Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2022 Jul 28;17(7):e0271997. doi: 10.1371/journal.pone.0271997. eCollection 2022.
Neonatal sepsis is a leading cause of neonatal morbidity and mortality, particularly in developing countries. Time to recovery is an indicator of the severity of sepsis, and risk factors varied significantly according to study population and settings. Moreover, published literature regarding the time to recovery of neonatal sepsis is scarce.
The aim of this study was to assess the time to recovery of neonatal sepsis and determinant factors among neonates admitted in the Public Hospitals of Central Gondar Zone, Northwest Ethiopia.
An institution-based prospective follow-up study design was conducted among 631 neonates with sepsis. A structured, pre-tested, interviewer-administered questionnaire was used. The median time to recovery, life-table, the Kaplan Meier curve, and the log-rank test were computed. Both bi-variable and multivariable Cox regression models were applied to analyze the data.
Of all septic neonates, 511 successfully recovered. They were followed for a total of 4,740-neonate day's observation and the median time to recovery was 7 days (IQR = 5-10 days). After adjusting for covariates, intrapartum fever (AHR = 0.69, 95%CI: 0.49, 0.99), induced onset of labor (AHR = 0.68, 95%CI: 0.49, 0.94), chest indrawing (AHR = 0.67, 95%CI: 0.46, 0.99), late onset sepsis (AHR = 0.55, 95%CI: 0.40, 0.75), non-oral enteral feeding (AHR = 0.38, 95%CI: 0.29, 0.50), assisted with bag and mask (AHR = 0.72, 95%CI: 0.56, 0.93), normal birth weight (AHR = 1.42, 95%CI: 1.03, 1.94), gestational age of 37-42 weeks (AHR = 1.93, 95%CI: 1.32, 2.84), septic shock (AHR = 0.08, 95%CI: 0.02, 0.39), infectious complications (AHR = 0.42, 95%CI: 0.29, 0.61), being in critical conditions (AHR = 0.68, 95%CI: 0.52, 0.89), and early recognition of illness (AHR = 1.83, 95%CI: 1.27, 2.63) were independently associated with the time to recovery of neonatal sepsis.
The time to recovery of this study was moderately acceptable as compared to the previous studies. The above-mentioned factors could be used for the early identification of neonates with sepsis at risk for protracted illness and it could guide prompt referral to higher centers in primary health sectors. This also will provide prognostic information to clinicians and families as longer recovery time has economic and social implications in our country.
新生儿败血症是导致新生儿发病率和死亡率的主要原因，尤其是在发展中国家。恢复时间是衡量败血症严重程度的一个指标，其危险因素因研究人群和环境而异。此外，关于新生儿败血症恢复时间的已发表文献很少。
本研究旨在评估在埃塞俄比亚西北部中央贡德尔地区公立医院住院的新生儿败血症的恢复时间和决定因素。
采用基于机构的前瞻性随访研究设计，对 631 例败血症新生儿进行研究。使用结构化的、预先测试过的、由访谈员管理的问卷。计算了恢复时间的中位数、生命表、Kaplan-Meier 曲线和对数秩检验。采用双变量和多变量 Cox 回归模型分析数据。
所有败血症新生儿中，511 例成功康复。他们总共接受了 4740 名新生儿日的观察，中位恢复时间为 7 天（IQR=5-10 天）。在调整了混杂因素后，产时发热（AHR=0.69，95%CI：0.49，0.99）、人工引产（AHR=0.68，95%CI：0.49，0.94）、胸部凹陷（AHR=0.67，95%CI：0.46，0.99）、晚发型败血症（AHR=0.55，95%CI：0.40，0.75）、非口服肠内喂养（AHR=0.38，95%CI：0.29，0.50）、辅助使用袋和面罩（AHR=0.72，95%CI：0.56，0.93）、正常出生体重（AHR=1.42，95%CI：1.03，1.94）、孕龄 37-42 周（AHR=1.93，95%CI：1.32，2.84）、败血症性休克（AHR=0.08，95%CI：0.02，0.39）、感染性并发症（AHR=0.42，95%CI：0.29，0.61）、危急情况（AHR=0.68，95%CI：0.52，0.89）和早期识别疾病（AHR=1.83，95%CI：1.27，2.63）与新生儿败血症的恢复时间独立相关。
与之前的研究相比，本研究的恢复时间处于中等水平。上述因素可用于早期识别有延长疾病风险的败血症新生儿，并可指导在初级卫生部门的基层医疗机构及时转诊。这也将为临床医生和家庭提供预后信息，因为在我们国家，较长的恢复时间会产生经济和社会影响。
