Independent statistician, Solagna, Italy.
Doctors with Africa CUAMM, Wolisso, Ethiopia.
BMC Pregnancy Childbirth. 2020 Nov 23;20(1):722. doi: 10.1186/s12884-020-03429-2.
Although under-5 mortality has decreased in the last two decades, neonatal mortality remains a global health challenge. Despite achieving notable progress, Ethiopia has still one of the highest neonatal mortality rates worldwide. We aimed to assess the risk factors for mortality among neonates admitted to a special care unit in a referral hospital in rural Ethiopia.
This was a retrospective observational study including all 4182 neonates admitted to the special care unit of the St. Luke Wolisso Hospital (Ethiopia) from January 2014 to December 2017. Data were retrieved from hospital charts and entered in an anonymized dataset. A logistic regression model was applied to identify predictors of mortality and effect sizes were expressed as odds ratios with 95% confidence intervals.
Proportion of deaths was 17% (709/4182 neonates). Neonates referred from other health facilities or home (odds ratio 1.52, 95% confidence interval 1.21 to 1.91), moderate hypothermia at admission (odds ratio 1.53, 95% confidence interval 1.09 to 2.15) and diagnosis of late-onset sepsis (odds ratio 1.63, 95% confidence interval 1.12 to 2.36), low birthweight (odds ratio 2.48, 95% confidence interval 2.00 to 3.09), very low birthweight (odds ratio 11.71, 95% confidence interval 8.63 to 15.94), extremely low birthweight (odds ratio 76.04, 95% confidence interval 28.54 to 263.82), intrapartum-related complications (odds ratio 4.69, 95% confidence interval 3.55 to 6.20), meconium aspiration syndrome (odds ratio 2.34, 95% confidence interval 1.15 to 4.43), respiratory distress (odds ratio 2.25, 95% confidence interval 1.72 to 2.95), other infections (odds ratio 1.92, 95% confidence interval 1.31 to 2.81) or malformations (odds ratio 2.32, 95% confidence interval 1.49 to 3.57) were associated with increased mortality. Being admitted in 2017 vs. 2014 (odds ratio 0.71, 95% confidence interval 0.52 to 0.97), and older age at admission (odds ratio 0.95, 95% confidence interval 0.93 to 0.97) were associated with decreased likelihood of mortality.
The majority of neonatal deaths was associated with preventable and treatable conditions. Education on neonatal resuscitation and postnatal management, and the introduction of an on-call doctor for high-risk deliveries might have contributed to the reduction in neonatal mortality over time.
尽管在过去的二十年中，5 岁以下儿童的死亡率有所下降，但新生儿死亡率仍然是全球卫生挑战。尽管取得了显著进展，但埃塞俄比亚仍然是世界上新生儿死亡率最高的国家之一。我们旨在评估在埃塞俄比亚农村一家转诊医院的特别护理病房中住院的新生儿死亡的危险因素。
这是一项回顾性观察性研究，包括 2014 年 1 月至 2017 年 12 月期间在圣卢克沃利索医院（埃塞俄比亚）特别护理病房入院的所有 4182 名新生儿。数据从医院图表中检索并输入到匿名数据集。应用逻辑回归模型确定死亡率的预测因素，效应大小表示为 95%置信区间的优势比。
死亡率为 17%（709/4182 名新生儿）。从其他卫生机构或家中转诊的新生儿（优势比 1.52，95%置信区间 1.21 至 1.91）、入院时中度低体温（优势比 1.53，95%置信区间 1.09 至 2.15）和诊断为晚发性败血症（优势比 1.63，95%置信区间 1.12 至 2.36）、低出生体重（优势比 2.48，95%置信区间 2.00 至 3.09）、极低出生体重（优势比 11.71，95%置信区间 8.63 至 15.94）、极低出生体重（优势比 76.04，95%置信区间 28.54 至 263.82）、分娩时相关并发症（优势比 4.69，95%置信区间 3.55 至 6.20）、胎粪吸入综合征（优势比 2.34，95%置信区间 1.15 至 4.43）、呼吸窘迫（优势比 2.25，95%置信区间 1.72 至 2.95）、其他感染（优势比 1.92，95%置信区间 1.31 至 2.81）或畸形（优势比 2.32，95%置信区间 1.49 至 3.57）与死亡率增加相关。与 2014 年相比，2017 年入院（优势比 0.71，95%置信区间 0.52 至 0.97）和入院年龄较大（优势比 0.95，95%置信区间 0.93 至 0.97）与降低死亡率的可能性相关。
大多数新生儿死亡与可预防和可治疗的疾病有关。新生儿复苏和产后管理方面的教育，以及为高危分娩配备随叫随到的医生，可能有助于随着时间的推移降低新生儿死亡率。
