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

Prevalence of Factors involved in intracranial hemorrhage of premature neonates less than 34 weeks' gestation

Intracranial hemorrhage is one of the major causes of neonatal mortality and morbidity. It is the most severe cranial problem in that period. Those who survive would be affected by hydrocephalus, encephalomalacia, and finally brain atrophy. With accurate knowledge of risk factors, hemorrhage may be diagnosed earlier and the complications managed earlier. This study was performed in Neonatal Intensive Care Unit of Imam Khomeini Hospital. All the neonates less than 34 weeks of gestation were undergone intracranial sonography from Feb 2005 to Feb 2006. Sonography was performed via anterior fontanel with proper probe according to neonatal age. 113 neonates less than 34 weeks of gestation have been studied. Mean gestational age was 32 weeks. Mean neonatal weight were 1566 +/- 734 grams. Intracranial hemorrhage was evident in 21% of them; 16.8% was grade 1, 0.9% grade 2, 2.7% grade 3, 0.9% grade 4. The mean weight of neonates with hemorrhage was 1504.11 grams. Intracranial hemorrhage had correlation with respiratory acidosis and pneumothorax. The latter was also correlated with hemorrhage grade. Supposing the safety and non-invasiveness of intacranial sonography, we suggest performing sonography in all premature neonates with low birth weight, and also in those neonates with pneumothorax and respiratory acidosis

Effect of cleansing the birth canal with antiseptic solution on maternal and neonatal mortality in Alexandria

The objective of this study was to determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnataly. The design was that of a clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention. The study took place at El-Shatby University Maternity Hospital [tertiary care hospital], Alexandria, Egypt. A total of 1742 women giving birth in a six month period and their 1790 babies. Cleansing was done as a manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine. The Main outcome measures were the effects of the intervention on neonatal and maternal morbidity and mortality. The results showed that 909 women giving birth to 936 babies were enrolled in the intervention phase and 833 women giving birth to 854 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced [158/936] [16.9%] v 165/854 [19.3%], P< 0.01], as were admissions for neonatal sepsis [7.5 v 17.6 per 1000 live births, P<0.002], overall neonatal mortality [28.9 v 37.5 per 1000 live births, P<0.06], and mortality due to infectious causes [2.1 v 7.0 per 1000 live births, P<0.005]. Among mothers receiving the intervention, admissions related to delivery were reduced [30.0 v 40.8 per 1000 deliveries, P<0.02], as were admissions due to postpartum infections [2.2 v 4.8 per 1000 deliveries, P<0.02] and duration of hospitalization [Wilcoxon P=0.008]. Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality

Effects of hypertension of pregnant mothers on neonates, Taleghani Hospital- 1999

Recent studies show that presence of hypertension during pregnancy results to neonatal morbidity and mortality. The aim of this study is to investigate and identify the neonatal out comes, which their mothers were afflicted with hypertension during pregnancy. This was a Cohort type of study and in this regard, 160 pregnant women with hypertension were considered from Obs and Gyn Department of Taleghani Hospital, Shahid Beheshti Medical Sciences University. 80 pregnant women without hypertension were considered as control group. Morbidity and mortality were compared in these neonates. Results of this study showed that in group of mothers afflicted with hypertension, morbidity and mortality of neonates were 7.5 times, low apgar scores, 9 times birth of premature neonate, 3.5 times, low birth weight of neonate [fetal growth retardation] 2 times of control group. Since hypertension in pregnant women has many serious side effects for neonates, therefore it is recommended that there should be improved cares during pregnancy and on time of recognition and control of this disease, which can be lead to serious problems, and mortality of neonates