Time To Death And Its Predictors Among Asphyxiated Neonates Admitted To Jimma University Medical Center, Southwest Ethiopia: A Retrospective Cohort Study

Abstract

Background: Perinatal asphyxia is a failure to initiate and sustain breathing at birth. It is the second leading cause of neonatal mortality in sub-Saharan African countries and accounts for 31% of neonatal mortality in Ethiopia. There is limited scientific evidence in Ethiopia on time to death and its predictors among asphyxiated neonates, especially at a referral hospital; therefore, the objective of this study was to assess time to death and its predictors among asphyxiated neonates admitted to Jimma University Medical Center, southwest Ethiopia. Methods: A retrospective cohort study was conducted on all eligible 373 asphyxiated neonates admitted to Jimma University Medical Center from April 12/2019 to May 5 /2022. Data were extracted from May 18 to June 3/2022, entered into Epidata 3.1, and analyzed by R 4.2 version. A Kaplan Meier plot with a Log-rank test was used to evaluate the median survival time difference. Bivariable Cox regression was used to select variables for the final model at a p-value<0.25. Multivariable Cox regression was used to identify independent predictors of mortality of neonates considering a 95% confidence interval of adjusted hazard ratio and a corresponding p-value≤0.05. Result: During a total of 2888 person-days, 84 neonates (22.52 % (95CI:18.38, 27.10)) died, yielding an incidence rate of 29.09 (95%CI: 23.20, 36.01) per 1000 person-days. The median survival time was 20 days(95%CI: 18, 23)). Almost half (47.62%) of the death was during the first 7 days. Survival probability at the first, second, and third follow-up dates were 96.5%, 94.4%, and 92.3% respectively. Stage III Hypoxic ischemic encephalopathy (AHR: 3.46(95%CI: 1.55, 7.70)), acute kidney injury (AHR: 2.82 (95%CI: 1.28, 6.23)), and stress ulcers (AHR: 2.24 (95%CI: 1.26, 3.97)) were independent predictors of time to death. Conclusion and recommendation: The incidence of neonatal mortality was higher than in a previous study done in Ethiopia. Stage III Hypoxic ischemic encephalopathy, Acute kidney injury, and Stress ulcers were independent predictors of time to death, therefore, early identification and close follow-up are suggested for neonates who have those conditions.