Time to death and its predictors among preterm neonates admitted at neonatal intensive care unit in Debretabor Comprehensive Specialized Hospital northwest Ethiopia: retrospective follow up study

Abstract

Background: Preterm neonatal mortality remains a global public concern, From the 130 million babies born each year globally; approximately 15 million are born and died preterm. Ethiopia’s preterm neonatal mortality rate is unacceptably high against the goal. Objective: To assess time to death and its predictors among preterm neonates admitted at neonatal intensive care unit (NICU) in Debre tabor Comprehensive Specialized Hospital. Methods: A hospital-based retrospective follow-up study was conducted among preterm neonates admitted to the NICU in Debre tabor Comprehensive Specialized Hospital Northwest Ethiopia from July 1 2020 to July1 2023.Data were collected after selecting participants using computer generated simple random sampling. Data coded and entered using Epi-data version 7 and exported to STATA version 14 for analysis. Kaplan Meier curve used to compare survival status between different categories of study participants and log rank tests used to assess its significance level. The assumption of the cox proportional hazard model checked both graphically using log-log stphplot and statistically using Schoenfeld residuals. Moreover, cox-Snell residual used to test the goodness of fit. Those variables having p-value < 0.25 in the bivariable analysis was included in the multivariable cox-proportional hazards regression model. Finally, the level of significance for predictors declared at a p-value less than 0.05 with adjusted hazard ratio and 95% confidence interval (CI). Results: A total of 385 neonates followed for an overall 3781person days observation with a median time to death of 22 days and with an incidence density of neonatal mortality, 34.6 (95% CI: 29.3–41.4) per 1000 neonatal days. Respiratory distress syndrome (AHR: 4.0(95%CI (2.6, 5.9)), neonatal sepsis (AHR: 1.7(95%CI (1.1, 2.4)), fetal presentation at delivery (AHR: 2.1(95%CI (1.4, 3.1)) were declared predictors of preterm neonatal death. In addition, the first week of life found a time at which most (60.3%) preterm neonate died Conclusion: The first weeks of preterm neonate found to be the time at which most preterm neonatal death occurred. Respiratory distress syndrome, neonatal sepsis and fetal presentation found predictors of preterm neonatal time to death. Recommendation: Early identification and continuous care for neonates coming with an assessment of preterm, respiratory distress, and sepsis and due attention for the first weeks of life should be given