Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Aug;7(8):e1130-e1138.
doi: 10.1016/S2214-109X(19)30220-7.

Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study

Lulu M Muhe  1 , Elizabeth M McClure  2 , Assaye K Nigussie  3 , Amha Mekasha  4 , Bogale Worku  5 , Alemayehu Worku  4 , Asrat Demtse  4 , Beza Eshetu  6 , Zemene Tigabu  7 , Mahlet A Gizaw  8 , Netsanet Workneh  6 , Abayneh Girma  7 , Mesfin Asefa  8 , Ramon Portales  8 , Tiruzer Bekele  7 , Mesele Bezabih  6 , Gesit Metaferia  8 , Mulatu Gashaw  6 , Bewketu Abebe  7 , Hailu Berta  9 , Addisu Alemu  6 , Tigist Desta  4 , Rahell Hailu  4 , Goitom Gebreyesus  4 , Sara Aynalem  8 , Alemseged L Abdissa  6 , Riccardo Pfister  10 , Zelalem Tazu Bonger  4 , Solomon Gizaw  4 , Tamrat Abebe  4 , Melkamu A Berhane  6 , Yonas Bekuretsion  4 , Sangappa Dhaded  11 , Janna Patterson  12 , Robert L Goldenberg  13
Affiliations
Observational Study

Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study

Lulu M Muhe et al. Lancet Glob Health. 2019 Aug.

Abstract

Background: Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia.

Methods: We did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data.

Findings: Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28-31 weeks (512 [54%] of 952), 32-34 weeks (349 [18%] of 1975), and 35-36 weeks (159 [8%] of 1888).

Interpretation: Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death.

Funding: Bill & Melinda Gates Foundation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study flow diagram NICU=neonatal intensive care unit.
Figure 2
Figure 2
Distribution of primary cause of death of preterm infants N=1109. The four most common causes of death are shown and the less common causes are grouped as others. *Sepsis, pneumonia, and meningitis.
See this image and copyright information in PMC

Comment in

References

    1. Liu L, Oza S, Hogan D. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388:3027–3035. - PMC - PubMed
    1. Chawanpaiboon S, Vogel JP, Moller AB. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7:e37–e46. - PMC - PubMed
    1. Behrman RE, Butler AS, editors. Mortality and acute complications in preterm infants. National Academies Press; Washington DC: 2007.
    1. UNICEF. WHO. World Bank. UN-DESA Population Division Levels and trends in child mortality report 2017. 2018. Estimates developed by the UN inter-agency group for child mortality estimation. http://www.who.int/maternal_child_adolescent/documents/levels_trends_chi...
    1. WHO Preterm birth Key facts. 2018. http://www.who.int/news-room/fact-sheets/detail/preterm-birth

Publication types