Preterm Neonatal Mortality and Its Determinants at a Tertiary Hospital in Western Uganda: A Prospective Cohort Study

Abstract

Background: Prematurity contributes greatly to the neonatal mortality burden in sub-Saharan Africa. This study evaluated the proportion of preterm neonatal death, medical conditions at admission, and determinants of mortality of preterm neonates in the neonatal intensive care unit (NICU) of a tertiary hospital in Western Uganda. Materials and Methods: A prospective cohort study of 351 consecutively enrolled preterm neonates was conducted from March to June 2019. Interviewer-administered questionnaires and physical assessment of neonates were used to obtain socio-demographic and clinical data for mothers and their preterm neonates. Descriptive statistics for participants' characteristics were generated, while bivariate and multivariate logistic regression models were fitted so as to establish the determinants of mortality outcome. A p-value <0.05 was considered statistically significant. Results: In-hospital neonatal mortality of 31.6% (95% CI: 26.9-36.7) was noted, with 65.8% of deaths occurring within 72 hours from admission. The most common medical conditions at admission were: hypothermia (67.2%), respiratory distress syndrome (43.0%), small for gestational age (15.7%), and perinatal asphyxia (14.5%). Under multivariate regression modelling, maternal age ≥35 years (AOR: 4.5; 95% CI: 1.35-15.31), no antenatal care (AOR: 4.7; 95% CI: 1.05-21.21), >4 ANC visits (AOR: 5.3; 95% CI: 1.88-15.21), neonatal resuscitation (AOR: 3.4; 95% CI: 1.66-6.82), outborn status (AOR: 2.3; 95% CI: 1.20-4.50), singleton pregnancy (AOR: 3.7; 95% CI: 1.74-7.89), <28 weeks' gestation (AOR: 12.0; 95% CI: 2.24-64.27), and male sex (AOR: 2.0; 95% CI: 1.04-3.74), respiratory distress syndrome (AOR: 2.6; 95% CI: 1.22-5.70), apnea (AOR: 6.2; 95.5% CI: 1.09-35.38), hypothermia (AOR: 2.3; 95% CI: 1.09-4.92), and small for gestational age (AOR: 4.7; 95% CI: 2.06-10.74) were significantly associated with mortality. Conclusion and Recommendations: In-hospital mortality of preterm neonates was high. We identified various maternal and neonatal risk factors, indicating a need for stakeholders to enhance efforts towards prevention of preterm-associated complications and optimize facility based continuum of care.