A total of 325 medical records were reviewed and all of them were analyzed. Among neonates admitted to neonatal intensive care unit (NICU) over 2013 to 2017, 34.2% (111) deaths were recorded.
Majority (59.7%) of the neonates admitted to NICU over the five years were male. The mean age of the neonates in days was 6 (+6.694 SD). The mean age of the neonates’ mothers was 27.21 years (+4.982 SD) (Table 1).
Two hundred thirty nine (73.5%) of the mothers were multipara and 26.5% (86) were primipara. The report indicated as 7.4% (24) of the mothers had history of urinary tract infection (UTI) during their current pregnancy. Majority (87.7%) of the mothers had history of ANC and 12.3% (40) had no ANC for the current pregnancy. Similarly, the largest share (87.1%) of the mothers had history of immunization for tetanus toxoid. Almost all (95.1%) mothers had no history of fever attack during the recent pregnancy. Majority (72.9%) of the mothers gave the current birth through spontaneous vaginal delivery (SVD) (Figure 1)..
More than half of the mothers (57.8%) gave birth in hospital followed by health center (31.1%), home (10.2%) and clinics (0.9%). Two hundred seventy (83.1%) of them had history of hypertension and only 0.6% (2) had history of malarial infection during pregnancy. Life birth was the leading (57.2%) immediate previous pregnancy outcome followed by still birth (8.3%) (Figure 2)..
The mean birth weight of the neonates was 2591.78 grams (+788.51 SD) whereas 36.54 weeks (+3.339 SD) was the average gestational age on birth. The mean of the first minute APGAR score was 3.93 (+2.39 SD) and that of the fifth minute was 4.99 (+2.96SD). From the total neonates, 9.2% (30), 64.9% (211) and 25.8% (84) had normal, moderate and low APGAR score on the first minute. On the other hand, 33.2% (108), 43.1% (140) and 23.7% (77) had normal, moderate and low APGAR score on the fifth minute respectively. Majority (49.5%) of the neonates were term birth followed by preterm birth (40.6%) (Figure 3)..
Majority of the neonates (56.9%) had normal birth weight followed by low birth weight (32.9%), very low birth weight (5.8%), macrosomia (3.7%) and extremely low birth weight (0.6%). More than half (70.5%) of the neonates were in early neonatal period on admission. Neonatal sepsis was the leading diagnosis (36.9%) on admission. The other diagnoses on admission were: low birth weight (21.8%), birth asphyxia (11.4%), congenital anomalies (8.3%), prematurity (4.6%) and others (16.9%) like hyperbilirubinemia, neonatal meningitis, hypoglycemia etc.
The most commonly given antibiotic as component of treatment after admission was ampicillin with gentamycin (72.6%). This is followed by ceftriaxone (16.6%), Cloxacillin (1.6%) and others (8.9%) such as Vancomycin, Ceftazidine, Azitromycin etc. Intranasal oxygen was administered for the majority (84.6%) of admitted neonates. The commonly reported immediate causes of death were sepsis, prematurity, respiratory failure, cardiac arrest and birth asphyxia.
Factors associated with neonatal mortality
In bivariate analysis, age of the neonate, previous pregnancy outcome, maternal history of hypertension during pregnancy, diagnoses on admission, birth weight and 5th minute APGAR score were significantly associated with neonatal mortality. However, age of the neonate, maternal history of hypertension during pregnancy and diagnosis on admission turned insignificant in multivariate analysis (Table 2)..
Neonates who born to mothers who had history of previous pregnancy outcomes such as abortion and death after delivery had almost 4 [P = 0.003, AOR = 4.227, 95%CI: 1.653, 10.810] and 12 times [P = 0.004, AOR = 12.250, 95%CI: 2.230, 67.288] more probability of death than those born to mothers whose previous pregnancy outcome was life birth respectively. Neonates with very low birth weight had almost 25 more odds of death than neonates having normal birth weight [P = 0.000, AOR = 24.760, 95% CI: 4.859, 126.18]. In addition, those neonates who had moderate 5th minuteAPGAR score had approximately 3 times more probability of death than those who had normal APGAR score of the same minute [P = 0.004, AOR = 2.719, 95%CI: 1.368, 5.405].