Survival and Predictors of Mortality Among Neonates Admitted to Neonatal Intensive Care Unit at Bombe Primary Hospital, Southern Ethiopia: Institution-Based Retrospective Cohort Study

Abstract

Background: Neonatal mortality includes all deaths of neonate occurring before the 28th day of life. Neonatal mortality has been declining over two decades in Sub-Saharan Africa, including Ethiopia. The foremost causes of death are preventable and treatable. Regardless, recognizing the predictors may be a crucial step in lowering neonatal mortality. However, evidences on the survival status of neonates and/or neonatal death predictors were limited in Ethiopia, particularly in the study area. Thus, this study aimed to answer these questions. Methods: An institution-based retrospective cohort study was done among 380 Neonates admitted to the Neonatal Intensive Care Unit at Bombe Primary Hospital from January 1, 2018, to December 31, 2019. Bivariable and multivariable Cox regression analyses were conducted to identify predictors of mortality. Association was summarized using adjusted hazard ratio (AHR), and statistical significances were declared at 95% CI and P-value <0.05. Proportionality assumption was tested by a global test based on Schoenfeld residuals analysis. Results: The overall incidence of neonatal mortality was 20.8 (95% CI: 15.2, 28.5) per 1000 neonatal days. Late initiation of early breastfeeding (EBF) after 1 hr. [AHR: 2.9; 95% CI: 1.32, 6.37], 5th min APGAR score <5 [AHR: 3; 95% CI: 1.32; 6.88], low birth weight [AHR: 2.59; 95% CI: 1.1,6.26], hypothermia [AHR: 2.6; 95% CI: 1.1, 6.22] and mothers' time of rupture of membrane >12 hours before delivery [AHR: 2.49; 95% CI: 1.25, 4.97] were increased the risk of neonatal mortality, while cesarean section delivery 91.6% [AHR= 0.084; 95% CI: 0.10, 0.65] and antenatal care (ANC) utilization 61% [AHR: 0.39; 95% CI: 0.15-0.91] decreased the risk of neonatal mortality. Conclusion: The incidence of neonatal mortality rate was high at the Bombe primary hospital. Therefore, to improve neonatal survival, it is recommended that complications and low birth weight be managed, that early exclusive breastfeeding be initiated, that service quality be improved, and that a continuum of care be ensured.