Predictors of Neonatal mortality among Neonates who admitted in Neonatal intensive Care Unit at Arba Minch General Hospital

Introduction: The neonatal period refers to the first 28 days of life. Newborns are particularly vulnerable to death. The predictors associated with neonatal mortality need to be addressed, as identifying the predictors will contribute to reducing the rates of neonatal morbidity and mortality. Method: A facility-based retrospective cohort study was conducted of 332 records of neonates who were admitted to the neonatal intensive care unit at Arba Minch General Hospital. Data were collected from randomly selected neonate records using computer-generated random numbers. Data were entered into Epi-info version 3.5.1 and exported to SPSS v.23 for analysis. Crude hazard ratios, adjusted hazard ratios and 95% confidence intervals were used to assess the strength of association and statistical significance. The incidence density rate of death with respect to 'person time at risk' was calculated. Variables which had a p-value of ≤ 0.25 in bivariate analysis were considered as candidates for multivariate regression analysis; variables that had a p-value of ≤0.05 in the multivariate analysis were considered as independent predictors of neonatal mortality in the final Cox regression analysis. Result: The incidence density rate of neonatal mortality was 31.6 per 1,000 neonate days. The neonatal mortality predictors were 5th-minute APGAR score ≤5 (AHR: 1.9; 95%CI: 1.02,3.54); 2nd to 4th birth order (AHR:13; 95%CI: 5.1,33.4); 5th birth order (AHR:24; 95%CI: 10.5,55.2); history of two to four live births(AHR: 0.16; 95%CI: 1.07,3.63); history of ≥5 live births (AHR: 0.18; 95%CI: 0.06,0.51); and not initiating exclusive breastfeeding within the first hour of delivery (AHR: 1.8: 95%CI: 1.03,3.18). Conclusion: The incidence density rate of neonatal mortality was 31.6 per 1,000 neonate days, and maternal age, APGAR score, birth order, parity, and exclusive breastfeeding initiation were independent predictors of neonatal mortality

Anaesthetic outcomes in neonatal surgical care in a tertiary health facility in Nigeria

ABSTRACT: There is always a concern about the survival of new-borns undergoing corrective surgical procedure early in life. Perioperative care, especially in sick babies, is challenging, and this makes ascribing outcomes to care given difficult. This study was aimed at determining and evaluating factors associated with poor outcomes in new-borns undergoing surgery and anaesthesia. This was a retrospective case notes review of 37 neonates who received general anaesthesia during surgical care over a three-year period. After ethical approval for the study, the demographic data, indications for surgery, American Society of Anesthesiologists' (ASA) classifications, preoperative, intraoperative and postoperative challenges present in these neonates as well as their outcome were extracted. A total of 48 neonates were operated over a three-year period, and only 37(77.1%) case files were available for review. Male: Female ratio was about 2:1, the two most common procedures performed were bowel resection and anastomosis in 7(18.9%) and colostomy 7(18.9%). Overall mortality was 29.7%. Neonatal mortality was significantly higher in patients with postoperative sepsis (p=0.006) and respiratory challenge (p=0.035). The median time to death was 9 days. Only one (9.1%) patient died within 24hours postoperative. Mortality in neonates undergoing surgical procedure early in life is very high in this study. However, it is difficult to implicate anaesthesia in our study as the cause of mortality as most occurred very late after many days of surgery. Availability of postoperative elective ventilation for selected patients may improve outcome