Time to death and its predictors among neonates admitted to the neonatal intensive care unit of Zewditu Memorial Hospital, Addis Ababa, Ethiopia

Abstract

Background Worldwide, an estimated 2.5 million neonatal deaths occur annually where 80% of these occur in low- and middle-income countries (LMIC). The top causes of neonatal mortality in these countries are prematurity, low birth weight, perinatal asphyxia, and neonatal sepsis. Ethiopia like any other LMICs faces multifaceted problems that contribute to a high neonatal mortality rate. Objectives This study was done to assess the time to death and its predictors among neonates admitted to the neonatal intensive care unit of Zewditu Memorial Hospital from Sept 11th, 2020- Sept 10th, 2023. Methods Health facility based retrospective cohort study design was used. A total of 1,014 neonatal medical records were included in the study. Systematic random sampling was used to select the charts. Kobo toolbox was used for data collection and STATA 17 was used for data analysis. Descriptive statistics and bivariate and multivariate Cox regression analyses were done to determine predictors of neonatal mortality. Kaplan Meier survival estimate was done to show the cumulative probability of survival and Log rank test was used to compare survival curves. Hazard ratios (HRs) with 95% confidence intervals (CI) were calculated and significance was set at p<0.05. Results A total of 1,014 neonates were included in this study with a total follow-up of 7,945 neonate days. The incidence rate was 13.72 deaths per 1,000 neonate day observations (95%CI:11.37,16.55). The median time to death was 3 days. Predictors of time to death among neonates in this study were birthweight less than 1,000 gms (AHR=27.32), birthweight between 1,000 – 1,499 gms (AHR=6.84), perinatal asphyxia (AHR=3.40), neonatal sepsis (AHR= 2.57) and meconium aspiration syndrome (AHR=2.32). Conclusion and Recommendations The neonatal mortality rate in Zewditu Memorial Hospital is high. Therefore, we recommend strengthening antenatal and intrapartum care for mothers as well as the care given to neonates within the neonatal intensive care unit.