treatments from non-biomedical sources. Religious and cultural reasons were reported to be major impediments for treatment seeking for newborn danger signs. There is an urgent need to introduce or expand locally modified program interventions, such as community-based newborn care, to educate the community on the causes of neonatal danger signs and the need for prompt care seeking from qualified providers.
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Affiliation(s)
| | | | | | | | - Zemene Tigabu Kebede
- Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia
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Bogale TN, Worku AG, Bikis GA, Kebede ZT. Why gone too soon? Examining social determinants of neonatal deaths in northwest Ethiopia using the three delay model approach. BMC Pediatr 2017; 17:216. [PMID: 29282018 PMCID: PMC5745914 DOI: 10.1186/s12887-017-0967-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Without improving the survival of newborns, meaningful reduction in under-five mortality is difficult. Most neonatal deaths are preventable when appropriate and timely care is sought. In Ethiopia, there is lack of evidence on the type and contribution of delays in treatment seeking to neonatal deaths. METHODS A community based social autopsy (SA) of 39 neonatal deaths was conducted from March 16 to 24, 2016 in Dabat Health and Demographic Surveillance System (HDSS) in northwest Ethiopia. The result was linked with verbal autopsy (VA) information completed for each of the deaths as part of the ongoing HDSS. The SA tool was adapted from INDEPTH Network. Three delay model approach was used to classify the delay types that contributed for the deaths investigated. Descriptive statistics was used to analyze the data. RESULTS SA was completed for 37 (94.9%) of the 39 neonatal deaths. Of all the deaths, 51.3% (19/37) of them occurred within the first 24 h, 75.6% (28/37) within the first 6 days and the remaining in 7-28 days. Birth asphyxia was the leading cause of death (34%) followed by bacterial sepsis (31%) and prematurity (16%). The median time from recognition of illness to initiation of modern treatment was 1 day (IQR 1-2.5 days). Delay in treatment seeking outside home (delay one) was associated with 81% of the deaths. Delay in receiving care at a health facility (delay three) and delay in transport (delay two) were associated with 16 and 3% of the deaths, respectively. The major contributors of death for delay one were bacterial sepsis (33.3%), birth asphyxia (30%), unspecified illness (20%) and acute lower respiratory tract illnesses (6.7%). For delay three, the major causes of death included birth asphyxia (50%), prematurity (33.3%) and bacterial sepsis (16.7%). CONCLUSIONS Delays created at home and at health facility were the major delays contributing to the death of newborns. More focus has to be given in improving delays at home and at health facility.
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Nguyen N, Vandenbroucke L, Hernández A, Pham T, Beuchée A, Pladys P. Early-onset neonatal sepsis is associated with a high heart rate during automatically selected stationary periods. Acta Paediatr 2017; 106:749-754. [PMID: 28196284 DOI: 10.1111/apa.13782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/27/2016] [Accepted: 02/09/2017] [Indexed: 12/27/2022]
Abstract
AIM This study examined the heart rate variability characteristics associated with early-onset neonatal sepsis in a prospective, observational controlled study. METHODS Eligible patients were full-term neonates hospitalised with clinical signs that suggested early-onset sepsis and a C-reactive protein of >10 mg/L. Sepsis was considered proven in cases of symptomatic septicaemia, meningitis, pneumonia or enterocolitis. Heart rate variability parameters (n = 16) were assessed from five-, 15- and 30-minute stationary sequences automatically selected from electrocardiographic recordings performed at admission and compared with a control group using the U-test with post hoc Benjamini-Yekutieli correction. Stationary sequences corresponded to the periods with the lowest changes of heart rate variability over time. RESULTS A total of 40 full-term infants were enrolled, including 14 with proven sepsis. The mean duration of the cardiac cycle length was lower in the proven sepsis group than in the control group (n = 11), without other significant changes in heart rate variability parameters. These durations, measured in five-minute stationary periods, were 406 (367-433) ms in proven sepsis group versus 507 (463-522) ms in the control group (p < 0.05). CONCLUSION Early-onset neonatal sepsis was associated with a high mean heart rate measured during automatically selected stationary periods.
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Affiliation(s)
- Nga Nguyen
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Department of Pediatrics; Hanoi Medical University; Hanoi Vietnam
- Neonatal Department; National Hospital of Pediatrics; Hanoi Vietnam
| | - Laurent Vandenbroucke
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Obstetrics Department; CHU Rennes; Rennes France
| | - Alfredo Hernández
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
| | - Tu Pham
- Hanoi French Hospital; Hanoi Vietnam
| | - Alain Beuchée
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Division of Neonatology and CIC-1414; Department of Pediatrics; CHU Rennes; Rennes France
| | - Patrick Pladys
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Division of Neonatology and CIC-1414; Department of Pediatrics; CHU Rennes; Rennes France
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Low Neonatal Mortality and High Incidence of Infectious Diseases in a Vietnamese Province Hospital. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2087042. [PMID: 27597956 PMCID: PMC4997011 DOI: 10.1155/2016/2087042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 04/11/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022]
Abstract
Background. Neonatal deaths constitute the majority of child mortality in Vietnam, but studies are scarce and focus on community settings. Methods. During a 12-month period, all sick neonates admitted to a pediatric department in a province hospital were studied. Potential risk factors of death covering sociodemographic factors, pregnancy history, previous neonatal period, and status on admission were registered. The neonates were followed up until discharge or death or until 28 completed days of age if still hospitalized or until withdrawal of life support. The main outcome was neonatal death. Results. The neonatal mortality was 4.6% (50/1094). In a multivariate analysis, four associated risk factors of death were extremely low birth weight (OR = 22.9 (2.3–233.4)), no cry at birth (OR = 3.5 (1.3–9.4)), and cyanosis (OR = 3.3 (1.2–8.7)) and shock (OR = 12.3 (2.5–61.5)) on admission. The major discharge diagnoses were infection, prematurity, congenital malformations, and asphyxia in 88.5% (936/1058), 21.3% (225/1058), 5.0% (53/1058), and 4.6% (49/1058), respectively. In 36, a discharge diagnosis was not registered. Conclusion. Infection was the main cause of neonatal morbidity. Asphyxia and congenital malformations were diagnosed less frequently. The neonatal mortality was 4.6%. No sociodemographic factors were associated with death. Extreme low birth weight, no cry at birth, and cyanosis or shock at admission were associated with death.
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Tran HT, Doyle LW, Lee KJ, Dang NM, Graham SM. A high burden of late-onset sepsis among newborns admitted to the largest neonatal unit in central Vietnam. J Perinatol 2015; 35:846-51. [PMID: 26156065 DOI: 10.1038/jp.2015.78] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/16/2015] [Accepted: 05/29/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to determine the prevalence, causes and outcome of sepsis in hospitalized neonates in the largest neonatal unit in central Vietnam. STUDY DESIGN A 1-year prospective cohort study of newborns admitted to the neonatal unit in Da Nang. A sepsis work-up including blood culture was undertaken before commencing antibiotics for neonates with suspected sepsis. RESULT Of 2555 neonatal admissions, 616 neonates had 729 episodes of suspected invasive sepsis. A pathogen was isolated from blood in 115 (16%) episodes in 106 neonates. The prevalence of early-onset sepsis (EOS) was 8 (95% confidence interval (CI): 4 to 11) per 1000 admissions, and of late-onset sepsis (LOS) was 34 (95% CI: 27 to 41) per 1000 admissions. Of 86 neonates with LOS, 69 (80%) also fulfilled the criteria for nosocomial sepsis. The commonest bacterial causes of EOS were coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus, and of LOS were Acinetobacter, CoNS and Klebsiella pneumoniae. Fungal sepsis occurred in 35 neonates of which most were nosocomial sepsis. In vitro resistance to multiple antibiotics was common among Gram-negative bacteria. Antibiotics were prescribed and given to 68% of all admissions, and 14% of all admissions received four or more different antibiotics. The case fatality rate for confirmed sepsis was 46%. CONCLUSION Late-onset, nosocomial sepsis was common and associated with a high mortality in hospitalized newborns in the largest neonatal unit in central Vietnam. These findings highlighted the need for improved infection control measures and antibiotic stewardship, which have since been implemented.
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Affiliation(s)
- H T Tran
- Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam.,Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - L W Doyle
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - K J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - N M Dang
- Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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Tran HT, Doyle LW, Lee KJ, Dang NM, Graham SM. Morbidity and mortality in hospitalised neonates in central Vietnam. Acta Paediatr 2015; 104:e200-5. [PMID: 25649520 DOI: 10.1111/apa.12960] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/29/2015] [Indexed: 11/28/2022]
Abstract
AIM This study explored neonatal morbidity and mortality in hospitalised patients in central Vietnam and risk factors associated with mortality. METHODS We conducted a prospective cohort study of all newborn infants (<28 days) hospitalised in a neonatal unit over a 1-year period and followed until discharge. The main outcome measures were case fatality rate and the rate of different clinical diagnoses. RESULTS There were 2555 admissions during the study period. The leading primary causes of admissions were infections (41%), haematological problems such as jaundice (23%) and prematurity and its complications (18%). The overall case fatality rate was 8.6%, and it was 59% among very low-birthweight (<1500 g) neonates. Mortality was inversely associated with birthweight and gestational age. Of the 220 deaths, 57% occurred within the first 7 days of life. Although the causes of death were often multifactorial, the leading primary causes were infections (32%), prematurity and its complications (25%), birth defects (24%) and birth asphyxia (6%). Risk factors associated with death were being outborn, early gestational age, small for gestational age, confirmed sepsis and birth defects. CONCLUSION Mortality rates were high among hospitalised neonates in central Vietnam, and this paper suggests interventions that might improve outcomes.
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Affiliation(s)
- Hoang T. Tran
- Neonatal Unit; Department of Paediatrics; Da Nang Hospital for Women and Children; Da Nang Vietnam
- Centre for International Child Health; University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Vic. Australia
| | - Lex W. Doyle
- University of Melbourne Department of Obstetrics and Gynaecology; Royal Women's Hospital; Melbourne Vic. Australia
- Clinical Epidemiology and Biostatistics Unit; Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
| | - Katherine J. Lee
- Clinical Epidemiology and Biostatistics Unit; Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
| | - Na M. Dang
- Neonatal Unit; Department of Paediatrics; Da Nang Hospital for Women and Children; Da Nang Vietnam
| | - Stephen M. Graham
- Centre for International Child Health; University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
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