Maternal Sociodmographic and ANC characteristics
A total of 489 neonates were admitted in the study period. About 279 (57.1%) mothers of the neonates were in the age group of 21-30 years with a mean age of 26.44 +6.04 years. And 198 (40.5%) were unable to read and write, while 452(90%) of the mothers were married moreover, more than half of 255(52.1%) participants were an urban resident. Regarding ANC follow-up, two-third of mothers 378(77.3%) had attended ANC at least once but only 116(23.7%) were received the recommended follow up for the current pregnancy. Around 180(36.8%) of mothers, started ANC follow up before 24 weeks of gestation (Table 1).
Table 1: Characteristics of mothers of neonates who were admitted to NICU of public hospitals in eastern Ethiopia, 2018[n=489].
Characteristics
|
Category
|
Frequency
|
Percent
|
Age
|
less than 20 years
|
109
|
22.3
|
21-30 years
|
279
|
57.1
|
31-40 years
|
95
|
19.4
|
≥ 41 years
|
6
|
1.2
|
Education level
|
Unable to read and write
|
198
|
40.5
|
Able to read and write
|
59
|
12.1
|
Primary Education
|
111
|
22.7
|
Secondary Education
|
80
|
16.4
|
College and above
|
41
|
8.4
|
Marital status
|
Single
|
28
|
5.7
|
Married
|
452
|
92.4
|
Divorced
|
7
|
1.4
|
Widowed
|
2
|
0.4
|
Residence
|
Urban
|
255
|
52.1
|
Rural
|
234
|
47.9
|
ANC follow-up
|
Yes
|
378
|
77.3
|
No
|
111
|
22.7
|
Place of ANC follow up
|
Public
|
320
|
65.4
|
Private
|
58
|
11.9
|
Gestational age at the start of ANC follow up
|
< 24wks
|
180
|
36.8
|
24 -29 wks
|
149
|
30.5
|
30- 35 wks
|
37
|
7.6
|
greater than 35wks
|
12
|
2.5
|
Number of ANC follow up attended
|
One
|
37
|
7.6
|
Two
|
80
|
16.4
|
Three
|
145
|
29.7
|
four and above
|
116
|
23.7
|
Obstetrics characteristics
The majority, 283(57.9%) of neonates were from multi-Para mothers. Ninety percent of the neonates were delivered as a singleton and 380 (77.7%) were delivered at the index Hospitals. Regarding birth attendants, 299(61.1%) were midwives, about 288(58.9%) of mothers had a labor duration ranging 4-12 hours. In addition, more than two-thirds 338(69.1%) of the deliveries were through spontaneous vaginal delivery and 319(65%) of neonate were birth at term gestation (Table 2).
Table 2: Obstetrics characteristics of mothers with their neonates who were admitted to NICU of public hospitals in eastern Ethiopia, 2018[n=489].
Characteristics
|
Category
|
Frequency
|
Percent
|
Parity
|
Primipara
|
206
|
42.1
|
Multipara
|
283
|
57.9
|
Type of pregnancy
|
Single
|
440
|
90.0
|
Twins
|
49
|
10.0
|
Place of delivery
|
At the index Hospital
|
380
|
77.7
|
Another hospital
|
30
|
6.1
|
Health center
|
53
|
10.8
|
Private facilities
|
4
|
0.8
|
Home
|
22
|
4.5
|
Birth attendant
|
Midwife
|
299
|
61.1
|
Physician
|
151
|
30.9
|
Nurse
|
11
|
2.2
|
HEWS
|
2
|
0.4
|
TBA
|
23
|
4.7
|
Others
|
3
|
0.6
|
Duration of labor
|
< 4hrs
|
43
|
8.8
|
4-12hrs
|
288
|
58.9
|
Greater than12 hrs.
|
158
|
32.3
|
Amniotic fluid status during labor
|
Clear
|
360
|
73.6
|
Meconium stained
|
107
|
21.9
|
Bloodstained
|
22
|
4.5
|
Mode of delivery
|
Spontaneous Vaginal
|
338
|
69.1
|
Cesarean section
|
122
|
24.9
|
Instrumental Delivery
|
29
|
5.9
|
Gestational age at birth
|
Pre-term
|
160
|
32.7
|
Term
|
319
|
65.2
|
Post term
|
10
|
2.0
|
Length of hospital stay
|
<3 days
|
160
|
32.7
|
4-7
|
229
|
46.8
|
>7
|
100
|
20.4
|
Complications during pregnancy
Only 81(16.6%) of mothers had a complication during the current pregnancy. From those complications, preeclampsia or eclampsia 43(8.8%) was the commonest one. In addition, about 30(6.1%) mothers were suffered from Medical illness during pregnancy. Nearly half 226(46.2%) of the mothers had a complication during labor and the most common complication 103 (21.1%) were prolonged duration of labor (Table 3).
Table 3: distribution on complications during current pregnancy and labor among mothers of neonates admitted to NICU of public Hospitals in eastern Ethiopia, 2018[n=489].
Characteristics
|
Category
|
Frequency
|
Percent
|
Obstetric complications during current pregnancy
|
Yes
|
81
|
16.6
|
No
|
408
|
83.4
|
Preeclampsia or eclampsia
|
43
|
8.8
|
Chorioamnionitis
|
8
|
1.6
|
Premature rupture of membrane
|
18
|
3.7
|
Ant partum hemorrhage
|
17
|
3.5
|
Other
|
1
|
0.2
|
Medical illness during pregnancy
|
Yes
|
30
|
6.1
|
No
|
459
|
93.9
|
Diabetes mellitus
|
5
|
1.0
|
Hypertension
|
8
|
1.6
|
Tuberculosis
|
1
|
0.2
|
Cardiac disease
|
1
|
0.2
|
Anemia
|
14
|
2.9
|
Human immunodeficiency virus
|
3
|
0.6
|
Others
|
2
|
0.4
|
Complication during labor
|
Yes
|
226
|
46.2
|
|
No
|
263
|
53.8
|
|
Prolonged labor
|
103
|
21.1
|
|
Premature rupture of membrane
|
62
|
12.7
|
|
Fetal distress
|
84
|
17.2
|
|
Cord prolapsed
|
8
|
1.6
|
Neonatal Characteristics
The majority, 306(62.6%) were male and more than three- fourth 378 (77.3%) were admitted within the first day of life. More than half 274(56.4%) of the neonates had a Normal birth weight (2500-3999grams). More than two-thirds 350(71.6%) of the neonates were hypothermic upon admission, around 35(27.2%) of neonates have suffered from birth asphyxia at 5th minute and 301(61.1%) were initiated exclusive breastfeeding (Table 4).
Table 4: Neonatal characteristics among neonates admitted to NICU of public Hospitals in eastern Ethiopia, 2018[n=489].
Variable
|
Category
|
Frequency
|
Percent
|
Sex of the newborn
|
Male
|
306
|
62.6
|
Female
|
183
|
37.4
|
Age of neonate on admission
|
≤ one day
|
378
|
77.3
|
>one days
|
111
|
22.7
|
Birth weight
|
< 1000grams
|
8
|
1.6
|
1000-1499 grams
|
33
|
6.7
|
1500-2499 grams
|
145
|
29.7
|
2500-3999 grams
|
274
|
56.0
|
≥ 4000 grams
|
29
|
5.9
|
Temperature at admission(0c)
|
< 36.5
|
350
|
71.6
|
36.5-37.5
|
92
|
18.8
|
>37.5
|
47
|
9.6
|
Score at Apgar 5thminutes
|
≤3
|
7
|
1.4
|
4-6
|
126
|
25.8
|
7-10
|
251
|
51.3
|
Unknown
|
105
|
21.5
|
Initiation of Feeding
|
NPO
|
152
|
31.1
|
|
EBF
|
301
|
61.1
|
|
Formula Feeding
|
36
|
7.4
|
Treatment modalities
Nearly, 435 (89%) of neonates have received antibiotics and Intravenous fluids 416(85.1%) as main treatment while only 72 (14.7%) were utilizing the kangaroo mother care (figure 1).
The proportion of Neonatal death
Among admitted newborn, 98(20%) died and the majority of death occurs in the first day of life. the remaining were survived and discharged (Figure 2).
Cause of Neonatal Mortality
Regarding the cause of death, the most common causes were prematurity 48(49%) followed by birth asphyxia 37(37.8%) and infection 32(32.6%) among neonates admitted in NICU as shown in (Figure 3).
Predictors of Neonatal death
In the multivariate logistic analysis, low 5th minutes Apgar score, low birth weight, preterm birth, length of hospital stay, being febrile and feeding status were independent predictors of neonatal mortality. Being preterm was almost three times more likely to die as compared with term neonates (AOR, 2.78 [95% CI: 1.17, 6.57]). Low birth weight babies were about two times more likely to die when compared with normal birth weight (AOR, 2.39 [95% CI: 1.04, 5.41]). Furthermore, neonates with low 5th minutes Apgar score was five times more likely die as compared with 5th minutes APGAR score of greater than or equal to seven (AOR, 5.18[95% CI: 2.51, 10.66]); length of staying was another variable found to be predictors of mortality(AOR,3.63 [95% CI:1.82, 7.22]), Neonates stayed for less than 3 days were more likely die than those who stayed 4-7 days , this implied that majorities of deaths occurred in the first 72 hours of life. In addition, neonates with fever at admission were seven times more likely to die as compared with the normal temperature at admission (AOR, 6.68 [95% CI: 1.34, 33.13]). Moreover, neonates who have not initiated feeding in the first 24 hours were about twelve times more likely to die than those were initiated with exclusively breastfeeding (AOR, 12.16 [95% CI: 5.98, 24.70]) and found to be significant predictors of neonatal mortality (Table 5).
Table 5: Multivariate analysis for Predictors of Neonatal Mortality among neonates admitted to NICU of public hospitals, eastern Ethiopia, 2018[n=489]
Neonatal mortality
|
|
|
Characteristics
|
Died
|
Improved
|
COR
|
AOR
|
P value
|
Maternal Age
|
|
|
|
|
|
21-30 years
|
51
|
228
|
1
|
|
|
<20 years
|
29
|
80
|
1.62(0.96, 2.73)
|
1.50(0.67, 3.34)
|
-
|
31-40 years
|
17
|
78
|
0.97(0.53, 1.78)
|
1.85(0.76, 4.48)
|
|
>40 years
|
1
|
5
|
0.89(0.102, 7.818)
|
2.40(0.23, 24.89)
|
|
Marital status
|
|
|
|
|
|
Married
|
88
|
364
|
1
|
1
|
|
Single
|
9
|
19
|
1.96(0.86, 4.48)
|
1.33(0.35, 5.03)
|
|
Others
|
1
|
8
|
0.52(0.06, 4.18)
|
1.62(0.15, 16.94)
|
-
|
Parity
|
|
|
|
|
|
Multi-Para
|
50
|
233
|
1
|
1
|
|
Primi-para
|
48
|
158
|
1.42(0.91, 2.21)
|
1.94(0.93, 4.05)
|
-
|
Place of delivery
|
|
|
|
|
|
Inborn (in this hospital)
|
253
|
127
|
1
|
1
|
|
Other facility
|
46
|
41
|
0.56(0.29, 1.09)
|
0.50(0.17, 1.51)
|
|
Home
|
16
|
6
|
0.35(0.08, 1.53)
|
0.26(0.03, 2.40)
|
-
|
Duration of labor
|
|
|
|
|
|
4 -12 hrs
|
177
|
111
|
1
|
1
|
|
less than 4 hrs
|
27
|
16
|
0.80(0.35, 1.81)
|
0.45(0.12, 1.63)
|
-
|
More than 12hrs
|
111
|
47
|
0.69(0.41, 1.14)
|
0.62(0.30, 1.25)
|
|
Mode of delivery
|
|
|
|
|
|
Spontaneous vaginal
|
221
|
117
|
1
|
1
|
|
Cesarean section
|
79
|
43
|
1.23(0.73, 2.05)
|
1.00(0.47, 2.10)
|
-
|
Instrumental
|
15
|
14
|
2.78(1.24, 6.17)
|
1.34(0.40, 4.44)
|
|
Length of hospital stay
|
|
|
|
|
|
4-7 days
|
172
|
57
|
1
|
1
|
|
<3 days
|
68
|
92
|
4.03(2.43, 6.67)
|
3.63(1.82, 7.22) *
|
.000
|
>7 days
|
75
|
25
|
0.77(0.35, 1.63)
|
0.61(0.23, 1.58)
|
|
Gestational age at birth
|
|
|
|
|
|
Term
|
227
|
92
|
1
|
1
|
|
Preterm
|
82
|
78
|
3.56(2.23, 5.66)
|
2.78(1.17, 6.56) *
|
.020
|
Post term
|
6
|
4
|
4.65(1.25, 17.19)
|
4.54(0.83, 24.70)
|
|
Birth weight
|
|
|
|
|
|
2500-3999 grams
|
211
|
86
|
1
|
1
|
|
Less than 2499 grams
|
77
|
86
|
3.46(2.17, 5.49)
|
2.39(1.04, 5.49) *
|
.040
|
> 4000 grams
|
27
|
2
|
0.23(0.03, 1.73)
|
0.67(0.06, 6.80)
|
|
APGAR at 5th minutes
|
|
|
|
|
|
7-10
|
188
|
63
|
1
|
1
|
|
≤ 6
|
68
|
65
|
5.62(3.32, 9.47)
|
5.18(2.51, 10.66) *
|
.000
|
Unrecorded
|
59
|
46
|
1.33(0.67, 2.60)
|
2.50(0.82, 7.54)
|
|
Temperature on admission
|
|
|
|
36.5 –37.5c0
|
64
|
28
|
1
|
1
|
|
<36.5 c0
|
218
|
132
|
3.37(1.56, 7.23)
|
2.75(0.97, 7.78)
|
|
>37.5 c0
|
33
|
14
|
1.25(0.38, 4.05)
|
6.68(1.345, 33.13) *
|
.020
|
Initiation of Feeding
|
|
|
|
|
|
EBF
|
237
|
64
|
1
|
1
|
|
NPO
|
53
|
99
|
16.71(9.32, 29.94)
|
12.16(5.98, 24.70) *
|
.000
|
FF
|
25
|
11
|
2.69(0.930, 7.80)
|
1.71(0.47, 6.15)
|
|
|
|
|
|
|
|
|
|
*statistically significant at p ≤ 0.05