Time To Preterm Neonate Mortality And Risk Factors Among Those Admitted To Jimma Medical Center, Jimma, Southwest Ethiopia, 2023: Survival Analysis.

Abstract

Background: preterm birth is one of the highest global challenges in the 21st century and accounts for about 1 million neonatal deaths worldwide. Despite many strategies and interventions being implemented to reduce preterm neonatal mortality, the rate of neonatal mortality in Ethiopia is unacceptably high and not reduced as expected. In addition, little is known about the time to preterm mortality and its risk factors. Therefore, this study aimed to assess time to mortality and risk factors among preterm neonates admitted to the neonatal intensive care unit of Jimma Medical Center from 2018-2022, Jimma, Southwest Ethiopia, 2023 Methods: Institution-based retrospective follow-up study was conducted at Jimma Medical Center from May to June, 2023. All preterm neonates admitted to the Neonatal Intensive Care Unit at Jimma Medical Center from [2018-2022] were taken. A total of 476 samples were recruited by applying Computer-generated random sampling technique to select eligible medical records. Data were collected by record review method with pre-tested structured checklist and entered using Epi-data version 4.6, and analyzed using STATA 17. Kaplan-Meier and log-rank tests were used to estimate the survival time and compare survival curves. Descriptive statistics, bivariable, and multivariable analyses were done in a Cox- regression model. Adjusted Hazard Ratios with 95% Confidence Intervals (CI) was used to assess the relationship between risk factors associated with time to death. Finally, variables with P-value of <0.05 were considered statistically significant in predicting preterm mortality. Objective: Result: A total of 456 preterm neonates included in this study, 111 (82.2%) of deaths occurred during the first week after admission with the overall incidence rate of 34(95%CI:28.72,40.24) per 1000 neonate-day. Not initiating breastfeeding within one hour of birth (AHR=1.96(95%C:1.18,3.23), low 1st and 5th minute APGAR score(AHR=1.77(95%C1:1.06,2.94),and (AHR=2.49(95%C1:1.54,4.02) respectively, respiratory distress syndrome(AHR=1.9(95%CI:1.15,3.14),lack of kangaroo-mother care(AHR=2.61(95%CI:1.65,4.12), low birth weight (AHR=0.52 ( 95% CI:0.32,0.83) were found to be significantly associated with the time to preterm neonate mortality. Conclusion: The first week after admission was the hazardous time to death. Neonates who were not breastfed within 1 hour of birth, low 1st and 5th minute APGAR score, respiratory distress syndrome, and lack of kangaroo-mother care were found to be independent risk factors of preterm neonatal mortality. On the other way being born with low birth weight prolong time to death. Therefore, emphasis should be given to neonates during the first week after admission and with identified risk factors to prolong time to death and reduce preterm mortality.